(P93) Epidemiology of Neisseria gonorrhoeae in Europe: Systematic review, meta-analyses, and meta-regressions

Background: Epidemiology of Neisseria gonorrhoeae (NG) infection is inadequately understood though this infection is a global high priority because of antimicrobial resistance. This study characterized NG epidemiology in Europe.

Methods: Cochrane and PRISMA guidelines were followed to systematically review, report, synthesize, and analyze NG prevalence data up to September 30, 2021. Random-effects meta-analyses were conducted to estimate pooled mean prevalence. Meta-regression analyses were conducted to investigate factors associated with prevalence and to determine sources of between-study heterogeneity.

Results: 844 publications were included yielding 1,573 overall and 2,199 stratified NG prevalence measures. Pooled mean prevalence of current urogenital infection was 1.0% (95% CI: 0.7-1.2%) among general populations, 3.2% (95% CI: 1.8-4.8) among female sex workers, 4.9% (95% CI: 4.2-5.6%) among sexually transmitted infection clinic attendees, and 12.1% (95% CI: 8.8-15.8%) among symptomatic men. Among men who have sex with men (MSM), pooled mean prevalence was 0.9% (95% CI: 0.5-1.4%), 5.6% (95% CI: 3.6-8.1%), and 3.8% (95% CI: 2.5-5.4%) for current urogenital, anorectal, and oropharyngeal infection, respectively. Current urogenital, anorectal, and oropharyngeal infection was 1.45-fold (95% CI: 1.19-1.76), 2.75-fold (95% CI: 1.88-4.01), and 2.63-fold (95% CI: 1.77-3.92) higher, respectively, among men compared to women. Current urogenital infection declined by 0.96-fold (95% CI: 0.96-0.97) per year over the last three decades, but current anorectal and oropharyngeal infection increased by 1.02-fold (95% CI: 1.01-1.03) and 1.01-fold (95% CI: 1.00-1.04) per year, respectively.

Conclusions: NG epidemiology in Europe has two distinct and contrasting epidemiologies for vaginal sex transmission in heterosexual sex networks versus anal and oral sex transmission in MSM sexual networks. The increased transmission may foster opportunities for new drug-resistant strains to emerge. Europe is far from achieving the World Health Organization target of 90% incidence reduction by 2030.