Objective To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations.
Methods A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains.
Findings A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%–7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99).
Conclusions Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission.
PROSPERO registration number CRD42018102934.
- Neisseria gonorrhoeae
- epidemiology (general)
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Contributors HC contributed to the study design, conducted the systematic searches of the literature, selected studies for inclusion, performed data extraction and data analyses, and wrote the first draft of the paper. AM contributed to title and abstract screening, full-text screening and data extraction. FAH double extracted the data. IT and LJA conceived and led the design of the study. LJA led the data extraction, analyses and drafting of the article. KB, JK, and TCM contributed to the study design. All authors contributed to the discussion and interpretation of the results and to the writing of the article, and have read and approved the final manuscript.
Funding This work was supported by funding from the WHO. This work was also funded by the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a cosponsored programme executed by the WHO. JK and IT are staff members of the WHO. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the views, decisions or policies of the WHO.
Disclaimer The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the WHO.
Competing interests The authors have no conflicts of interests to declare.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data are available as part of the manuscript and its supplementary material.
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