The Impact of Sexual Health Service Disruptions on Chlamydia and Gonorrhea Cases Among Youth and Young Adults in Canada

Abstract

Background: Access to sexual health services declined globally during the COVID-19 pandemic. This study assessed the immediate and sustained impacts of the pandemic on reported chlamydia and gonorrhea cases among youth and young adults in two Canadian provinces with differing sexual health services. Method: Laboratory-confirmed cases of chlamydia and gonorrhea among individuals under the age of 25 years were analyzed using data from provincial surveillance systems from 2016 to 2021 in Ontario and British Columbia. Interrupted time series analyses were conducted using Seasonal Autoregressive Integrated Moving Average (SARIMA) models, stratified by sex and province. Sensitivity analyses examined trends excluding the initial five months of the pandemic (March-August 2020) and examined sustained impact through 2023. Results: Following the onset of the COVID-19 pandemic, chlamydia rates declined immediately by 39.13 cases per 100,000 population (95% CI: –45.76 to –32.50) in Ontario and by 23.13 per 100,000 (95% CI: –27.91 to –18.35) in British Columbia, corresponding to relative reductions of 42% and 29%, respectively. Gonorrhea rates decreased by 3.25 per 100,000 (95% CI: –4.72 to –1.77) in Ontario and by 1.70 per 100,000 (95% CI: –3.92 to 0.51) in British Columbia, translating to relative reductions of 37% and 22%. Declines in reported cases were more pronounced among females for chlamydia, while males exhibited more sustained decreases over time. Sensitivity analyses confirmed these significant declines after excluding the initial pandemic period and persistent reductions through 2023. Conclusion: Reported chlamydia and gonorrhea rates among youth and young adults declined substantially during the pandemic, with greater decreases in Ontario than in British Columbia. British Columbia’s smaller declines may be partly explained by broader access to their online testing services, GetCheckedOnline. Sustained reductions suggest ongoing underdiagnosis and underreporting are the last effects of the pandemic and should be accounted for in public health surveillance.