Objective To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15–49 years, in 2016. Methods For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. Findings For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3–4.5); gonorrhoea 0.9% (95% UI: 0.7–1.1); trichomoniasis 5.3% (95% UI:4.0–7.2); and syphilis 0.5% (95% UI: 0.4–0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9–3.7); gonorrhoea 0.7% (95% UI: 0.5–1.1); trichomoniasis 0.6% (95% UI: 0.4–0.9); and syphilis 0.5% (95% UI: 0.4–0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1–165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6–123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4–231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5–7.1 million) syphilis cases. Conclusion Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016–202 1.

With HIV prevalence levels up to 30%, fishermen as a group have a comparable prevalence to at-risk populations such as female sex workers (FSWs), truck drivers, military personnel, and prisoners. This study examines sexual risk behavior among fishermen, primarily in Africa and Asia. A meta-analysis embedded within a systematic review is utilized for this study. This study included 44 peer-reviewed articles and gray literature from 1992 to 2012. The study found that 42% of fishermen engaged in transactional sex, 48% of whom reported not using a condom with FSWs. Ninety percent of the fishermen reported having partners outside of their regular partner, but only 7% reported using a condom with their regular partner. Mobility, peer norms, and alcohol were found to be contextual risks for HIV infection. The findings have important implications for HIV prevention, targeting fishermen, and their sexual networks. Prevention strategies are needed to address HIV risk among this population.

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Syphilis prevalence has been declining in every region by several percentage points per year. Nevertheless, the prevalence by region continued to vary, from as little as 0.1% in the European Region to as high as 3% in the African Region.

Background The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of betweenstudy heterogeneity were determined using meta-regression. Findings We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3•0% (95% CI 2•3-3•8) in general populations, 2•8% (1•0-5•2) in intermediate-risk populations, 13•2% (7•2-20•7) in female sex workers, 11•3% (9•0-13•7) in infertility clinic attendees, 12•4% (7•9-17•7) in women with miscarriage, 12•4% (9•4-15•7) in symptomatic women, and 17•4% (12•5-22•8) in symptomatic men. Pooled prevalence of current rectal infection was 7•7% (4•2-12•0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29•0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region.