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. 2024 Apr 12:15:1390001.
doi: 10.3389/fmicb.2024.1390001. eCollection 2024.

Neisseria gonorrhea in Ethiopia, prevalence among STI suspected patients and its antimicrobial susceptibility: a systematic review and meta-analysis

Mengistie Yirsaw Gobezie  1 , Nuhamin Alemayehu Tesfaye  1 , Tewodros Solomon  1 , Mulat Belete Demessie  1 , Tesfaye Dessale Kassa  2 , Teklehaimanot Fentie Wendie  1 , Ermiyas Alemayehu  3 , Minimize Hassen  1
Affiliations

Neisseria gonorrhea in Ethiopia, prevalence among STI suspected patients and its antimicrobial susceptibility: a systematic review and meta-analysis

Mengistie Yirsaw Gobezie et al. Front Microbiol. .

Abstract

Introduction: Neisseria gonorrhea (N. gonorrhea) represents a significant causative agent of sexually transmitted infections (STIs), posing considerable global health challenges. Despite the presence of diagnostic tools and empirically guided therapies, the escalating AMR of N. gonorrhea continues to pose a threat. This study aims to assess the prevalence of N. gonorrhea among STI suspected patients in Ethiopia and explore the patterns of AMR to common antimicrobials.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis. A thorough search of electronic databases from July 11 to July 24, 2023, identified 10 eligible studies. Data were extracted and analyzed using a random-effects model. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated through Egger's regression test and funnel plots.

Results: The overall pooled prevalence of N. gonorrhea among STI suspected patients in Ethiopia was 20% (95% confidence interval (CI): 8-30, I2 = 99.0%; p-value <0.001). Substantial regional variations were observed, with the highest prevalence in Addis Ababa (55, 95% CI: 45-65) and the lowest in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) (4, 95% CI: 2-8). The pooled prevalence of AMR to ciprofloxacin, ceftriaxone, azithromycin, benzylpenicillin, tetracycline, and spectinomycin was 37, 9, 10, 79, 93, and 2%, respectively. Significant heterogeneity existed between studies (I2 = 99.0%; p value <0.001). Publication bias, identified through funnel plot examination and Egger's regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (6.2, 95% CI: -6.8 to 19.3).

Conclusion: The prevalence of N. gonorrhea among STI suspected patients in Ethiopia is alarming, particularly in specific regions. The elevated AMR to ciprofloxacin underscores the immediate need for alternative treatment options and enhanced surveillance systems. Future initiatives should prioritize strengthening laboratory capacities and implementing targeted interventions to curtail N. gonorrhea transmission and prevent the emergence of AMR.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42023459698.

Keywords: Ethiopia; Neisseria gonorrhea; antimicrobial susceptibility; meta-analysis; prevalence; sexually transmitted infections; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the included studies for the systematic review and meta-analysis of the prevalence of Neisseria gonorrhea among STI suspected patients in Ethiopia.
Figure 2
Figure 2
Pooled estimate of the prevalence of N. gonorrhea among STI suspected patients in Ethiopia.
Figure 3
Figure 3
Subgroup analysis of the prevalence of N. gonorrhea by regions.
Figure 4
Figure 4
Subgroup analysis of the prevalence of N. gonorrhea by study periods.
Figure 5
Figure 5
Meta regression of the prevalence of N. gonorrhea and sample size.
Figure 6
Figure 6
Funnel plot of prevalence N. gonorrhea among STI suspected patients in Ethiopia.
Figure 7
Figure 7
Antimicrobial resistance pattern of N. gonorrhea over the study periods in Ethiopia.
See this image and copyright information in PMC

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