Background The coronavirus disease-2019 (COVID-19) pandemic has severely impacted South Africa. Healthcare service provision and utilisation have been affected by socio-economic factors, reduced mobility, and reprioritisation as well as interruption of services. The impact of the COVID-19 pandemic on STI services is unclear.

Methods In this non-randomised study, we used the male urethritis syndrome (MUS) quarterly data from the clinical surveillance sites in the Eastern Cape (EC) province of South Africa. MUS is the main proxy measure of STI services in South Africa. MUS data were compared for a 12-month period before COVID-19 (April 2019-March 2020) and a 9-month period during the COVID-19 epidemic (April-December 2020) in each of the 8 districts. MUS data were related to the magnitude of the COVID-19 epidemic at the end of December 2020 as defined by the number of laboratory-confirmed COVID-19 cases over the population size.

Results The quarterly number of MUS cases dropped by 30% overall in the EC province, from 13072 before COVID-19 to 9142 cases during the COVID-19 epidemic (p<0.001). The reduction in quarterly MUS cases varied between districts, with 11% for the smallest and 45% for the largest reduction. The COVID-19 burden ranged from 0.72% to 4.19% between districts. There was a clear positive association of reduction in reported MUS cases and the burden of COVID-19, with districts with the largest COVID-19 burden showing the largest reductions in MUS cases (R-square 0.83, F 30.057, p=0.002).

Conclusion These data demonstrate a clear reduction in STI services resulting from the COVID-19 epidemic in the rural Eastern Cape Province of South Africa. Although underreporting may have occurred, taking reports of higher population vulnerability and increased rates of unprotected sex into account, the reduction in reported MUS cases suggest that COVID-19 may have increased the burden of untreated STIs in our community.