Abstract
BackgroundThe World Health Organization (WHO) recommends periodic gonorrhoea prevalence assessments in the general population or proxies thereof (including pregnant women, women attending family planning clinics, military recruits, and men undergoing employment physicals for example) and in population groups at increased risk, including men-who-have-sex-with-men (MSM) and sex workers.MethodWe evaluated reported prevalence data, including estimates from proxy general population samples to reflect the WHO recommendations. We describe the outcomes from the general population country-by-country and extend previous reviews to include MSM, sex workers, and extragenital infections.Result and conclusionIn our systematic search, 2015 titles were reviewed (January 2010–April 2019) and 174 full-text publications were included. National, population-based prevalence data were identified in only four countries (the United States of America, the United Kingdom, Peru, New Caledonia) and local population-based estimates were reported in areas within five countries (China, South Africa, Brazil, Benin, and Malawi). The remaining studies identified only reported test positivity from non-probability, proxy general population samples. Due to the diversity of the reviewed studies, detailed comparison across studies was not possible. In MSM, data were identified from 64 studies in 25 countries. Rectal infection rates were generally higher than urogenital or pharyngeal infection rates, where extragenital testing was conducted. Data on sex workers were identified from 41 studies in 23 countries; rates in female sex workers were high. Current prevalence monitoring was shown to be highly suboptimal worldwide. Serial prevalence monitoring of critical epidemiological variables, and guidelines to optimize prevalence study conduct and reporting beyond antenatal settings are recommended.
Highlights
The World Health Organization (WHO) recommends periodic gonorrhoea prevalence assessments in the general population or proxies thereof and in population groups at increased risk, including men-who-have-sex-with-men (MSM) and sex workers
We aimed to evaluate global prevalence reporting in the general population, and proxies thereof, on a country-by-country basis, extending previous reviews to report on key population groups of MSM and female and male sex workers (FSW and Male sex workers (MSW)), including extragenital as well as urogenital infection
Prevalence reporting in the general population We identified 2015 citations relating to gonorrhoea ‘prevalence’ (Fig. 1), subsequently categorized into (a) the general population or proxy general population groups, Fig. 1 PRISMA diagram describing selection of citations reporting gonorrhoea prevalence
Summary
The World Health Organization (WHO) recommends periodic gonorrhoea prevalence assessments in the general population or proxies thereof (including pregnant women, women attending family planning clinics, military recruits, and men undergoing employment physicals for example) and in population groups at increased risk, including men-who-have-sex-with-men (MSM) and sex workers. Gonorrhoea affects the urogenital tract, oropharynx, rectum, or conjunctiva, and repeat infections are common. Urogenital infections are often asymptomatic, in women, but irrespective of symptoms, gonorrhoea is associated with substantial morbidity. Gonorrhoea can cause epididymitis [2]. Rectal and pharyngeal gonorrhoea cases, mostly asymptomatic, are Whelan et al BMC Infectious Diseases (2021) 21:1152 prevalent in men-who-have-sex-with-men (MSM), but can be common in women and, pharyngeal infection, in men who have sex only with women [4]. The presence of gonorrhoea is a co-factor in human immunodeficiency virus (HIV) transmission [5]
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