Global epidemiology of Neisseria gonorrhoeae in infertile populations: protocol for a systematic review

Abstract

Introduction: A key target of the WHO's 'Global Health Sector Strategy on sexually transmitted infections, 2016-2021' is achieving 90% reduction in Neisseria gonorrhoeae (gonorrhoea for short) incidence globally by 2030. Though untreated, gonorrhoea has been linked to infertility, the epidemiology of this infection in infertile populations remains poorly understood and somewhat a neglected area of reproductive health. Our proposed systematic review aims to fill this gap by characterising comprehensively gonorrhoea infection in infertile populations globally.

Methods and analysis: All available studies of gonorrhoea infection in infertile populations, including infertility clinic attendees, will be systematically reviewed informed by Cochrane Collaboration guidelines. Findings will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources will be searched using broad index terms exploded to cover all subheadings and free text terms with no language or year restriction. Any epidemiological measure in infertile populations based on primary data will be eligible for inclusion. Measures based on different assay types will be extracted as separate studies for different analyses. Only one biospecimen type per assay type will be considered based on a predefined priority order. Samples including fewer than 10 participants or assessing infection in the upper genital tract will be excluded. Quality assessments will be conducted for all measures included in the review. Meta-analyses will be implemented using DerSimonian-Laird random effect models to estimate the mean prevalence of gonorrhoea in infertile populations globally, and stratified by WHO region, assay type, sex, infertility type, infertility diagnosis, among other factors. Detailed heterogeneity assessment will be performed, and potential sources of between-study heterogeneity will be explored using meta-regression. Review will be conducted from 26 March 2018 to 28 July 2019.

Ethics and dissemination: An institutional review board clearance is not required as all data are publicly available. The findings will be disseminated through a peer-reviewed publication and international scientific meetings/workshops with key stakeholders.

Prospero registration number: CRD42018102934.

Keywords: Neisseria gonorrhoeae; Gonorrhea; epidemiology; infertility; prevalence; sexually transmitted infections.