(P357) Proportion of Asymptomatic Sexually Transmitted Infections in Women in Low- and Middle-Income Countries: a Systematic Review and Meta-Analysis

Background: Syndromic management of sexually transmitted infections (STIs) based on the identification of symptoms is the default option in contexts with limited access to laboratory testing. However, women often have fewer symptoms than men, therefore this approach leaves many women with asymptomatic STIs untreated. Untreated infections may result in serious complications. Our objective was to estimate the proportion of women who are asymptomatic for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) among those infected in low and middle-income countries.

Methods: We searched Medline, Scopus, and Web of Science for studies published since 1^st January 2000. We included cross-sectional studies, cohort studies, and randomized trials. We selected those that used molecular methods to detect CT, NG and TV. We also included studies that detected TV by InPouch or by microscopy if performed within 2 hours following sampling. We used random effect models in the meta-analysis for pooled prevalence and proportion estimates. We performed sub-group analysis (female sex workers, HIV positive women, etc). We evaluated the quality of each article and performed sensitivity analyses. This study was registered with PROSPERO, CRD42022286673.

Results: We included forty-nine eligible studies. The proportion of CT, NG and TV infections who were asymptomatic were: 60.9%, 95%CI: [50.8 – 70.6%], 53.6% [38.9 – 68.1%] and 53.0% [41.0 – 64.9%] respectively. We found that the proportion of asymptomatic CT, NG and TV was higher in Africa in comparison to Oceania, Latin America and Asia, and higher in rural settings in comparison to urban settings (table 1). Additionally, HIV-positive women were more often asymptomatic (CT: 64.7%, 95%CI: 48.0; 79.9, NG: 61.0%, 95%CI: 42.7; 78.0, TV: 70.5% 95%CI: 60.7; 79.6) than non-specific groups of women for the three STIs (CT: 59.4%, 95%CI: 42.7; 75.2, NG: 56.5%, 95%CI: 34.9; 77.2, TV: 56.5%, 95%CI: 34.9; 77.2).

Conclusion: The proportion of asymptomatic women infected by one of the three major STIs is very high. Those women may not seek treatment and be at risk to develop sequelae. In addition, they may contribute to sustaining the transmission of STIs. Alternative approaches to syndromic management need urgently to be considered.