Background There is limited knowledge regarding the extent of the disease burden of syphilis in the Middle East and North Africa (MENA) region. The objective of this study was to provide, for the first time, a review of the prevalence of syphilis in the MENA region.
Methods A systematic review of all available data on syphilis prevalence in 23 countries in MENA was conducted following the PRISMA guidelines. Sources of data included PubMed and Embase databases which were searched with no restrictions on time or language. Identified records were screened for relevance and eligibility. All studies with a prevalence measure of syphilis were eligible for inclusion irrespective of study design.
Results The search yielded 383 records out of which 98 articles were found eligible for inclusion. Results were classified and analysed according to three defined population risk groups: High-risk, intermediate-risk, and general population (low risk). High-risk populations had the following prevalence levels: female sex workers (1% - 87%), men who have sex with men (4%–60%), male sex workers (4%–63%) and injecting drug users (1%–18%). Select intermediate risk groups had the following prevalence levels: STD clinic attendees (1%–33%), prisoners (0%–23%), and truck drivers (4%–7%). Select general population groups had the following prevalence levels: blood donors (0%–3%) and ANC attendees (0%–19%).
Conclusions The quality of studies and their designs varied and diagnostic methods were not always clear. High prevalence levels were identified among high-risk populations, and relatively high levels were also found among intermediate risk groups. Low prevalence levels however were documented among general population groups. Though the overall prevalence of syphilis in MENA may not be large, there is still significant burden of disease that needs to be addressed. Given the limitations in available data, further studies are needed to better characterise the infection trends.