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Epidemiology & Monitoring

Category: Gonorrhoea - general

(P88) The epidemiology of Neisseria gonorrhoeae in the Middle East and North Africa: Systematic review, meta-analyses, and meta-regressions

Tuesday, July 25, 2023
16:00 – 18:00 CST
Background: Epidemiology of Neisseria gonorrhoeae infection in the Middle East and North Africa (MENA) remains poorly understood in a context of increasing global circulation of extensively drug-resistant gonorrhea strains. This study aimed to provide a detailed assessment of gonorrhea epidemiology in MENA.

Methods: Epidemiological evidence was systematically reviewed, synthesized, analyzed, and reported following PRISMA guidelines. Random-effects meta-analyses were conducted to estimate the pooled mean prevalence for each at-risk population stratified by assay type. Meta-regression was conducted to examine associations with prevalence and to determine sources of between-study heterogeneity.

Results: A total of 335 overall (392 stratified) gonorrhea prevalence measures were identified on 144,476 individuals from 20 (out of 23) MENA countries. Pooled prevalence of current urogenital infection was 1.9% (95% confidence interval-CI: 1.1-2.9%) in general populations, 0.8% (95% CI: 0.2-1.5%) in intermediate-risk populations, 6.5% (95% CI: 4.4-9.0%) in female sex workers, 8.3% (95% CI: 3.1-15.4%) in infertility clinic attendees, 3.0% (95% CI: 0.4-7.0%) in women with miscarriage or ectopic pregnancy, 3.9% (95% CI: 2.5-5.3%) in symptomatic women, and 41.9% (95% CI: 35.4-48.6%) in symptomatic men. In men who have sex with men, pooled prevalence was 1.6% (95% CI: 0.4-3.4%) for current urogenital infection and 10.4% (95% CI: 3.5-4.6-18.0%) for current anorectal infection. Multivariable meta-regression explained 59% of prevalence variation and identified population type and country income as the strongest predictors of gonorrhea prevalence. No evidence was found for temporal changes in prevalence over the last three decades.

Conclusions: Gonorrhea prevalence in MENA is comparable to global levels. High prevalence was found in infertility clinic attendees and in women with miscarriage or ectopic pregnancy, suggesting gonorrhea infection as a contributor to poor reproductive health outcomes in MENA.

Financial disclosure: This publication was made possible by NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors. The authors are also grateful for infrastructure support provided by the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine-Qatar. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.