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Vaezzadeh K, Sepidarkish M, Mollalo A, As'adi N, Rouholamin S, Rezaeinejad M, Mojtahedi MF, Hosseini SMM, Taheri M, Mahjour S, Mohammadi M, Chemaitelly H, Rostami A. Global prevalence of Neisseria gonorrhoeae infection in pregnant women: a systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:22-31. [PMID: 35998807 DOI: 10.1016/j.cmi.2022.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neisseria gonorrhoeae infection (gonorrhoea) is associated with several pregnancy complications, including preterm labour, spontaneous abortion, stillbirth, miscarriage, growth retardation, and intrauterine death. OBJECTIVES We performed a systematic review and meta-analysis to estimate the global and regional prevalence of gonorrhoea in pregnant women as a scientific basis for further studies. DATA SOURCES We systematically searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases from inception to 10 July 2022. STUDY ELIGIBILITY CRITERIA We included cross-sectional, cohort, and case-control studies that reported the prevalence of gonorrhoea in pregnant women. In addition, we included baseline data for randomized controlled trials. PARTICIPANTS Pregnant women who were tested for gonorrhoea. METHODS Pooled prevalence estimates at 95% CIs were calculated using a random-effects meta-analysis model. We stratified countries according to WHO-defined regions and socio-economic factors. Moreover, sub-group-, meta-regression, and sensitivity analyses were conducted to investigate the effects of pre-determined factors on prevalence estimates and heterogeneity. RESULTS We identified 235 studies (249 datasets) on 19 104 175 pregnant women from 71 countries. The worldwide pooled prevalence of gonorrhoea in pregnant women was estimated at 1.85% (95% CI 1.73-1.97%), with the highest rate in the African region (3.53%) (2.84-4.29%) and the lowest rate in the European region (0.52%) (0.27-0.84%). Overall, the prevalence estimates were high among low-income countries (3.03%), pregnant women with HIV (2.81%), and pregnant women <20 years old (8.06%). A significant decreasing trend in prevalence was observed over time (β = -0.0008, 95% CI -0.0012 to -0.0004, p 0.001). DISCUSSION Our findings indicate that a substantial number of pregnant women have been infected with gonorrhoea globally, which calls for immediate public health measures to reduce the potential risk of infection. The study highlights the inadequacy or lack of data for many countries, emphasizing the need to expand systematic data collection efforts at national and regional levels.
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Affiliation(s)
- Kosar Vaezzadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran.
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, Ohio, United States
| | - Nayereh As'adi
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farid Mojtahedi
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Mehdi Hosseini
- Department of Cellular and Molecular Biology, Faculty of Biological Science, Islamic Azad University, Tonekabon Branch, Iran
| | - Maryam Taheri
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Sanaz Mahjour
- Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Mohsen Mohammadi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar-Foundation-Education City, Cornell University, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Fu L, Sun Y, Han M, Wang B, Xiao F, Zhou Y, Gao Y, Fitzpatrick T, Yuan T, Li P, Zhan Y, Lu Y, Luo G, Duan J, Hong Z, Fairley CK, Zhang T, Zhao J, Zou H. Incidence Trends of Five Common Sexually Transmitted Infections Excluding HIV From 1990 to 2019 at the Global, Regional, and National Levels: Results From the Global Burden of Disease Study 2019. Front Med (Lausanne) 2022; 9:851635. [PMID: 35308518 PMCID: PMC8924524 DOI: 10.3389/fmed.2022.851635] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Sexually transmitted infections (STIs) are common worldwide and pose a challenge to public health. We conducted this study to assess the annual incidence of five common STIs, including syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes at the global, regional, and national levels. Materials and Methods We obtained detailed data on STIs excluding HIV from 1990 to 2019 from the Global Burden of Disease (GBD) 2019 database. Estimated annual percentage change (EAPC) was calculated to quantify trends in age-standardized incidence rates (ASR) of STIs, stratified by gender, sociodemographic index (SDI) region, and pathogenic microorganism. Results Globally, incident cases of STIs increased by 58.15% from 486.77 million in 1990 to 769.85 million in 2019, but the annual change in ASR was only -0.04% (95% CI -0.09 to 0.01) per year. EAPC was 0.16 (0.06 to 0.26) for syphilis, 0.09 (0.05 to 0.13) for genital herpes, 0.06 (0.03 to 0.09) for trichomoniasis, -0.21 (-0.36 to -0.06) for chlamydia, and -0.14 (-0.19 to -0.08) for gonorrhea. High SDI regions reported significant increases in ASR of syphilis and chlamydia. Conclusions The burden of disease from STIs remains large, though control of STIs has contributed to the decreasing incidence in most regions, especially in the low-SDI regions. Globally, over the past 20 years, the ASR has remained stable for trichomoniasis and genital herpes decreased for chlamydia and gonorrhea, and increased for syphilis.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Min Han
- Department of Medical Administration, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Fei Xiao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yiguo Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peiyang Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yong Lu
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Junyi Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongsi Hong
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jin Zhao
- Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Chen X, Gan Y, Chang D, Mi X, Liu D. Availability of Chlamydia trachomatis Testing and Its Importance in the Surveillance of Genital Chlamydial Infection. Jpn J Infect Dis 2020; 74:209-213. [PMID: 33132299 DOI: 10.7883/yoken.jjid.2020.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reported prevalence of genital Chlamydia trachomatis infection (GCTI) is much lower in low-income countries than that in high-income countries. This study surveyed the prevalence of GCTI in 456 hospitals in Shandong province, China in December 2018. Among the hospitals surveyed, antigen testing, PCR testing, and either antigen or PCR testing were available in 200 (43.9%), 88 (19.3%), and 268 (58.8%) hospitals, respectively. PCR testing was more available in tertiary hospitals than in primary and secondary hospitals (χ2 = 28.560, P = 0.000). Significant differences were observed in the availability of antigen testing (χ2 = 15.708, P = 0.003), PCR testing (χ2 = 22.494, P = 0.000), and either antigen or PCR testing (χ2 = 21.729, P = 0.000) among different types of hospitals. In 2018, 1532 cases of GCTI were reported in 99 hospitals. Tertiary hospitals reported more cases than those in primary and secondary hospitals (χ2 = 24.082, P = 0.000). The distribution of different types of hospitals that reported GCTI cases was consistent with that of hospitals that provided laboratory testing for GCTI. Antigen and PCR testing were only available in 200 (43.9%) and 88 (19.3%) hospitals, respectively. The results highlighted that the availability of laboratory testing for GCTI in Shandong province was poor, suggesting that the prevalence of GCTI in the province had been sorely underestimated.
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Affiliation(s)
- Xinlong Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, China.,Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Yanling Gan
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Xiongfei Mi
- Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Dianchang Liu
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, China
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Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. Eur J Obstet Gynecol Reprod Biol 2020; 255:1-12. [PMID: 33059307 DOI: 10.1016/j.ejogrb.2020.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.
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Prevalence of syphilis, gonorrhoea and chlamydia in women in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa, 1995-2017: Spectrum-STI
model estimates. Western Pac Surveill Response J 2020; 11:29-40. [PMID: 32963889 PMCID: PMC7485516 DOI: 10.5365/wpsar.2019.10.2.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15-49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs). Methods The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995-2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas. Results Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sensitivity analyses. Discussion This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO's Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.
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Global Epidemiology of Sexually Transmitted Infections in the Twenty-First Century: Beyond the Numbers. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Guy Mahiane S, Pretorius C, Korenromp E. Second Order Segmented Polynomials for Syphilis and Gonorrhea Prevalence and Incidence Trends Estimation: Application to Spectrum's Guinea-Bissau and South Africa Data. Int J Biostat 2019; 15:ijb-2017-0073. [PMID: 31194678 DOI: 10.1515/ijb-2017-0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/10/2019] [Indexed: 11/15/2022]
Abstract
This paper presents two approaches to smoothing time trends in prevalence and estimating the underlying incidence of remissible infections. In the first approach, we use second order segmented polynomials to smooth a curve in a bounded domain. In the second, incidence is modeled instead and the prevalence is reconstructed using the recovery rate which is assumed to be known. In both approaches, the number of knots and their positions are estimated, resulting in non-linear regressions. Akaike Information Criterion is used for model selection. The method is illustrated with Syphilis and Gonorrhea prevalence smoothing and incidence trend estimation in Guinea-Bissau and South Africa, respectively.
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Affiliation(s)
- Severin Guy Mahiane
- Modeling Planning and Policy Analysis, Avenir Health, 655 Winding Brook Dr, Suite 4040, Glastonbury, CT 06033, USA
| | - Carel Pretorius
- Modeling Planning and Policy Analysis, Avenir Health, Glastonbury, CT, USA
| | - Eline Korenromp
- Modeling, Planning and Policy Analysis, Avenir Health, Geneva, Switzerland
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Kularatne RS, Niit R, Rowley J, Kufa-Chakezha T, Peters RPH, Taylor MM, Johnson LF, Korenromp EL. Adult gonorrhea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017. PLoS One 2018; 13:e0205863. [PMID: 30321236 PMCID: PMC6188893 DOI: 10.1371/journal.pone.0205863] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate trends in prevalence and incidence of syphilis, gonorrhea and chlamydia in adult men and women in South Africa. METHODS The Spectrum-STI tool estimated trends in prevalence and incidence of active syphilis, gonorrhea and chlamydia, fitting South African prevalence data. Results were used, alongside programmatic surveillance data, to estimate trends in incident gonorrhea cases resistant to first-line treatment, and the reporting gap of symptomatic male gonorrhea and chlamydia cases treated but not reported as cases of urethritis syndrome. RESULTS In 2017 adult (15-49 years) the estimated female and male prevalences for syphilis were 0.50% (95% CI: 0.32-0.80%) and 0.97% (0.19-2.28%), for gonorrhea 6.6% (3.8-10.8%) and 3.5% (1.7-6.1%), and for chlamydia 14.7% (9.9-21%) and 6.0% (3.8-10.4%), respectively. Between 1990 and 2017 the estimated prevalence of syphilis declined steadily in women and men, probably in part reflecting improved treatment coverage. For gonorrhea and chlamydia, estimated prevalence and incidence showed no consistent time trend in either women or men. Despite growing annual numbers of gonorrhea cases - reflecting population growth - the estimated number of first line treatment-resistant gonorrhea cases did not increase between 2008 and 2017, owing to changes in first-line antimicrobial treatment regimens for gonorrhea in 2008 and 2014/5. Case reporting completeness among treated male urethritis syndrome episodes was estimated at 10-28% in 2017. CONCLUSION South Africa continues to suffer a high STI burden. Improvements in access and quality of maternal, STI and HIV health care services likely contributed to the decline in syphilis prevalence. The lack of any decline in gonorrhea and chlamydia prevalence highlights the need to enhance STI services beyond clinic-based syndromic case management, to reinvigorate primary STI and HIV prevention and, especially for women, to screen for asymptomatic infections.
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Affiliation(s)
- Ranmini S. Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronelle Niit
- Health Information Systems Programme, Pretoria, South Africa
| | - Jane Rowley
- Independent consultant, London, United Kingdom
| | - Tendesayi Kufa-Chakezha
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Remco P. H. Peters
- Anova Health Institute, Johannesburg, South Africa
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Melanie M. Taylor
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
| | - Leigh F. Johnson
- University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa
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Korenromp EL, Ríos C, Apolinar ALS, Caicedo S, Cuellar D, Cárdenas I, Nuñez RL, Cuéllar NC, Ruíz M, Cruz A, Gaitan-Duarte H, Valderrama CD, Forero MIB, Taylor M, Rowley J, Gómez B, Alonso M. Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995-2016. Rev Panam Salud Publica 2018; 42:e118. [PMID: 31093146 PMCID: PMC6385794 DOI: 10.26633/rpsp.2018.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/06/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate adult (15-49 years old) prevalence and incidence of active syphilis, gonorrhea, and chlamydia, and incidence of congenital syphilis (CS) and adverse birth outcomes (ABOs) in Colombia, over 1995-2016. METHODS The Spectrum-STI epidemiological model tool estimated gonorrhea and chlamydia prevalences as moving averages across prevalences observed in representative general population surveys. For adult syphilis, Spectrum-STI applied segmented polynomial regression through prevalence data from antenatal care (ANC) surveys, routine ANC-based screening, and general population surveys. CS cases and ABOs were estimated from Spectrum's maternal syphilis estimates and proportions of women screened and treated for syphilis, applying World Health Organization case definitions and risk probabilities. RESULTS The Spectrum model estimated prevalences in 2016 of 0.70% (95% confidence interval (CI): 0.15%-1.9%) in women and 0.60% (0.1%-1.9%) in men for gonorrhea and of 9.2% (4.4%-15.4%) in women and 7.4% (3.5%-14.7%) in men for chlamydia, without evidence for trends over 1995-2016. The prevalence of active syphilis in 2016 was 1.25% (1.22-1.29%) in women and 1.25% (1.1%-1.4%) in men, decreasing from 2.6% (2.1%-3.2%) in women in 1995. Corresponding CS cases in 2016 (including cases without clinical symptoms) totaled 3 851, of which 2 245 were ABOs. Annual CS and ABO estimates decreased over 2008-2016, reflecting decreasing maternal prevalence and increasing cases averted through ANC-based screening and treatment. CONCLUSIONS The available surveillance and monitoring data synthesized in Spectrum-STI- and the resulting first-ever national STI estimates for Colombia-highlighted Colombia's persistently high STI burden. Adult syphilis and congenital syphilis are estimated to be falling, reflecting improving screening efforts. Strengthened surveillance, including with periodic screening in low-risk populations and future refined Spectrum estimations, should support planning and implementation of STI prevention and control, including CS elimination.
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Affiliation(s)
| | - Cielo Ríos
- Ministry of Health and Social Protection, Bogotá, Bogotá, Colombia
| | | | - Sidia Caicedo
- Ministry of Health and Social Protection, Bogotá, Bogotá, Colombia
| | - Diego Cuellar
- Ministry of Health and Social Protection, Bogotá, Bogotá, Colombia
| | - Iván Cárdenas
- Ministry of Health and Social Protection, Bogotá, Bogotá, Colombia
| | | | | | - Martha Ruíz
- Ministry of Health and Social Protection, Bogotá, Bogotá, Colombia
| | - Adriana Cruz
- International Training Center and Medical Research, Cali, Colombia
| | | | | | | | - Melanie Taylor
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - Jane Rowley
- Independent consultant, London, London, United Kingdom
| | - Bertha Gómez
- Pan American Health Organization, Bogotá, Bogotá, Colombia
| | - Mónica Alonso
- Pan American Health Organization, Washington D.C., United States of America
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Korenromp EL, Mahiané SG, Nagelkerke N, Taylor MM, Williams R, Chico RM, Pretorius C, Abu-Raddad LJ, Rowley J. Syphilis prevalence trends in adult women in 132 countries - estimations using the Spectrum Sexually Transmitted Infections model. Sci Rep 2018; 8:11503. [PMID: 30065272 PMCID: PMC6068092 DOI: 10.1038/s41598-018-29805-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/17/2018] [Indexed: 11/09/2022] Open
Abstract
We estimated national-level trends in the prevalence of probable active syphilis in adult women using the Spectrum Sexually Transmitted Infections (STI) model to inform program planning, target-setting, and progress evaluation in STI control. The model fitted smoothed-splines polynomial regressions to data from antenatal clinic surveys and screening and representative household surveys, adjusted for diagnostic test performance and weighted by national coverage. Eligible countries had ≥1 data point from 2010 or later and ≥3 from 2000 or later from adult populations considered representative of the general female population (pregnant women or community-based studies). Between 2012 and 2016, the prevalence of probable active syphilis in women decreased in 54 (41%) of 132 eligible countries; this decrease was substantive (≥10% proportionally, ≥0.10% percentage-point absolute difference and non-overlapping 95% confidence intervals in 2012 and 2016) in 5 countries. Restricting eligible data to prevalence measurements of dual treponemal and non-treponemal testing limited estimates to 85 countries; of these, 45 countries (53%) showed a decrease. These standardized trend estimates highlight the need for increased investment in national syphilis surveillance and control efforts if the World Health Organization target of a 90% reduction in the incidence of syphilis between 2018 and 2030 is to be met.
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Affiliation(s)
| | | | | | - Melanie M Taylor
- World Health Organization, Dept. of Reproductive Health and Research, Geneva, Switzerland
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, USA
| | - Rebecca Williams
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - R Matthew Chico
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Enkhbat E, Korenromp EL, Badrakh J, Zayasaikhan S, Baya P, Orgiokhuu E, Jadambaa N, Munkhbaatar S, Khishigjargal D, Khad N, Mahiané G, Ishikawa N, Jagdagsuren D, Taylor MM. Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000-2016: Estimates using the Spectrum STI tool. Infect Dis Model 2018; 3:13-22. [PMID: 30839908 PMCID: PMC6326223 DOI: 10.1016/j.idm.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Mongolia's health ministry prioritizes control of Sexually Transmitted Infections, including syphilis screening and treatment in antenatal care (ANC). METHODS Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool, using data from ANC surveys and routine screening over 1997-2016. Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis (CS) and CS-attributable adverse birth outcomes (ABO), which we compared with CS case reports. RESULTS Syphilis prevalence in pregnant women was estimated at 1.7% in 2000 and 3.0% in 2016. We estimated 652 CS cases, of which 410 ABO, in 2016. Far larger, annually increasing numbers of CS cases and ABO were estimated to have been prevented: 1654 cases, of which 789 ABO in 2016 - thanks to increasing coverages of ANC (99% in 2016), ANC-based screening (97% in 2016) and treatment of women diagnosed (81% in 2016). The 42 CS cases reported nationally over 2016 (liveborn infants only) represented 27% of liveborn infants with clinical CS, but only 7% of estimated CS cases among women found syphilis-infected in ANC, and 6% of all estimated CS cases including those born to women with undiagnosed syphilis. DISCUSSION/CONCLUSION Mongolia's ANC-based syphilis screening program is reducing CS, but maternal prevalence remains high. To eliminate CS (target: <50 cases per 100,000 live births), Mongolia should strengthen ANC services, limiting losses during referral for treatment, and under-diagnosis of CS including still-births and neonatal deaths, and expand syphilis screening and prevention programs.
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Key Words
- ABO, Adverse Birth Outcome
- ANC, antenatal care
- ANC-1, attendance of antenatal care at least once during a pregnancy
- Antenatal care
- CI, confidence interval
- CS, Congenital Syphilis
- Congenital syphilis
- Epidemiological modelling
- F, women
- N, sample size tested
- NCCD, Mongolia National Center for Communicable Diseases
- RPR, Rapid Plasma Reagin test
- STI, sexually transmitted infection
- Screening
- Surveillance
- Syphilis
- TP, Treponema pallidum
- WHO, World Health Organization
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Affiliation(s)
- Erdenetungalag Enkhbat
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Eline L. Korenromp
- Avenir Health, Geneva, Switzerland, 1 route de Morillons / 150 Route de Ferney (WCC, Office 164), PO Box 2100, CH-1211 Geneva 2, Switzerland
| | - Jugderjav Badrakh
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Setsen Zayasaikhan
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Purevsuren Baya
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Enkhjargal Orgiokhuu
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | | | - Sergelen Munkhbaatar
- Mongolia Global Fund Supported Project on AIDS and TB, Peace Avenue 13/3, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Delgermaa Khishigjargal
- Mongolia Center for Health Development, Enkhtaivan Street - 13b, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Narantuya Khad
- Mongolia Center for Health Development, Enkhtaivan Street - 13b, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Guy Mahiané
- Avenir Health, 655 Winding Brook Drive, Glastonbury, CT, CT-06033, USA
| | - Naoko Ishikawa
- World Health Organization, Western Pacific Regional Office, PO Box 2932 (United Nations Avenue), 1000 Manila, Philippines
| | - Davaalkham Jagdagsuren
- Mongolia National Centre for Communicable Disease, AIDS/STI Surveillance and Research Department, Ulaanbaatar, 210648, Bayanzurkh District, Nam-Yan-Ju Street, Mongolia
| | - Melanie M. Taylor
- World Health Organization, Department of Reproductive Health and Research, 8 Avenue Appia (L152), 1211 Geneva, Switzerland
- Centers for Disease Control and Prevention, Atlanta GA, USA
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