Characteristics of reported gonorrhea diagnoses during compared to pre COVID-19 pandemic, Baltimore City, Maryland

BACKGROUND: Sexual health service disruptions due to COVID-19 mitigation measures may have decreased gonorrhea screening and biased case-ascertainment towards symptomatic individuals. We assessed changes in reported symptoms and other characteristics among reported gonorrhea cases during- vs. pre-pandemic periods in one city with persistent gonorrhea transmission. METHODS: Enhanced surveillance data collected on a random sample of gonorrhea cases reported to the Baltimore City Health Department between March 2018-September 2021 was used. Logistic regression assessed differences in case characteristics by diagnosis period (during-pandemic: March 2020-September 2021;pre-pandemic: March 2018-September 2019). RESULTS: Analyses included 2,750 (1,090 during-pandemic, 1,660 pre-pandemic) gonorrhea cases, representing 11,904 reported cases. During- vs. pre-pandemic, proportionally fewer cases were reported by sexual health clinics (8.8% vs. 23.2%), and more frequently reported by emergency departments/urgent care centers (23.3% vs. 11.9%). Adjusting for diagnosing provider, fewer cases who were males with urethral infections [aOR: 0.65, 95% CI: (0.55-0.77)], aged <18 [aOR: 0.64, (0.47-0.89)], and females [aOR: 0.84, (0.71-0.99)] were reported, and cases with insurance [aOR: 1.85, (1.40-2.45)], living with HIV [aOR: 1.43, (1.12-1.83)], or recent (≤12 months) gonorrhea history [aOR: 1.25, (1.02-1.53)] were more frequently reported during- vs. pre-pandemic. Reported symptoms and same-day/empiric treatment did not differ across periods. CONCLUSIONS: We observed no changes in reported symptoms among cases diagnosed during- vs. pre-pandemic. Increased frequency of reported diagnoses who were insured, living with HIV, or with recent gonorrhea history are suggestive of differences in care access and/or care seeking behaviors among populations with high gonorrhea transmission during the pandemic.