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. 2024 Aug 19;2(1):56.
doi: 10.1186/s44263-024-00088-9.

Epidemiology of gonorrhea in countries of the Middle East and North Africa: systematic review, meta analyses, and meta regressions

Hiam Chemaitelly #  1   2   3 , Manale Harfouche #  1   2 , Alex Smolak  1 , Rwedah Ageeb  1   2 , Yousra A Mohamoud  1 , Ahmed S Alaama  4 , Joumana G Hermez  4 , Laith J Abu-Raddad  5   6   7   8   9
Affiliations

Epidemiology of gonorrhea in countries of the Middle East and North Africa: systematic review, meta analyses, and meta regressions

Hiam Chemaitelly et al. BMC Glob Public Health. .

Abstract

Background: The epidemiology of Neisseria gonorrhoeae (NG) infection in the Middle East and North Africa (MENA) region remains poorly understood, despite the global recognition of its disease burden and the growing concern regarding antimicrobial resistance. This study aimed to systematically review the evidence on NG prevalence in MENA, estimate the pooled mean prevalence across different populations, and explore population-level associations with prevalence as well as sources of between-study heterogeneity.

Methods: The study conducted a systematic review, risk of bias assessment, meta-analyses, and meta-regressions, utilizing both published and unpublished evidence sourced from international, regional, and national databases, in adherence to PRISMA guidelines. Random-effects meta-analyses and meta-regressions were employed to analyze the data.

Results: The study identified 341 NG prevalence measures from 21 countries in MENA. The pooled mean prevalence of current urogenital infection was 1.9% (95% confidence interval (CI) 1.1-2.8%) in the general population, with a higher pooled prevalence in studies with sample sizes < 200 (3.1%; 95% CI 1.5-5.0%) compared to those with sample sizes ≥ 200 (1.1%; 95% CI 0.5-1.9%). Among specific populations, the pooled prevalence was 6.5% (95% CI 4.4-9.0%) in female sex workers, 7.5% (95% CI 2.8-14.0%) in attendees of infertility clinics, 3.0% (95% CI 0.4-7.0%) in women with miscarriage or ectopic pregnancy, 3.9% (95% CI 2.7-5.3%) in symptomatic women, and 41.4% (95% CI 34.9-48.1%) in symptomatic men. For male sex workers and men who have sex with men, the pooled prevalence of current urogenital infection was 1.6% (95% CI 0.4-3.4%), while the prevalence of current anorectal infection was 10.4% (95% CI 4.6-18.0%). Through multivariable meta-regressions, 64% of the prevalence variation was explained, revealing a hierarchical pattern in prevalence by population type and sex, and a prevalence decline at a rate of 1% per year.

Conclusions: NG prevalence in MENA is comparable to the global prevalence, underscoring a neglected and underrecognized disease burden, with social and economic consequences. Persistent transmission of NG among key populations and other populations at risk increases the potential for the emergence of new drug-resistant strains. MENA is far from achieving the World Health Organization's target of reducing NG incidence by 90% by 2030.

Keywords: Neisseria gonorrhoeae; Gonorrhea; Infertility; Middle East and North Africa; Prevalence; Sexually transmitted infection.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study selection flowchart for assessing Neisseria gonorrhoeae prevalence in the Middle East and North Africa, compliant with PRISMA guidelines Abbreviations: AIDS Acquired immunodeficiency syndrome, HIV Human immunodeficiency virus, MENA Middle East and North Africa, PRISMA Preferred Reporting Items for Systematic Reviews and Meta-analyses aThe publication reporting this measure has insufficient clarity in its methods, making it difficult to determine the accuracy of the reported prevalence
Fig. 2
Fig. 2
Forest plot of pooled mean prevalence of Neisseria gonorrhoeae in urogenital specimens among general populations in the Middle East and North Africa Abbreviations: NAAT Nucleic acid amplification test, PCR Polymerase chain reaction
See this image and copyright information in PMC

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