New meta-analysis highlights continued lack of STI resources in the MENA area

One of the best tools for fighting infections is testing. It allows healthcare providers to see pathogens as they enter our bodies. Trying to treat and manage an infection without testing is like entering a boxing ring with a blindfold on. You can do it, but you’re unlikely to fare very well.

A new meta-analysis has been released in BMC Infectious Diseases about the state of STI prevalence in the Middle East and North Africa region (MENA). Researchers analysed 23 MENA countries, 19 different STIS, and data from over 20 million participants.

The meta-analysis sheds light on the chronic issues the area has with testing provision and public health plans that effectively address these issues.

Keep reading to find out more about the state of play of sexually transmitted infections in the region.

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Chlamydia

Chlamydia is the most common bacterial STI in the world. The meta-analysis revealed that Chlamydia was the second-most reported infection at 11%.

Data reveal a concerning trend of Chlamydia infections in MENA, with a high crude prevalence observed in the clinical population (12%), followed by symptomatic (7%0), high risk (8%), and screening populations (5%).

Researchers showed that “[this] suggests that Chlamydia is frequently detected among individuals seeking medical care or exhibiting symptoms, underscoring the importance of comprehensive screening and early detection efforts.”

They also pointed to structural limitations in MENA healthcare systems as a contributing factor:

“Addressing potential barriers and biases in healthcare access and utilisation, as well as promoting gender-equitable sexual and reproductive health education, could be crucial for improving chlamydia control and reducing the burden of this infection across diverse populations.”

In order to effectively manage the spread of infections, researchers observed that:

“[Findings] from four randomised controlled trials of chlamydia screening interventions demonstrated that screening for asymptomatic genital chlamydia was significantly associated with a lower risk of pelvic inflammatory disease in young women.”

Since we are talking about an infection that is almost always silent in women, but can lead to infertility problems if left untreated, this is a major concern.

HPV

HPV is also a serious concern in the MENA region – less for the infection itself but for the complications the infections can cause.

HPV causes the vast majority of cervical cancers. However, a retrospective analysis of the Gulf Center for Cancer Control and Prevention registry between 1998-2012 found that:

“Most cases of cervical cancer in the GCC region were diagnosed at advanced stages. Indeed, the study found that nearly half of the patients presented with regional or distant metastasis, significantly reducing their chances of survival. Furthermore, the researchers reported that only 28% of patients in these countries sought medical care for early-stage cervical cancer[…]”

These findings underscore the urgent need to implement comprehensive cervical cancer screening programs, extended vaccination programs, and awareness campaigns in GCC countries.

Hepatitis B

The meta-analysis indicated that Hepatitis B (HBV) caused 10.9% of reported STIs in the MENA region, being responsible for an estimated 2,600,000 reported cases. This is a much larger proportion than in other parts of the world.

The analysis also highlighted how HBV varied across screening, clinical, and high-risk populations. The highest prevalence of HBV was observed in clinical groups (10%), much more than high-risk populations (3%) and screening populations (1%). Prevalence of HBV also varied significantly between countries, with some countries having a much higher prevalence than others. This is because the spread of HBV, although often sexually transmitted, can be due to poor living conditions and therefore affects socio-economic groups differently.

It was also observed that HBV was prevalent among patients with Hepatitis C and HIV/AIDS, highlighting the complex interplay between HBV and other comorbidities.

Mycoplasma and Ureaplasma

While most STI prevention strategies focus on infections like HIV, HPV, and Chlamydia, the prevalence of other genital pathogens was not well reported in the MENA region.

The researchers of the analysis highlight the prevalence of infections like Mycoplasma and Ureaplasma, which are especially concerning in light of increasing antimicrobial resistance.

Almost all cases of Mycoplasma hominis and Ureaplasma bacteria are harmless, and even when they appear on tests, they almost never require treatment, as the chance of these bacteria turning into an infection that causes damage is very low.

However, emerging evidence suggests that Mycoplasma genitalium may contribute to various reproductive health issues. Because of the emergence of antibiotic resistance and a continuous rise in resistance, the treatment option are limited, making treatment more challenging and expensive.

“These findings suggested a concerning trend of widespread AMR among Mycoplasma and Ureaplasma species, which is likely to persist and potentially worsen in the future. This can be attributed to various factors, including the high prevalence of these infections, the extensive and unregulated use of antimicrobials, the limited surveillance of AMR and clinical failures, and the exceptional ability of these bacteria to develop resistance.”

Again, researchers called for increased and sustained testing and detection strategies to ensure that these infections can be tracked and treated effectively.

HIV

The fight against HIV has seen remarkable progress thanks to the widespread use of antiretroviral therapy, bringing HIV-related deaths to their lowest point since 1994.

Yet, the battle is far from over. HIV-related deaths are still too high, with over 1.5 million new infections each year. Children and adolescents, in particular, face significant barriers to accessing the necessary services.

However, many people still experience substantial barriers to care:

“The MENA region has experienced concerning increases in the incidence of HIV and AIDS-related mortality in recent years. Between 2000 and 2015, new HIV infections climbed by more than 33%, and AIDS deaths more than tripled. Despite progress in HIV research and surveillance in MENA, much of the data remain unpublished or inaccessible.”

The problem is compounded by the fact that relatively few meta-analyses examining the status of HIV in the MENA region have been published. The ones that have been done largely focus on high-risk populations like female sex workers. Testing levels for many of these populations also remain low.

How can we fix it?

This meta-analysis highlights critical gaps in testing in the MENA region. A comprehensive, multipronged approach to tackling the challenges posed by STIs is urgently needed.

Here’s what Mike Asher, CEO of Better2Know, had to say:

“There have long been challenges around STI monitoring in the Middle East and North Africa. Gaps in the system leave health professionals flying blind, trying to fight an opponent they cannot see. Health officials and governments need to ensure equitable access to healthcare by addressing the discrimination and stigma attached to STIs. Doing so will help shift people’s behaviours, allowing them to seek testing and treatment when needed.”

“By adopting a rights-based, people-centred strategy, policymakers, healthcare providers, and public health stakeholders can work together to address the unique challenges faced in the MENA region. The role of widespread access to sexual health testing will remain crucial in the fight against STIs.”

Final thoughts

If you live in the Middle East and you’re concerned for your sexual health, or you’ve had a sexual encounter that you’re worried about, you’ll want to get tested.

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