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Global epidemiology of Neisseria gonorrhoeae in infertile populations: protocol for a systematic review
  1. Hiam Chemaitelly1,
  2. Manale Harfouche1,
  3. Karel Blondeel2,3,
  4. Thabo Christopher Matsaseng2,
  5. James Kiarie2,
  6. Igor Toskin2,
  7. Laith J Abu-Raddad1,4,5
  1. 1 Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
  2. 2 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  3. 3 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  4. 4 Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City, New York, USA
  5. 5 College of Health and Life Sciences, Hamadbin Khalifa University, Doha, Qatar
  1. Correspondence to Dr Laith J Abu-Raddad; lja2002{at}


Introduction A key target of the WHO’s ‘Global Health Sector Strategy on sexually transmitted infections, 2016–2021’ is achieving 90% reduction in Neisseria gonorrhoeae (gonorrhoea for short) incidence globally by 2030. Though untreated, gonorrhoea has been linked to infertility, the epidemiology of this infection in infertile populations remains poorly understood and somewhat a neglected area of reproductive health. Our proposed systematic review aims to fill this gap by characterising comprehensively gonorrhoea infection in infertile populations globally.

Methods and analysis All available studies of gonorrhoea infection in infertile populations, including infertility clinic attendees, will be systematically reviewed informed by Cochrane Collaboration guidelines. Findings will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources will be searched using broad index terms exploded to cover all subheadings and free text terms with no language or year restriction. Any epidemiological measure in infertile populations based on primary data will be eligible for inclusion. Measures based on different assay types will be extracted as separate studies for different analyses. Only one biospecimen type per assay type will be considered based on a predefined priority order. Samples including fewer than 10 participants or assessing infection in the upper genital tract will be excluded. Quality assessments will be conducted for all measures included in the review. Meta-analyses will be implemented using DerSimonian-Laird random effect models to estimate the mean prevalence of gonorrhoea in infertile populations globally, and stratified by WHO region, assay type, sex, infertility type, infertility diagnosis, among other factors. Detailed heterogeneity assessment will be performed, and potential sources of between-study heterogeneity will be explored using meta-regression. Review will be conducted from 26 March 2018 to 28 July 2019.

Ethics and dissemination An institutional review board clearance is not required as all data are publicly available. The findings will be disseminated through a peer-reviewed publication and international scientific meetings/workshops with key stakeholders.

PROSPERO registration number CRD42018102934

  • Gonorrhea
  • Neisseria gonorrhoeae
  • infertility
  • sexually transmitted infections
  • epidemiology
  • prevalence

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  • Contributors The proposed study was conceived by LJA-R and designed by HC and LJA-R. HC developed the search strategy with input from LJA-R, IT, KB, JK and TCM. Literature searches and duplicate screening was conducted by HC. Strategies for the conduct of data screening, data extraction, quality risk assessment, data synthesis and statistical analyses were developed by HC and LJA-R. HC wrote the first draft of this protocol and of the PROSPERO registration form. All authors contributed to discussion of the study process and to the writing of the manuscript. All authors have read and approved the final manuscript.

  • Funding This publication was made possible 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.

  • Disclaimer TCM, 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.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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