COVID-19 Policies and Sexually Transmitted Infections in 22 US States, January 2020-December 2021

Objectives. To quantify the effects of 5 jurisdiction-level COVID-19 policies on chlamydia, gonorrhea, and syphilis rates in 22 US jurisdictions between January 2020 and December 2021. Methods. We applied a mixed-effects, negative binomial, interrupted time series model to estimate the impact that each policy of interest had on reported cases. Results. Mandatory stay-at-home periods were associated with a decrease in reported chlamydia (incident rate ratio [IRR] = 0.75; 95% confidence interval [CI] = 0.71, 0.80) and gonorrhea (IRR = 0.85; 95% CI = 0.78, 0.94) cases. We also observed decreased chlamydia case reporting when gatherings were restricted to 10 people (IRR = 0.88; 95% CI = 0.85, 0.92), masking was recommended (IRR = 0.90; 95% CI = 0.85, 0.97), or polymerase chain reaction testing was limited to symptomatic individuals (IRR = 0.72; 95% CI = 0.67, 0.77). Universal vaccine access corresponded to decreases in reported gonorrhea (IRR = 0.83; 95% CI = 0.75, 0.92) but increases in syphilis (IRR = 1.33; 95% CI = 1.04, 1.70) cases. We also observed effects by sex, race, and ethnicity. Conclusions. COVID-19 policies had disparate effects on sexually transmitted infection rates that varied across demographic groups. Overall results were attenuated after the first lockdown period (March-May 2020), but demographic variations persisted. (Am J Public Health. 2025;115(5):789-798. https://doi.org/10.2105/AJPH.2024.307957).