The COVID-19 pandemic, while primarily a global health crisis, has had significant and often unexpected effects on other health conditions, including sexually transmitted infections (STIs). Recent research conducted by a team from Universidad Complutense de Madrid and Hospital Universitario Puerta de Hierro-Majadahonda, led by Dr. Alexandra Ibáñez-Escribano has revealed a notable decrease in the diagnosis of Trichomonas vaginalis infections during the pandemic. Their study, published in Microorganisms, highlights the consequences of healthcare shifts during the pandemic on the diagnosis and epidemiology of trichomoniasis, the most common non-viral STI globally.
Before the pandemic, the diagnosis of trichomoniasis showed a modest increase in detection rates. However, during the pandemic years, this rate significantly decreased. The authors suggest that this reduction is likely not due to a true decline in infections but rather the result of decreased screening and diagnostic activities amidst the overwhelming pressures on healthcare services during the COVID-19 crisis.
The researchers analyzed data from thousands of vaginal samples collected from women attending the hospital over a four-year period, comparing pre-pandemic and pandemic data. The study revealed that the number of samples analyzed dropped significantly during the pandemic, with a particularly stark decrease observed in the first year of the pandemic. This reduction in screening is attributed to the focus on COVID-19, which not only stretched healthcare resources but also altered patient behaviors, with fewer women seeking routine gynecological care during the pandemic.
Interestingly, while the overall number of diagnosed cases decreased, the study found that a higher proportion of the cases during the pandemic were symptomatic. In the pre-pandemic period, the majority of diagnosed women presented symptoms, compared to nearly all during the pandemic. This shift suggests that only the most severe cases were likely to seek medical attention during this time, further supporting the notion that the pandemic led to underdiagnosis of asymptomatic or less severe infections.
Another concerning finding from the study was the significant increase in co-infections with Chlamydia trachomatis during the pandemic, nearly doubling compared to the pre-pandemic years. This increase underscores the importance of comprehensive STI screening, particularly in a time when healthcare systems are under strain. The authors also highlighted the lack of routine screening for trichomoniasis during pregnancy, which poses additional risks given the association between trichomoniasis and adverse pregnancy outcomes, including preterm birth and low birthweight.
Lead author Celia Bolumburu emphasized the need for continued vigilance in STI screening and the importance of not allowing the focus on COVID-19 to overshadow other critical public health issues. “The decrease in trichomoniasis diagnoses during the pandemic is likely a reflection of reduced healthcare access and screening, rather than a true reduction in incidence. As healthcare systems recover, it will be crucial to monitor these trends and ensure that infections like trichomoniasis are not neglected,” she stated.
The study concludes by calling for enhanced screening protocols and greater awareness of trichomoniasis as a significant STI, particularly in the context of pregnancy. The researchers also suggest that the trends observed during the pandemic could serve as a valuable lesson in the importance of maintaining robust public health systems capable of managing multiple health crises simultaneously.
Dr. Alexandra Ibáñez-Escribano clarified: “All sexually transmitted infections are experiencing an alarming increase after the COVID-19 pandemic, and we are sure that the same is happening with trichomoniasis. However, as it is a neglected STI, reflecting the fact that it is not a notifiable disease there are no epidemiological data. However, trichomoniasis may be a very interesting marker of high-risk sexual behaviour. This STI deserves more attention.”
Journal Reference
Bolumburu, C., Zamora, V., Muñoz-Algarra, M., de la Cruz Conty, M.L., Escario, J.A., & Ibáñez-Escribano, A. (2024). “Impact of COVID-19 Pandemic on the Trends of Trichomonas vaginalis Infection in a Tertiary Hospital of Madrid, Spain.” Microorganisms, 12(620). DOI: https://doi.org/10.3390/microorganisms12030620
About the Authors
Alexandra Ibáñez Escribano is an Associate Professor in the Department of Microbiology and Parasitology at the Faculty of Pharmacy of the Complutense University of Madrid (UCM). She achieved her Ph.D. degree in Microbiology and Parasitology in 2015. Her research was focused on the identification of new lead compounds against the sexually transmitted parasite Trichomonas vaginalis and the evaluation of biomolecular aspects of clinical samples, including resistance level and the presence of bacterial and viral endosymbionts. She subsequently obtained the position of Research Teaching Staff in the Department of Microbiology and Parasitology at the UCM and became a member of the university research group “Epidemiology, Diagnosis and Antiparasitic Therapy”. Her research has continued to focus on trichomoniasis. In recent years, she has also assessed the actual impact of this neglected sexually transmitted infection in the population, in collaboration with tertiary hospitals such as Puerta de Hierro Hospital.
Celia Bolumburu holds a PhD in Microbiology and Parasitology and a degree in Pharmacy from the Universidad Complutense de Madrid (UCM). Since 2016, she has been collaborating at the Microbiology and Parasitology Department at UCM, where her research focuses on the epidemiological and biomolecular study of Trichomonas vaginalis in collaboration with the Puerta de Hierro Hospital (Spain). Her past research also includes research placement learning DNA topology at the Centro de Investigaciones Biológicas (CIB-CSIC) and studies on chronic fatigue syndrome at the Institute of Neuroscience, Newcastle University (UK). In addition to her research, she works in the medical department of the pharmaceutical industry, combining her expertise in scientific investigation with the practical view in healthcare.
Vega Zamora graduated from the Complutense University of Madrid (Spain) with her Ph.D. degree in Microbiology and Parasitology in 2017. At that moment, she was joining a 4 years training as a resident in Clinical Microbiology in the Puerta de Hierro Hospital (Spain), which she finished in 2019. Her Ph.D. research focused on the immunomodulatory properties of the larval antigens of Anisakis simplex in mice and humans. She investigated how these antigens could modify the expression of surface molecules, cytokines and transcription factors, alone or combined with TLR agonists, in bone marrow dendritic cells. Also, she researched the relationship between the levels of Anti-A. simplex antibodies in the serum of healthy/septic individuals and the different subtypes of T/B cells. As a resident, she also participated in the development of a research project between the Puerta de Hierro Hospital and the Complutense University of Madrid (Spain). Her research there focused on the prevalence, and the relationship between endosymbionts and drug resistance or clinical outcomes of trichomoniasis. After that, she did a short-term postdoc in Fichorova Lab from February to July 2020 as a Research Intern, where she focused on the research of new biome-friendly vaginal products for improved genital health in women with the Genitourinary Syndrome of Menopause. Back in Spain, she spent 3 years in Valdepeñas Hospital as a Clinical Microbiologist, where she was actively involved in the Infectious Diseases and Antimicrobial Stewardship Program Team (2020-2023). At the moment, she is seeking new horizons to focus on Public Health and Infectious Diseases. Outside of the lab, Vega loves learning new languages, traveling, and writing.
