Lehto Ann, Susi Apryl, Prabhakar Sarah, Chokshi Binny, Rajnik Michael, Nylund Cade, Brown Jill
Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2025 Jan 16;190(1-2):33-39. doi: 10.1093/milmed/usae431.
We sought to evaluate the impact of the COVID-19 pandemic on trends in chlamydia, gonorrhea, and pelvic inflammatory disease (PID) encounter rates within the Military Health System.
This cross-sectional study queried electronic health records of 18- to 44-year-old female active duty service members and dependents during the pre-pandemic period (January 2018-February 2020), pandemic period 1 (March 2020-March 2021), and pandemic period 2 (April 2021-April 2022). We calculated monthly chlamydia, gonorrhea, and PID encounter rates using ICD-10 codes. We used change point analysis for trends in encounter rates and Poisson regression for differences in rates by age, active duty status, military rank, TRICARE region, and pandemic period.
There were 36,102, 7,581, and 16,790 unique individuals with chlamydia, gonorrhea, and PID encounters, respectively, over the pre-pandemic and pandemic time frames. Chlamydia and gonorrhea encounter rates were highest in ages 18 to 19, in active duty service members, and junior enlisted compared to senior enlisted and officer sponsor rank. Chlamydia and gonorrhea encounter rates varied by TRICARE region. Chlamydia encounter rates were lower in both pandemic periods 1 and 2 compared to the pre-pandemic period, whereas gonorrhea encounter rates were lower only in pandemic period 2 compared to the pre-pandemic period. Trend analysis showed monthly chlamydia encounter rates did not significantly change from January 2018 through August 2020, and then decreased 2.4% monthly through the remainder of the study period (P < .05). Gonorrhea encounter rates did not significantly change from the beginning of the study period through February 2021 and then declined 1.9% monthly through the remainder of the study period (P < .05). Pelvic inflammatory disease encounter rates were highest in ages 18 to 19 and 20 to 24, in the TRICARE North region compared to the South region, in active duty service members compared to non-active duty, and in junior enlisted compared to senior enlisted and officer sponsor rank. Pelvic inflammatory disease encounter rates were lower in pandemic periods 1 and 2 compared to the pre-pandemic period. Pelvic inflammatory disease encounter rates declined 8.0% monthly from January 2020 through April 2020 (P < .05), followed by a 11.0% monthly increase from May 2020 through July 2020 (P < .05) and a 0.9% monthly decrease for the remainder of the study period (P < .05).
Chlamydia, gonorrhea, and PID encounter rates in the Military Health System all declined in the pandemic period. Pelvic inflammatory disease was most influenced by the pandemic onset as demonstrated by an immediate decline in encounter rates followed by an increase several months into the pandemic. Young age, active duty, and junior enlisted status were associated with higher chlamydia, and gonorrhea, and PID encounter rates over the pre-pandemic and pandemic time frames. Lower encounter rates during the pandemic may be related to decreased access to health care services, reduced screening for sexually transmitted infections, or changes in sexual behavior. The less profound decline in gonorrhea encounter rates likely reflects the more symptomatic nature of gonorrhea compared to chlamydia. TRICARE regional differences varied for chlamydia, gonorrhea, and PID encounters.
我们试图评估新冠疫情对军事医疗系统中衣原体、淋病和盆腔炎（PID）就诊率趋势的影响。
这项横断面研究查询了大流行前时期（2018年1月至2020年2月）、大流行时期1（2020年3月至2021年3月）和大流行时期2（2021年4月至2022年4月）18至44岁现役女性军人及其家属的电子健康记录。我们使用国际疾病分类第十版（ICD - 10）编码计算每月衣原体、淋病和盆腔炎的就诊率。我们对就诊率趋势进行了变化点分析，并使用泊松回归分析年龄、现役状态、军衔、特里卡医保地区和大流行时期对就诊率差异的影响。
在大流行前和大流行期间，分别有36102、7581和16790名个体有衣原体、淋病和盆腔炎就诊记录。衣原体和淋病就诊率在18至19岁人群、现役军人以及初级士兵中最高，与高级士兵和军官家属相比。衣原体和淋病就诊率因特里卡医保地区而异。与大流行前时期相比，大流行时期1和2的衣原体就诊率均较低，而淋病就诊率仅在大流行时期2低于大流行前时期。趋势分析表明，从2018年1月到2020年8月，每月衣原体就诊率没有显著变化，然后在研究期剩余时间每月下降2.4%（P < 0.05）。从研究期开始到2021年2月，淋病就诊率没有显著变化，然后在研究期剩余时间每月下降1.9%（P < 0.05）。盆腔炎就诊率在18至19岁和20至24岁人群中最高，与南区相比，在北区的特里卡医保地区，与非现役军人相比，现役军人中以及与高级士兵和军官家属相比，初级士兵中盆腔炎就诊率最高。与大流行前时期相比，大流行时期1和2的盆腔炎就诊率较低。从2020年1月到2020年4月，盆腔炎就诊率每月下降8.0%（P < 0.05），随后从2020年5月到2020年7月每月上升11.0%（P < 0.05），在研究期剩余时间每月下降0.9%（P < 0.05）。
军事医疗系统中衣原体、淋病和盆腔炎的就诊率在大流行期间均有所下降。盆腔炎受疫情爆发影响最大，表现为就诊率立即下降，随后在疫情爆发数月后上升。在大流行前和大流行期间，年轻、现役和初级士兵身份与较高的衣原体、淋病和盆腔炎就诊率相关。大流行期间就诊率较低可能与获得医疗服务的机会减少、性传播感染筛查减少或性行为改变有关。淋病就诊率下降幅度较小可能反映了与衣原体相比，淋病更具症状性。衣原体、淋病和盆腔炎就诊的特里卡医保地区差异各不相同。
