Manara - Qatar Research Repository
2 files

Epidemiology of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics

journal contribution
submitted on 2024-05-27, 11:25 and posted on 2024-06-06, 07:06 authored by Hiam Chemaitelly, Helen A Weiss, Alex Smolak, Elzahraa Majed, Laith J Abu-Raddad


The epidemiology of sexually transmitted infections (STIs) and the role of commercial heterosexual sex networks in driving STI transmission in the Middle East and North Africa (MENA) region remain largely unknown.


To characterize the epidemiology of Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Herpes simplex virus type 2 (HSV-2) among female sex workers (FSWs) in MENA using an indepth quantitative assessment.


A systematic review on ten international, regional, and country-level databases was conducted, and reported following PRISMA guidelines. Pooled prevalences of current and/or ever infection for each STI were estimated using random-effects meta-analyses. Sources of between-study heterogeneity were investigated through random-effects meta-regressions.


One T. pallidum incidence study and 144 STI prevalence studies were identified for 45812 FSWs in 13 MENA countries. The pooled prevalence of current infection was 12.7% (95% confidence interval (CI)=8.5%-17.7%) for T. pallidum, 14.4% (95% CI=8.2%-22.0%) for C. trachomatis, 5.7% (95% CI=3.5%- 8.4%) for N. gonorrhoeae, and 7.1% (95% CI=4.3%-10.5%) for T. vaginalis. The pooled prevalence of ever infection (seropositivity using antibody testing) was 12.8% (95% CI=9.4%-16.6%) for T. pallidum, 80.3% (95% CI=53.2%-97.6%) for C. trachomatis, and 23.7% (95% CI=10.2%-40.4%) for HSV-2. The multivariable meta-regression for T. pallidum infection demonstrated strong subregional differences, with the Horn of Africa and North Africa showing, respectively 6-fold (adjusted odds ratio (AOR): 6.4; 95% CI=2.5-16.7) and 5-fold (AOR=5.0; 95% CI=2.5-10.6) higher odds of infection than Eastern MENA. There was also strong evidence for declining T. pallidum odds of infection at 7% per year (AOR=0.93; 95% CI=0.88-0.98). Study-specific factors including diagnostic method, sample size, sampling methodology, and response rate, were not associated with syphilis infection. The multivariable model explained 48.5% of the variation in T. pallidum prevalence.


STI infection levels among FSWs in MENA are considerable, supporting a key role for commercial heterosexual sex networks in transmission dynamics, and highlighting the health needs of this neglected and vulnerable population. Syphilis prevalence in FSWs appears to have been declining for at least three decades. Gaps in evidence persist for multiple countries.

Other Information

Published in: Journal of Global Health
See article on publisher's website:


Open Access funding provided by the Qatar National Library.



  • English


International Global Health Society

Publication Year

  • 2019

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Hamad Bin Khalifa University
  • College of Health and Life Sciences - HBKU
  • Weill Cornell Medicine - Qatar