Chemaitelly Hiam, Harfouche Manale, Smolak Alex, Ageeb Rwedah, Mohamoud Yousra A, Alaama Ahmed S, Hermez Joumana G, Abu-Raddad Laith J
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.
World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.
BMC Glob Public Health. 2024 Aug 19;2(1):56. doi: 10.1186/s44263-024-00088-9.
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.
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a systematic review, risk of bias assessment, meta-analyses, and meta-regressions, utilizing both published and unpublished evidence sourced from international, regional, and national databases, in adherence to PRISMA guidelines.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.
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.
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.
尽管全球已认识到淋病奈瑟菌（NG）感染的疾病负担，且对抗菌素耐药性的担忧日益增加，但中东和北非（MENA）地区NG感染的流行病学情况仍知之甚少。本研究旨在系统回顾MENA地区NG流行率的相关证据，估计不同人群的合并平均流行率，并探讨人群水平上与流行率的关联以及研究间异质性的来源。
本研究按照PRISMA指南，对来自国际、区域和国家数据库的已发表和未发表证据进行了系统回顾、偏倚风险评估、荟萃分析和元回归分析。采用随机效应荟萃分析和元回归分析对数据进行分析。
该研究确定了来自MENA地区21个国家的341项NG流行率测量值。普通人群中当前泌尿生殖系统感染的合并平均流行率为1.9%（95%置信区间（CI）1.1 - 2.8%），样本量<200的研究中合并流行率较高（3.1%；95% CI 1.5 - 5.0%），而样本量≥200的研究中为1.1%（95% CI 0.5 - 1.9%）。在特定人群中，女性性工作者的合并流行率为6.5%（95% CI 4.4 - 9.0%），不孕不育诊所就诊者为7.5%（95% CI 2.8 - 14.0%），有流产或异位妊娠史的女性为3.0%（95% CI 0.4 - 7.0%），有症状女性为3.9%（95% CI 2.7 - 5.3%），有症状男性为41.4%（95% CI 34.9 - 48.1%）。男性性工作者和男男性行为者中，当前泌尿生殖系统感染的合并流行率为1.6%（95% CI 0.4 - 3.4%），而当前肛门直肠感染的流行率为10.4%（95% CI 4.6 - 18.0%）。通过多变量元回归分析，64%的流行率差异得到了解释，揭示了按人群类型和性别划分的流行率分层模式，且流行率以每年1%的速度下降。
MENA地区的NG流行率与全球流行率相当，凸显了这一被忽视和未得到充分认识的疾病负担及其社会和经济后果。NG在重点人群和其他高危人群中的持续传播增加了新耐药菌株出现的可能性。MENA地区远未实现世界卫生组织到2030年将NG发病率降低90%的目标。
