Abstract
Few investigations exist on the temporal association of sexually transmitted infections (STIs) with holidays, special events, or seasons. Limited studies suggest a summer and fall predominance to STIs, but associations with calendar holidays are unclear. We sought to examine the rates of gonorrhea, chlamydia, and trichomonas after US holidays, patient birthdays, and other major calendar events. We retrospectively examined patients aged 12–120 years of age (with an encounter at our institution between July 13, 2006 and September 23, 2023) that had a polymerase chain reaction or nucleic acid amplification test for Neisseria gonorrhea, Chlamydia trachomatis, or Trichomonas vaginalis or who had a rapid antigen or positive urine microscopy for Trichomonas vaginalis performed. We examined the STI testing date for a temporal relationship between US holidays and patient birthdays. We used each STI’s incubation period plus 14 days to determine if it was associated with the primary outcomes. Among 153,344 encounters, the majority were women (n = 130,182; 85%), single (n = 102,813; 67%), and White (n = 133,103; 90%). Mean (SD) age was 29 (10) years. For gonorrhea, Mardi Gras was associated with a lower risk (OR = 0.72; p = 0.015), while Memorial Day was associated with a higher risk of a positive test (OR = 1.38; p = 0.002). For chlamydia, the patient’s birthday (OR = 1.11; p = 0.02) was associated with an increased risk of a positive test. Finally, National Girlfriend’s Day (OR = 0.77; p = 0.005) was associated with a decreased risk of a positive test for trichomonas. On logistic regression, a weekend visit was found to be significantly associated with a positive test for gonorrhea, chlamydia, and trichomonas (p < 0.001 for all). No consistent association was found between calendar holidays or patient birthdays and the risk of positive testing for STIs.
Similar content being viewed by others
Introduction
The prevalence of sexually transmitted infections (STIs) is increasing in the US, with high rates being diagnosed in the emergency department (ED)1,2,3,4. The rates of STIs are especially high among teenagers and young adults, although the rates of STIs are also increasing in older adults1,2,3,4,5,6. The signs, symptoms, and laboratory findings of gonorrhea, chlamydia, and trichomonas can overlap with other genitourinary pathology, such as urinary tract infections, which may lead to increased difficulty in accurately diagnosing STIs7,8,9. In the acute care setting, where the results of STI testing is not immediately available, providers’ decision to treat for STIs is often based on clinical history, symptomatology, and treatment guidelines alone1.
Seasonal variation of human sexuality, including number of sexual encounters, has been reported in the literature, with adult and adolescent sexual activity being higher in the warmer months and lower in the colder months10,11,12. Adolescent sexual activity has shown a peak in April and is lowest from December through February12. Condom use and first coitus are highest in summer12,13,14,15. Plasma testosterone levels in males, which may correlate with increased sexual behaviors, are highest in late summer and fall11,16. Unwanted or violent sexual activity, including rape, has been most commonly reported in the summer or early fall and less frequently observed in the winter17,18,19,20,21,22,23. Among US college students, unwanted sexual activity was highest in the fall and during fall break23. Lastly, STIs and pelvic inflammatory disease diagnoses appear to peak in the summer and fall24,25,26,27,28,29,30,31,32,33,34.
Some US holidays (e.g., Mardi Gras, New Year’s Eve, and St. Patrick’s Day) are associated with alcohol consumption, some are associated with romance (e.g., Valentine’s Day and Sweetest Day), and others have a more religious significance (e.g., Christmas and Easter). Considering that increased sexual activity may occur during certain times of the year, particularly around major holidays when social norms suggest more free time for such activities, we aimed to explore whether there may be a correlation with STIs. We examined all US federally recognized holidays as well as major social and religious events. We hypothesized that different US holidays and major calendar events are associated with differing risks of acquiring an STI. Therefore, the objective of our study was to determine if these holidays, events, and patient birthdays were associated with an increased risk of positive testing for gonorrhea, chlamydia, and trichomonas.
Methods
Study design and setting
The biostatistics data retrieval team extracted patient encounter data at our institution’s Midwest sites who had research authorization, were between 12 and 120 years of age, had a polymerase chain reaction (PCR) or nucleic acid amplification test (NAAT) for Neisseria gonorrhea, Chlamydia trachomatis, or Trichomonas vaginalis, or had a rapid antigen or positive urine microscopy for Trichomonas vaginalis performed. Patients were considered infected with an STI if any test for gonorrhea, chlamydia, or trichomonas was positive. All encounters occurred between July 13, 2006, and September 23, 2023. For encounters occurring before 2015, we recategorized them as before 2015. Our dataset excluded pregnant individuals. We considered an STI to be associated with a holiday if the patient tested positive for the infection within the pathogen’s incubation period plus two weeks. We used 2–21 days after the holiday for gonorrhea, 7–35 days for chlamydia, and 5–42 days for trichomonas35,36,37. The Mayo Clinic Institutional Review Board at our institution approved this study. All research in this study was performed in accordance with relevant guidelines and regulations as stipulated by the aforementioned review board.
Statistical analysis
We summarized continuous variables using mean and standard deviation (SD), and categorical variables using frequency and percentage. Univariate associations of variables between the positive and negative STI groups were performed using Linear Model ANOVA for continuous variables and χ2 tests for categorical variables. Multivariable logistic regression was utilized to assess the relationship between each STI and individual holiday while controlling for age, sex, race, ethnicity, marital status, year of encounter, and weekend. The majority of these covariates were selected a priori given clinical data informed by the literature38. Weekend was defined as any testing occurring on a Saturday or Sunday. For each STI, a sensitivity analysis was performed that selected each patient’s first encounter to confirm that the results were similar to the models with all records that included multiple encounters per patient. All analysis was performed using R 4.0.3 (The R Foundation for Statistical Computing, Vienna, Austria). The R package arsenal was used to generate summary tables (Heinzen E, Sinnwell J, Atkinson E, Gunderson T, Dougherty G (2024). _arsenal: An Arsenal of ‘R’ Functions for Large-Scale Statistical Summaries_. R package version 3.6.4.0000). All tests were 2-sided, and a P value of < 0.05 was considered statistically significant.
Results
Table 1 provides a summary of patient characteristics. Age, race, ethnicity, gender, marital status, day of the week, and type of encounter (emergency vs. outpatient) were all significantly associated with testing positive for an STI. In Table 1, ‘Any STI’ was defined as positive if any of the 3 tests that a patient may have had for an STI (gonorrhea, chlamydia, or trichomonas) resulted in a positive test. Our analysis included 153,344 encounters.
Gonorrhea
Among those tested for gonorrhea, 144,998 (99%) were negative and 1,560 (1%) were positive (Table 2). Within our dataset, 6,786 encounters had no gonorrhea testing. There were 139,481 encounters with non-missing covariates included in the regression analyses. The following covariates were found to be significantly associated with a positive gonorrhea test: age ≥ 18 years of age (with the exception of age categories of 21–24 and ≥ 45), male gender (compared to female), Black/African American (compared to White), being single, and weekend visit (Table 3). Mardi Gras was associated with a lower risk (OR = 0.72, 95% CI 0.55–0.93, p = 0.015), while Memorial Day was associated with a higher risk of a positive gonorrhea test (OR = 1.38, 95% CI 1.12–1.67, p = 0.002) (Table 4).
Chlamydia
Among those tested for chlamydia, 145,271 (95%) were negative, and 7,762 (5%) were positive (Table 2). Within our dataset, 311 encounters had no chlamydia testing. There were 145,612 encounters with non-missing covariates included in the regression analyses. The following covariates were found to be significantly associated with a positive chlamydia test: age 18 to 20 years of age, male gender (compared to female), Black/African American and Other race (compared to White), being Hispanic or Latino, being single, and weekend visit (Table 5). The patient’s birthday (OR = 1.11, 95% CI 1.01–1.2, p = 0.02) was associated with an increased risk of a positive chlamydia test (Table 6).
Trichomonas
Among those tested for trichomonas, 39,664 (96%) were negative, and 1,537 (4%) were positive (Table 2). Within our dataset, 112,143 encounters had no trichomonas testing. There were 39,405 encounters with non-missing covariates included in the regression analyses. The following covariates were found to be significantly associated with a positive trichomonas test: older age (except for 18–20 years), male gender (compared to female), Black/African American (compared to White), being non-Hispanic, being single, and weekend visit (Table 7). National Girlfriend’s Day (OR = 0.77, 95% CI 0.64–0.92, p = 0.005) was associated with a decreased risk of a positive trichomonas test (Table 8).
Discussion
We did not find a clear association between major US holidays and being diagnosed with STIs. Our findings are consistent with an older study on STI testing from the ED39. While there may be a seasonal variation in STIs, an association with significant events or calendar holidays remains unclear. During Christmas, for example, sexual activity and condom purchases are said to be increased, but there is no clear associated peak in STIs during this same time24,27,30,40. An Australian study showed that sexual health clinic visits increased for approximately five days after holidays and festivals41. Conversely, no increased STI diagnosis prevalence was observed after Carnival in Rio de Janeiro, Brazil42. Travel overseas and holiday vacations may be associated with increased sexual activity and increased risk for STIs43]– [44. In the US, college students report risky sexual behavior (including unprotected intercourse and multiple partners) during spring break trips45. Similar increase in sexual risk-taking was observed in British University students on summer break when partaking in foreign travel46. These reports would corroborate the hypothesis that young adults engage in riskier sexual activities during times of vacation or holiday.
In our study, we did observe some statistically significant findings with STIs and other holidays. However, since the findings were not consistent among STIs, we felt the findings could result from multiple testing. For instance, in the case of gonorrhea, Memorial Day was associated with a higher risk of a positive test while a lower risk was observed with Mardi Gras. The patient’s birthday was associated with a higher risk of a positive chlamydia test. However, National Girlfriend’s Day was associated with a decreased risk of testing positive for trichomonas. We suspect that these observed differences are likely due to testing patterns and the large number of statistical tests conducted, rather than reflecting underlying biological differences or variations in patient behaviors.
Our results suggest no clear or consistent association of STIs with holidays. Previous literature findings are also mixed in the arena of seasonality of STIs; for example, a 5-year study detected no seasonal difference in the detection of trichomonas47 while a 3-year study on chlamydia suggested peaks of incidence during summer and early fall48. Considering the findings of our study over a 17-year timeframe, we advise that mathematical models of STI transmission should not attempt to account for holidays.
Limitations
Our institutions’ largest hospital acts as a quaternary referral center, so results may not be generalizable to other community EDs or areas with higher baseline STI rates. Our dataset had limited racial and ethnic diversity, with the majority of our patients being White and older, which are demographics associated with lower rates of STIs. All of our STI testing occurred within our Midwest hospital site and its neighboring satellite clinics, limiting geographic generalizability. We only included patients 12 years of age and older. Adolescents (age 12–17 years) represented 5.8% of our total dataset, and these patients may be less likely to be able to receive testing at certain times due to school or work. The aforementioned demographic composition of our patients limits the external validity and introduces potential population-based bias into our findings.
The dataset al.so included the years of the COVID-19 pandemic when individuals may have been less likely to travel during breaks or significant US holidays49. Also, a significant number of adults in the US postponed medical care during the pandemic, including 12.0% who avoided urgent or emergency care50. Furthermore, an additional limitation of our data is the potential to overlook individuals who engage in risky behaviors but do not consistently use health services, which could hinder the identification of potential STI cases in this group. Any of these issues could confound our results.
This analysis was exploratory, so we have not adjusted for multiple testing. The many statistical tests performed to answer the research question increase the likelihood of false positive results. We acknowledge that multiple comparisons could unintentionally affect the conclusions of our study. Specifically, the large number of tests conducted may lead to false significant associations. We see primarily null findings with the holidays, and the few significant findings are inconsistent across the types of STIs. Again, our analysis’s few positive results may be falsely positive as the result of performing many statistical tests.
We did not include all STIs in our analysis. STIs can be asymptomatic and, therefore, diagnosed outside our established timeframe. Not all ED patients were tested for STIs, so we cannot calculate the prevalence of infection among them; furthermore, the setting where STI testing was conducted (ED versus outpatient) may limit the generalizability of our findings. Our analysis did not account for weekends or holidays when the outpatient practice was closed, which could have affected testing rates. We examined multiple holidays with overlapping incubation periods, making assigning the STI to one specific holiday over another more challenging.
Conclusions
Testing positive for gonorrhea, chlamydia, and trichomonas was not consistently associated with a significant US calendar holiday or the patient’s birthday. Weekend visits were, however, significantly associated with a positive STI test result, likely reflecting testing occurring in the ED compared with the outpatient practice.
Data availability
Our data cannot be shared openly beyond our result section due to patient confidentiality and privacy. Any data requests should be directed to Dr. Johnathan Sheele.
References
Wilson, S. P. et al. Gonorrhea and chlamydia in the emergency department: continued need for more focused treatment for men, women and pregnant women. Am. J. Emerg. Med. 35 (5), 701–703. https://doi.org/10.1016/j.ajem.2017.01.002 (2017).
Schneider, K., FitzGerald, M., Byczkowski, T. & Reed, J. Screening for asymptomatic gonorrhea and Chlamydia in the pediatric emergency department. Sex. Transm Dis. 43 (4), 209–215. https://doi.org/10.1097/OLQ.0000000000000424 (2016).
Mehta, S. D., Shahan, J. & Zenilman, J. M. Ambulatory STD management in an inner-city emergency department: descriptive epidemiology, care utilization patterns, and patient perceptions of local public STD clinics. Sex. Transm Dis. 27 (3), 154–158. https://doi.org/10.1097/00007435-200003000-00007 (2000).
Centers for Disease Control and Prevention. Reported STDs at Unprecedented High in the US (2016). https://www.cdc.gov/nchhstp/newsroom/2016/std-surveillance-report-2015-press-release.html; [accessed Aug 28, 2020].
Van Epps, P., Musoke, L. & McNeil, C. J. Sexually transmitted infections in older adults: increasing tide and how to stem it. Infect. Dis. Clin. North. Am. 37 (1), 47–63. https://doi.org/10.1016/j.idc.2022.11.003 (2023).
Karaye, I. M. & Kyriacou, C. M. HIV and other sexually transmitted infections in older adults. Lancet Healthy Longev. 5 (1), e2–e3. https://doi.org/10.1016/S2666-7568(23)00256-8 (2024).
Elkins, J. M., Cantillo-Campos, S., Thompson, C., Mohseni, M. & Sheele, J. M. Descriptive evaluation of male emergency department patients in the united States with gonorrhea and chlamydia. Cureus ;12(10). (2020).
Sheele, J. M., Mi, L., Monas, J. & Mohseni, M. Patient and Provider Demographics and the Management of Genitourinary Tract Infections in the Emergency Department (Emergency Medicine International, 2023).
Tomas, M. E., Getman, D., Donskey, C. J. & Hecker, M. T. Overdiagnosis of urinary tract infection and underdiagnosis of sexually transmitted infection in adult women presenting to an emergency department. J. Clin. Microbiol. 53 (8), 2686–2692 (2015).
Udry, J. R. & Morris, N. M. Seasonality of coitus and seasonality of birth. Demography 4 (2), 673–679. https://doi.org/10.2307/2060307 (1967).
Reinberg, A. & Lagoguey, M. Circadian and circannual rhythms in sexual activity and plasma hormones (FSH, LH, testosterone) of five human males. Arch. Sex. Behav. 7 (1), 13–30. https://doi.org/10.1007/BF01541895 (1978).
Fortenberry, J. D., Orr, D. P., Zimet, G. D. & Blythe, M. J. Weekly and seasonal variation in sexual behaviors among adolescent women with sexually transmitted diseases. J. Adolesc. Health. 20 (6), 420–425. https://doi.org/10.1016/S1054-139X(96)00275-3 (1997).
Rodgers, J. L., Harris, D. F. & Vickers, K. B. Seasonality of first coitus in the united States. Soc. Biol. 39 (1–2), 1–14. https://doi.org/10.1080/19485565.1992.9988800 (1992).
Pittman, S., Tita, A. T., Barratt, M. S., Rubin, S. R. & Hollier, L. M. Seasonality and immediate antecedents of sexual intercourse in adolescents. J. Reprod. Med. 50 (3), 193–197 (2005).
Rodgers, J. L. & Udry, J. R. The Season-of-Birth paradox. Soc. Biol. 35 (3–4), 171–185 (1988).
Smals, A. G., Kloppenborg, P. W. & Benraad, T. J. Circannual cycle in plasma testosterone levels in man. J. Clin. Endocrinol. Metab. 42 (5), 979–982. https://doi.org/10.1210/jcem-42-5-979 (1976).
Tellez, C., Galleguillos, T., Aliaga, A. & Silva, C. Seasonal variation of sexual abuse in Santiago de Chile. Psychopathology 39 (2), 69–74. https://doi.org/10.1159/000090595 (2006).
Dong, K., Cao, Y., Siercke, B., Wilber, M. & McCalla, S. G. Advising caution in studying seasonal oscillations in crime rates. PLoS One. 12 (9), e0185432. https://doi.org/10.1371/journal.pone.0185432 (2017).
Michael, R. P. & Zumpe, D. Annual rhythms in human violence and sexual aggression in the united States and the role of temperature. Soc. Biol. 30 (3), 263–278. https://doi.org/10.1080/19485565.1983.9988541 (1983).
Michael, R. P. & Zumpe, D. Sexual violence in the united States and the role of season. Am. J. Psychiatry. 140 (7), 883–886. https://doi.org/10.1176/ajp.140.7.883 (1983).
Keating, S. M., Higgs, D. F., Willott, G. M. & Stedman, L. R. Sexual assault patterns. J. Forensic Sci. Soc. 30 (2), 71–88. https://doi.org/10.1016/s0015-7368(90)73310-5 (1990).
Bicakova-Rocher, A., Smolensky, M., Reinberg, A. & De Prins, J. Seasonal variations in socially and legally unacceptable sexual behaviour. Chronobiol Int. 2 (3), 203–208. https://doi.org/10.3109/07420528509055560 (1985).
Flack, W. F. et al. The red zone: Temporal risk for unwanted sex among college students. J. Interpers. Violence. 23 (9), 1177–1196. https://doi.org/10.1177/0886260508314308 (2008).
Schroeder, B., Tetlow, P., Sanfilippo, J. S. & Hertweck, S. P. Is there a seasonal variation in gonorrhea and chlamydia in adolescents? J. Pediatr. Adolesc. Gynecol. 14 (1), 25–27. https://doi.org/10.1016/s1083-3188(00)00079-6 (2001).
Albus, C. & Kohler, G. Is there is seasonal incidence of acute adnexitis? Zentralbl Gynakol. 110 (13), 824–826 (1988).
Damiba, A. E., Vermund, S. H. & Kelley, K. F. Rising trend of reported gonorrhoea and urethritis incidence in Burkina Faso from 1978 to 1983. Trans. R Soc. Trop. Med. Hyg. 84 (1), 132–135. https://doi.org/10.1016/0035-9203(90)90406-5 (1990).
Wright, R. A. & Judson, F. N. Relative and seasonal incidences of the sexually transmitted diseases. A two-year statistical review. Br. J. Vener. Dis. 54 (6), 433–440. https://doi.org/10.1136/sti.54.6.433 (1978).
Schofield, C. B. Seasonal variations in the reported incidence of sexually transmitted diseases in Scotland (1972-76). Br. J. Vener. Dis. 55 (3), 218–222. https://doi.org/10.1136/sti.55.3.218 (1979).
Cornelisse, V. J., Chow, E. P., Chen, M. Y., Bradshaw, C. S. & Fairley, C. K. Summer heat: a cross-sectional analysis of seasonal differences in sexual behaviour and sexually transmissible diseases in melbourne, Australia. Sex. Transm Infect. 92 (4), 286–291. https://doi.org/10.1136/sextrans-2015-052225 (2016).
Cornelius, C. E. 3rd. Seasonality of gonorrhea in the united States. HSMHA Health Rep. 86 (2), 157–160 (1971).
Kakran, M., Bala, M. & Singh, V. An analysis of underlying factors for seasonal variation in gonorrhoea in india: a 6-year statistical assessment. Indian J. Med. Microbiol. 33 (2), 215–220. https://doi.org/10.4103/0255-0857.154853 (2015).
Li, B. et al. Seasonal variation in gonorrhoea incidence among men who have sex with men. Sex. Health. 13 (6), 589–592. https://doi.org/10.1071/SH16122 (2016).
Tan, N. X. et al. Temporal trends in syphilis and gonorrhea incidences in Guangdong province, China. J. Infect. Dis. 209 (3), 426–430. https://doi.org/10.1093/infdis/jit496 (2014).
Shah, A. P., Smolensky, M. H., Burau, K. D., Cech, I. M. & Lai, D. Recent change in the annual pattern of sexually transmitted diseases in the united States. Chronobiol Int. 24 (5), 947–960. https://doi.org/10.1080/07420520701648325 (2007).
Handsfield, H. H., Lipman, T. O., Harnisch, J. P., Tronca, E. & Holmes, K. K. Asymptomatic gonorrhea in men. Diagnosis, natural course, prevalence and significance. N Engl. J. Med. 290 (3), 117–123. https://doi.org/10.1056/NEJM197401172900301 (1974).
Elwell, C., Mirrashidi, K. & Engel, J. Chlamydia cell biology and pathogenesis. Nat. Rev. Microbiol. 14 (6), 385–400. https://doi.org/10.1038/nrmicro.2016.30 (2016).
Hobbs, M. M., Sena, A. C., Swygard, H. & Schwebke, J. R. Trichomonas vaginalis and trichomoniasis. In: (eds Holmes, K. K., Sparling, P. F., Stamm, W. E., Piot, P., Wasserheit, J. N., Corey, L. et al.) Sexually Transmitted Diseases, 4th ed. New York: McGraw-Hill Medical; : 771–793. (2008).
Workowski, K. A. et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 70 (4), 1–187. https://doi.org/10.15585/mmwr.rr7004a1 (2021).
Mohseni, M. M. et al. Sexually transmitted infections in the emergency department are not associated with holidays or school breaks. Am. J. Emerg. Med. 45, 642–644 (2021).
Wellings, K., Macdowall, W., Catchpole, M. & Goodrich, J. Seasonal variations in sexual activity and their implications for sexual health promotion. J. R Soc. Med. 92 (2), 60–64. https://doi.org/10.1177/014107689909200204 (1999).
Gamagedara, N. et al. What are seasonal and meteorological factors are associated with the number of attendees at a sexual health service? An observational study between 2002–2012. Sex. Transm Infect. 90 (8), 635–640. https://doi.org/10.1136/sextrans-2013-051391 (2014).
Passos, M. R. et al. Is there increase of STDs during carnival?? Time series of diagnoses in a STD clinic. Rev. Assoc. Med. Bras. (1992). 56 (4), 420–427. https://doi.org/10.1590/s0104-42302010000400014 (2010).
Hwang, L. Y., Shafer, M. A., Pollack, L. M., Chang, Y. J. & Boyer, C. B. Sexual behaviors after universal screening of sexually transmitted infections in healthy young women. Obstet. Gynecol. 109 (1), 105–113. https://doi.org/10.1097/01.AOG.0000247643.17067.d9 (2007).
Rogstad, K. E. Sex, sun, sea, and stis: sexually transmitted infections acquired on holiday. BMJ 329 (7459), 214–217. https://doi.org/10.1136/bmj.329.7459.214 (2004).
Lewis, M. A., Patrick, M. E., Mittmann, A. & Kaysen, D. L. Sex on the beach: the influence of social norms and trip companion on spring break sexual behavior. Prev. Sci. 15 (3), 408–418. https://doi.org/10.1007/s11121-014-0460-8 (2014).
Vivancos, R., Abubakar, I. & Hunter, P. R. Foreign travel associated with increased sexual risk-taking, alcohol and drug use among UK university students: a cohort study. Int. J. STD AIDS. 21 (1), 46–51. https://doi.org/10.1258/ijsa.2009.008501 (2010).
Shrader, S., Hernandez, E. & Gaughan, J. Is there a seasonal difference in the detection of Trichomonas vaginalis by cervical cytology? Sci. World J. 3, 45–50. https://doi.org/10.1100/tsw.2003.10 (2003).
Herold, A. H. et al. Seasonality of Chlamydia trachomatis genital infections in university women. J. Am. Coll. Health. 42 (3), 117–120. https://doi.org/10.1080/07448481.1993.9940826 (1993).
Flaherty, G. T. & Nasir, N. Reiseangst: travel anxiety and psychological resilience during and beyond the COVID-19 pandemic. J. Travel Med. 27 (8), taaa150. https://doi.org/10.1093/jtm/taaa150 (2020).
Czeisler, M. É. et al. Delay or avoidance of medical care because of COVID-19-Related Concerns - United states, June 2020. MMWR Morb Mortal. Wkly. Rep. 69 (36), 1250–1257. https://doi.org/10.15585/mmwr.mm6936a4 (2020).
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conceptualization and design. Material preparation, data collection and analysis were performed by J.S., M.M., and A.M. The first draft of the manuscript was written by M.M., B.B., J.M., and N.H. All authors provided edits and commented on previous versions of the manuscript. M.M. finalized editing and submission of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Compliance with ethical standards
This study was approved by the Mayo Clinic Institutional Review Board. Due to the retrospective nature of the study, the Mayo Clinic Institutional Review Board waived the need of obtaining informed consent.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Mohseni, M., Monas, J., Hodgson, N. et al. Sexually transmitted infections are not associated with US holidays. Sci Rep 15, 22510 (2025). https://doi.org/10.1038/s41598-025-06959-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-025-06959-x
