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Impact of the first COVID-19 lockdown on male urethritis syndrome services in South Africa
  1. Philip Dorrell1,
  2. Yogan Pillay1,2,
  3. Regina Maithufi3,
  4. Zukiswa Pinini3,
  5. Thato Chidarikire3,
  6. Nomawethu Stamper4,
  7. Derusha Frank1,
  8. Remco P H Peters5,6,7
  1. 1Clinton Health Access Initiative, Pretoria, South Africa
  2. 2Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
  3. 3National Department of Health, Pretoria, South Africa
  4. 4Eastern Cape Department of Health, Bisho, South Africa
  5. 5Research Unit, Foundation for Professional Development, East London, South Africa
  6. 6Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
  7. 7Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Professor Remco P H Peters, Research Unit, Foundation for Professional Development, East London 5217, South Africa; rph.peters{at}


Objectives Globally, there have been significant changes in utilisation of STI testing and treatment services during the period of the COVID-19 pandemic. The impact of COVID-19 in countries that use syndromic STI management is not documented. This study used routine STI surveillance data to evaluate the impact of COVID-19 on utilisation of STI syndromic management services during the first wave of the COVID-19 epidemic in South Africa.

Methods We conducted a time-trend analysis of male urethritis syndrome (MUS) cases reported through routine national STI surveillance in South Africa and COVID-19 data available through the national dashboard. We defined three time periods (prelockdown, lockdown and postlockdown) based on COVID-19 response levels. Trends in MUS reporting was compared between these time periods at national and provincial level and with the number of positive COVID-19 tests in a district.

Results An overall reduction of 27% in the national number of MUS cases reported (monthly average from 27 117 to 20 107) occurred between the pre-COVID-19 and COVID-19 lockdown periods (p<0.001), with a range of 18%–39% between the nine provinces. Postlockdown, case numbers returned almost to the prelockdown level (26 304; −3.0%). No significant difference was found in number of MUS cases between the prelockdown and postlockdown periods. A weak correlation (R2=0,21) was identified between the change in number of MUS reported and COVID-19 positive tests in a district.

Conclusions A strong reduction in reported MUS cases for syndromic management was observed during the first wave of the COVID-19 epidemic and lockdown across all provinces in South Africa. This is likely the result of various healthcare system and service delivery factors associated with lockdown measures. The observed return of MUS cases reported to prelockdown measures is reassuring.

  • COVID-19
  • Epidemiology

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  • Handling editor Bea Vuylsteke

  • Contributors All authors have contributed to the manuscript and have read and approved the final version. PD, RM and RPHP conceptualised the study, analysed the data and wrote the draft and final version of the manuscript. RM, ZP, TC and NS authorised data access. YP, ZP, TC, NS and DF contributed to data interpretation and provided inputs on the draft and final versions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.