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Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression

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 Repor...

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Autores principales: Chemaitelly, Hiam, Majed, Alzahraa, Abu-Hijleh, Farah, Blondeel, Karel, Matsaseng, Thabo Christopher, Kiarie, James, Toskin, Igor, Abu-Raddad, Laith J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892374/
https://www.ncbi.nlm.nih.gov/pubmed/32423944
http://dx.doi.org/10.1136/sextrans-2020-054515
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author Chemaitelly, Hiam
Majed, Alzahraa
Abu-Hijleh, Farah
Blondeel, Karel
Matsaseng, Thabo Christopher
Kiarie, James
Toskin, Igor
Abu-Raddad, Laith J
author_facet Chemaitelly, Hiam
Majed, Alzahraa
Abu-Hijleh, Farah
Blondeel, Karel
Matsaseng, Thabo Christopher
Kiarie, James
Toskin, Igor
Abu-Raddad, Laith J
author_sort Chemaitelly, Hiam
collection PubMed
description 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.
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spelling pubmed-78923742021-03-03 Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression Chemaitelly, Hiam Majed, Alzahraa Abu-Hijleh, Farah Blondeel, Karel Matsaseng, Thabo Christopher Kiarie, James Toskin, Igor Abu-Raddad, Laith J Sex Transm Infect Epidemiology 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. BMJ Publishing Group 2021-03 2020-05-18 /pmc/articles/PMC7892374/ /pubmed/32423944 http://dx.doi.org/10.1136/sextrans-2020-054515 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Epidemiology
Chemaitelly, Hiam
Majed, Alzahraa
Abu-Hijleh, Farah
Blondeel, Karel
Matsaseng, Thabo Christopher
Kiarie, James
Toskin, Igor
Abu-Raddad, Laith J
Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
title Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
title_full Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
title_fullStr Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
title_full_unstemmed Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
title_short Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
title_sort global epidemiology of neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892374/
https://www.ncbi.nlm.nih.gov/pubmed/32423944
http://dx.doi.org/10.1136/sextrans-2020-054515
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