Epidemiology of Neisseria gonorrhoeae in South-East Asia: Systematic review, meta-analyses, and meta-regressions

Abstract

ObjectivesThe epidemiology of Neisseria gonorrhoeae (NG) infection in South-East Asia remains inadequately understood. This study aimed to systematically review and analyze the available evidence on NG prevalence to provide an understanding of the epidemiology in this region, highlighting prevalence patterns, key populations at risk, and factors influencing transmission. MethodsA systematic review of the literature up to September 3, 2024, was conducted, with findings reported in accordance with PRISMA guidelines. Random-effects meta-analyses were performed to estimate the pooled mean prevalence, while meta-regression analyses were conducted to explore associations, assess time trends, and identify sources of heterogeneity across studies. ResultsThe review identified 474 relevant publications, encompassing 885 overall and 1136 stratified NG prevalence measures. The pooled mean prevalence of urogenital infection was 0.5% (95% CI: 0.3–0.8%) in general populations, 13.9% (95% CI: 11.9–16.1%) among female sex workers, 16.8% (95% CI: 12.6–21.5%) among sexually transmitted infection clinic attendees, 4.6% (95% CI: 2.9–6.5%) in symptomatic women, and 38.5% (95% CI: 31.8–45.3%) in symptomatic men. Among men who have sex with men, transgender people, and male and transgender sex workers, the pooled mean prevalence was 0.9% (95% CI: 0.4–1.5%) for urogenital infection, 12.0% (95% CI: 8.8–15.7%) for anorectal infection, and 7.1% (95% CI: 4.0–10.9%) for oropharyngeal infection. Multivariable meta-regression analyses explained over 55% of the variation in prevalence, revealing a hierarchical pattern by population type, higher prevalence among men, and a decline in prevalence of 2% per calendar year over the past four decades. ConclusionsNG prevalence in South-East Asia is comparable to the global prevalence. The markedly high prevalence among key populations, coupled with Asia’s substantial burden of gonococcal antimicrobial resistance, underscores the urgent need for targeted interventions focused on these vulnerable groups.