OBJECTIVES:

This study compared the diagnostic setting and treatment of new cases of bacterial sexually transmitted infections (STIs) in Germany from 2018-2020.

METHODS:

This study utilized German claims data (AOK PLUS) from 01/01/2017-30/06/2021. We included continuously insured adult patients with an inpatient/outpatient chlamydia (ICD-10 A55/A56), gonorrhea (A54), or syphilis (A51/A53) diagnosis from 01/01/2018-31/12/2020. To account for potential re-infection, a 180-day window was used to detect new cases. Diagnostic setting was observed at index and a 6-month follow-up period was used to assess outpatient treatment with prescribed therapies.

RESULTS:

Overall, 8,913 individuals (cases: 10,032, female: 60.3%, mean age: 32.1 years) were included. Most chlamydia (97.4%), gonorrhea (96.3%), and syphilis (96.9%) cases were diagnosed in the outpatient setting. Among STI cases recorded in the outpatient setting (96.9%), the most common diagnosing physicians were gynecologists (54.5%), general practitioners (20.8%), and urologists (11.5%). No changes in relation to diagnosing physician were observed between pre-COVID and COVID-periods.

From 2018-2020, the share of syphilis and gonorrhea cases diagnosed in inpatient vs. outpatient settings varied; no difference between pre-COVID and COVID periods was detected. Despite the overall low number of inpatient chlamydia diagnoses, the proportion of new cases reported in hospitals decreased after the pandemic onset (median/range: 1.8%/1.3-2.0% vs. 2.6%/2.1-3.9% during pre-COVID).

Syphilis had the lowest treatment rate at 42.2% (penicillin: 27.9%, doxycycline: 13.1%, tetracycline: 0.0%), followed by gonorrhea with 54.9% (ceftriaxone: 16.2%, azithromycin: 39.6%), and chlamydia with 60.5% (doxycycline: 41.0%, azithromycin: 22.8%, levofloxacin: 1.1%). No longitudinal changes in relation to treatment were observed.

CONCLUSIONS:

Generally, diagnosis of bacterial STIs is uncommon in the hospital. Nevertheless, the share of chlamydia cases diagnosed in the inpatient setting decreased during COVID, possibly in relation to healthcare resource capacity constraints. Further research is needed to explore potential reasons for this trend and the substantial proportion of patients without treatment.