The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe potential for an expanded HIV epidemic in Papua New Guinea (PNG) demands an effective, evidence-based and locally-appropriate national response. As sexually transmitted infections (STIs) may be important co-factors in HIV transmission nationally, it is timely to conduct a systematic review of STI prevalences to inform national policy on sexual health and HIV/STI prevention.Methodology/Principal FindingsWe undertook a systematic review and meta-analysis of HIV and STI prevalences in PNG, reported in peer-reviewed and non-peer-reviewed publications for the period 1950–2010. Prevalence estimates were stratified by study site (community or clinic-based), geographic area and socio-demographic characteristics. The search strategy identified 105 reports, of which 25 studies (10 community-based; 10 clinic-based; and 5 among self-identified female sex workers) reported STI prevalences and were included in the systematic review. High prevalences of chlamydia, gonorrhoea, syphilis and trichomonas were reported in all settings, particularly among female sex workers, where pooled estimates of 26.1%, 33.6%, 33.1% and 39.3% respectively were observed. Pooled HIV prevalence in community-based studies was 1.8% (95% CI:1.2–2.4) in men; 2.6% (95% CI:1.7–3.5) in women; and 11.8% (95% CI:5.8–17.7) among female sex workers.Conclusions/SignificanceThe epidemiology of STIs and HIV in PNG shows considerable heterogeneity by geographical setting and sexual risk group. Prevalences from community-based studies in PNG were higher than in many other countries in the Asia-Pacific. A renewed focus on national STI/HIV surveillance priorities and systems for routine and periodic data collection will be essential to building effective culturally-relevant behavioural and biomedical STI/HIV prevention programs in PNG.

High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea

“…The prevalence of chlamydia, gonorrhoea and T. vaginalis observed at baseline is comparable to earlier clinic-based cross-sectional studies in PNG, summarised in a recent systematic review and metaanalysis conducted by our group. 11 Our study is the first to estimate the incidence of HIV, HSV-2 and other STIs in any population in PNG, and provides estimates that are among the first of any Asia-Pacific country.…”

HIV prevention: Making male circumcision the ‘right’ tool for the job

“…However, on the basis of the RCTs and the Cochrane review, researchers are now raising the possibility of incorporating male circumcision into HIV prevention initiatives in regions such as Papua New Guinea (Hill et al, 2012;Kelly et al, 2012), the Dominican Republic (Brito, Caso, Balbuena, & Bailey, 2009), the Caribbean (Duncan, 2010) and Thailand (Tieu et al, 2010). Although the rise of EBM enabled the 'male circumcision effect' to be taken as given, can we assume that the operation would have the same effect globally?…”

Prevalence and risk factors forChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginalisinfection in pregnant women in Papua New Guinea

“…Chlamydia, gonorrhoea and trichomonas infection have been found to be highly prevalent among women and men in a variety of different subpopulations within Papua New Guinea (PNG),5 6 but despite the known risks to the mother and baby, relatively little is known about the prevalence and risk factors associated with infection in pregnant women 5. In previous studies among rural women in PNG's Eastern Highlands Province, prevalences of asymptomatic infection with T. vaginalis , C. trachomatis and N. gonorrhoeae were 43%, 27% and 18%, respectively,7 8 whereas in antenatal women in Port Moresby, the capital city of PNG, C. trachomatis and T. vaginalis were common ( C. trachomatis 18%, T. vaginalis 19%) 9 10.…”

“…Self-collected vaginal swabs have been previously identified as an acceptable sampling method and result in similar STI diagnostic performance to clinician-collected endocervical swabs or first-void urine 5 16…”