e642 Letters to the Editor Table 1 Description of patient exanthema findings Characteristic Patients with morbilliform Patients with urticarial eruptions (n = 37) eruptions (n = 2) Demographics Age in years (mean  SD) 58.8  15.1 71.3  12.1 Gender Male 25 (67.6%) 1 (50.0%) Female 12 (32.4%) 1 (50.0%) Hospitalization: Length of stay in days (mean  SD) 34.2  18.8 28.5  16.3 Intensive care unit admission 34 (91.9%) 1 (50.0%) Death 3 (8.1%) – Culprit drugs Day of rash onset since admission (mean  SD) 12.0  9.5 0.0  7.1 Day of rash onset since COVID symptom onset (mean  SD) 24.7  12.6 7.5  10.7 Rash onset within 14 days of COVID-19 symptom onset 6 (16.2%) 1 (50.0%) Having any possible culprit drugs identified 36 (97.3%) 1 (50.0%) Having any likely† culprit drugs identified 28 (75.7%) 1 (50.0%) Having likely culprit drug exposure from 0 to 7 days of rash onset 17 1 Having likely culprit drug exposure from 8 to 14 days of rash onset 9 – Having likely culprit drug exposure from 15 to 28 days of rash onset 1 – Day of rash onset since exposure to likely drug culprits (mean  SD) 7.8  5.9 0.0  0.0 Most common likely culprit drugs identified Cefepime 16 – Ceftriaxone 8 1 Meropenem 3 – Vancomycin 4 – Azithromycin 1 – Abbreviations: SD, standard deviation. †Likely culprit drugs were distinguished by reviewers based on epidemiologic incidence of induction of cutaneous adverse reactions. 6 Bigby M. Drug-induced cutaneous reactions. JAMA 1986; 256: 3358. including STI. The main objective of this study was to analyse the 7 Schneck J et al. Effects of treatments on the mortality of Stevens-Johnson number of newly notified STI cases and HIV postexposure pro- syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. J Am Acad Dermatol 2008; phylaxis (PEP) in Barcelona during the COVID-19 pandemic. 58: 33–40. A retrospective study including all cases of gonorrhoea, pri- mary and secondary syphilis, lymphogranuloma venereum DOI: 10.1111/jdv.17459 (LGV) and new HIV diagnoses reported to the Public Health Agency of Barcelona (ASPB), from January 2019 to September 2020, was carried out. The number of PEP prescribed in three university hospitals in Barcelona (Hospital del Mar, Hospital Evolution of notified sexually Vall d’Hebron and Hospital Sant Pau), during the same period, was also included as an indicator of unprotected sexual practices transmitted infections in during the lockdown. Barcelona during the first wave The evolution of cases for each STI was evaluated with multi- ple linear regression analysis with time as a covariate. Fisher’s of the COVID-19 pandemic exact test was used to compare the numbers of diagnoses. The Dear Editor, study protocol was approved by the institutional review board With the arrival of COVID-19, STI units decreased their activ- (2020/9420). ity or even closed and individuals avoided healthcare facilities. The demographic characteristics of the included patients are These factors conditioned the diagnosis of severe conditions,1 shown in Table 1. Cases of gonorrhoea decreased globally in a JEADV 2021, 35, e619–e698 © 2021 European Academy of Dermatology and Venereology Letters to the Editor e643 Table 1 Clinical and epidemiological characteristics of the patients included in the study New diagnosis n Mean age Male sex (%) Transexual (%) MSM (%) HIV Coinfection Gonorrhoea Year 2019 3146 33 2675 (85.03%) 18 (0.57%) 1293 (71.79%) 436 (27.56%) (01/01–31/12) /ND: 1345 /ND: 1564 Year 2020 1563 33 1353 (86.73%) 5 (0.32%) 217 (62.54%) / 52 (18.98%) (01/01–30/09) /ND: 3 ND: 1216 /ND: 1289 LGV Year 2019 255 37.5 254 (99.61%) 1 (0.39%) 140 (95.89%) 92 (64.33%) (01/01–31/12) /ND: 1 /ND: 109 Year 2020 144 38.54 141 (99.29%) 1 (0.70%) 40 (95.23%) 18 (45%) (01/01–30/09) /ND: 2 /ND: 2 /ND: 102 /ND: 104 HIV Year 2019 269 33.92 241 (89.59%) 0 216 (80.3%) (01/01–31/12) Year 2020 48 34.96 44 (91.67%) 1 (2.08%) 38 (79.17%) (01/01–30/09) Primary syphilis Year 2019 214 38 194 (90.65%) 7 (3.27%) 160 (84.21%) 80 (44.69%) (01/01–31/12) /ND: 5 /ND: 24 /ND: 35 Year 2020 90 37 83 (92.22%) 2 (2.22%) 40 (81.63%) 15 (33.33%) (01/01–30/09) /ND: 1 /ND: 2 /ND: 41 /ND: 45 Secondary syphilis Year 2019 242 38 233 (96.28%) 1 (0.41%) 187 (88.21%) 90 (42.25%) (01/01–31/12) /ND: 3 /ND: 30 /ND: 29 Year 2020 112 36 103 (93.64%) 2 (1.81%) 44 (84.61%) 24 (45.28%) (01/01–30/09) /ND: 1 /ND: 2 /ND: 60 /ND: 59 Early syphilis Year 2019 456 38 427 (93.65%) 8 (1.75%%) 347 (86.32%) 170 (43.37%) (01/01–31/12) /ND: 8 /ND: 54 /ND: 64 Year 2020 202 36.5 /ND: 2 186 (93.94%) 4 (1.98%) 84 (83.17) 39 (39.8%) (01/01–30/09) /ND: 2 /ND: 4 /ND: 101 /ND: 104 MSM, men who have sex with men; ND, non-data. range of seven cases per month (beta change = 7, P- This study shows a marked decrease either in the newly value = 0.013), and a marked decrease was seen from March reported STIs or in the number of PEP treatments in Barcelona 2020 (beta change = 224, P < 0.001; Fig. 1a). Accordingly, from March to September 2020. A similar phenomenon has been immediately after the lockdown, during the third week of observed in different nationally or locally based surveillance March 2020, only 18 cases were notified (in contrast with 49 studies (the USA2, Australia3,4, Rome5 and London6). Con- cases during the same week in 2019), which means a differ- versely, in Milan a reduction in non-acute cases was noted.7 In ence of 63%. No statistical differences were detected among Lebanon, an increase in PEP treatments was detected.8 urethral gonorrhoea in both weeks, whereas non-urethral gon- In March 2020, a reduction of 63% in gonorrhoea notifica- orrhoea cases, which are commonly asymptomatic, showed a tions was noted, mainly attributable to asymptomatic cases. clear-cut reduction (seven cases in 2020 against 34 in 2019, Probably these findings are the consequence of the stop of screen- P < 0.005). A significant plunge in LGV notifications from ing programmes and a decrease in the number of consultations, March 2020 can be seen (Fig. 1b). The number of early syphi- testing and/or notifications during the lockdown. The future lis cases decreased in 2020 (1.2 cases per month, P = 0.047). impact of these events is unknown, but may result in an increase No trend changes were observed from March 2020 onwards. in new HIV diagnoses at later stages or in symptomatic STIs. However, in July 2020 there is a peak in primary syphilis The main limitation of this work is its retrospective nature. diagnoses. The general trend is a decrease in the number of Besides, the study is focused on notified cases, which may not new HIV diagnoses in the study period (beta change 1.4, reflect the real incidence. No information about PreP P < 0.001), without significant differences from March 2020 administration or discontinuation during the lockdown could be (Fig. 1c). During July, August and September 2020, no new analysed. HIV diagnoses were reported. The number of prescribed PEP In summary, a reduction in reported STI was detected. The went from 321 in 2019 (238 from January to September) to decrement in the reported cases of gonorrhoea could be attribu- 170 in 2020. During the lockdown period, prescriptions table to the underdiagnosis of asymptomatic cases. Further stud- decreased significantly (Fig. 1g). ies will confirm the consequences of these findings. JEADV 2021, 35, e619–e698 © 2021 European Academy of Dermatology and Venereology e644 Letters to the Editor JEADV 2021, 35, e619–e698 © 2021 European Academy of Dermatology and Venereology Letters to the Editor e645 Figure 1 Evolution of notified STI in Barcelona, from January 2019 to September 2020. (a) Gonorrhoea cases, (b) LGV (c), primary syphi- lis, (d) secondary syphilis, (e) early syphilis, (f) HIV and (g) HIV postexposure prophylaxis. Acknowledgements References STI-HIV group of Barcelona: R. Rovira, N. Mohammad Porras, 1 Tarantini L, Navazio A, Cioffi G, Turiano G, Colivicchi F, Gabrielli D. Being a cardiologist at the time of SARS-COVID-19: is it time to recon- (Dermatology Department, Hospital del Mar), M. De Antonio sider our way of working? G Ital Cardiol (Rome) 2020; 21: 354–357. Cusco (Pharmacy, Hospital del Mar), A. Curran, E. Arellano, D. 2 Crane MA, Popovic A, Stolbach AI, Ghanem KG. Reporting of sexually Martınez-Rasc on, V. Descalzo, M. Arando, V. Falc o (Depart- transmitted infections during the COVID-19 pandemic. Sex Transm Infect ment of Infectious Diseases, Hospital Universitari Vall 2021; 97: 101–102. 3 Hammoud MA, Grulich A, Holt M et al. Substantial decline in use of HIV d’Hebron, Barcelona, Spain; Vall d’Hebron Institut de Recerca, preexposure prophylaxis following introduction of COVID-19 physical Barcelona, Spain; Universitat Aut onoma de Barcelona, Barce- distancing restrictions in Australia: results from a prospective observa- lona, Spain) H. Knobel, A. Marcos Blanco (Infectious Diseases. tional study of gay and bisexual men. J Acquir Immune Defic Syndr 2021; Hospital del Mar), C. Rius, R. Clos, E. Masdeu, M. Ros, I. Avel- 86: 22–30. 4 Hammoud MA, Maher L, Holt M et al. Physical distancing due to lanes, R. Prieto, A. Artigues, A. Hernandez (Epidemiology Ser- COVID-19 disrupts sexual behaviors among gay and bisexual men in Aus- vice, Public Health Agency of Barcelona (ASPB)), I. Fuertes, J. tralia: implications for trends in HIV and other sexually transmissible Riera, I. Chivite (Hospital Clınic, Barcelona). infections. J Acquir Immune Defic Syndr 2020; 85: 309–315. 5 Latini A, Magri F, Dona MG, Giuliani M, Cristaudo A, Zaccarelli M. Is COVID-19 affecting the epidemiology of STIs? The experience of syphilis Conflict of interests in Rome. Sex Transm Infect 2021; 97: 78. None declared. 6 Junejo M, Girometti N, McOwan A, Whitlock G; on behalf of the Dean Street Collaborative Group. HIV postexposure prophylaxis during COVID-19. Lancet 2020; 7: e460. Funding source 7 Cusini M, Benardon S, Vidoni G, Brignolo L, Veraldi S, Mandolini PL. None. Trend of main STIs during COVID-19 pandemic in Milan, Italy. Sex Transm Infect 2021; 97: 99. Ethics approval 8 Maatouk I, Assi M, Jaspal R. Emerging impact of the COVID-19 outbreak on sexual health in Lebanon. Sex Transm Infect 2021; 97: The study protocol was approved by the institutional review 318. board of Hospital del Mar number 2020/9420. DOI: 10.1111/jdv.17460 G. Martin-Ezquerra,1 P. Monreal,1 L. Mercuriali,2 E. Can ~as-Ruano, 3,4,5 R.M. Pujol,1 X. Duran,6 M. Masferrer Niubo  ,7 P. Domingo,8 J. Villar-Garcia,9 J. Lopez-Contreras,8 A. Gonzalez-Cordo  n,10 P. Garcia-Olalla,2,11,* The first dose of COVID-19 M.-J. Barbera, 3,4,5 STI-HIV group of Barcelona† M. Ros, I.  Avellanes, R. Prieto, A. Artigues, A. Hernandez, I. Fuertes, vaccine may trigger pemphigus 1 J. Riera, I. Chivite, and bullous pemphigoid flares: is Dermatology Department, Institut Hospital del Mar d’Investigacions Mediques (IMIM), Hospital del Mar, Barcelona, Spain, 2Epidemiology the second dose therefore 3 Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain, Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, contraindicated? Barcelona, Spain, 4Vall d’Hebron Institut de Recerca, Barcelona, Spain, Dear Editor, 5 noma de Barcelona, Barcelona, Spain, 6Scientifics, Universitat Auto During the COVID-19 pandemics, the management of immuno- Statistics and Technical Department, Institut Hospital del Mar suppressed patients, those affected by autoimmune bullous dis- d’Investigacions Me diques (IMIM), Hospital del Mar, Barcelona, Spain, eases (AIBDs), became a matter of particular concern for 7 ncies, Seu de Barcelona, Universidad Nacional de Facultat de Cie healthcare systems; dissemination of sound and updated infor- Educacion a Distancia (UNED), Barcelona, Spain, 8Infectious Diseases mation became mandatory to orient physicians and more gener- Unit-Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, ally healthcare policy.1,2 Furthermore, AIBDs patients were Universitat Autonoma de Barcelona, Barcelona, Spain, 9Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain, 10Hospital Clınic i encouraged to take advantage from teledermatological rather Provincial, Barcelona, Spain, 11Consorcio de Investigacio n Biom edica en than in-person consultations; also, they were encouraged to Red de Epidemiologıa y Salud Pu blica (CIBERESP), Barcelona, Spain undergo COVID-19 vaccination, preferably during remission *Correspondence: P. Garcia-Olalla. E-mail: polalla@aspb.cat periods or at least while under low immunosuppression.3,4 To † See Acknowledgements date, data regarding the effect of COVID vaccines on AIBDs are JEADV 2021, 35, e619–e698 © 2021 European Academy of Dermatology and Venereology