18 February 2020
Middle East chlamydia rates comparable to other regions
Published online 27 August 2019
A data review reveals three per cent of the Middle East population is infected with the sexually transmitted disease, chlamydia.
Three per cent of people in the Middle East are infected with Chlamydia trachomatis, a sexually transmitted bacterial infection that can cause infertility and pregnancy complications, according to a data review published in The Lancet Global Health. The review reveals infection prevalence comparable to most regions in the world, including Europe.
Researchers sifted through data about more than 250,000 individuals from 20 Middle East and North African countries. “We searched for every data point we could get a hold of, whether published, or sitting in a drawer in some agency or facility,” says Weill Cornell Medicine - Qatar (WCM-Q) healthcare policy researcher, Laith Abu Raddad.
WCM-Q epidemiologist, Alex Smolak, and his colleagues had consistently found lower rates of sexually transmitted infections in the region, such as HIV and herpes type 2, compared to the rest of the world. They had assumed the same trend would apply to chlamydia, he says. Instead, they found chlamydia is as prevalent in the Middle East as elsewhere. They also found 11 and 12 per cent prevalence in infertile women and in women who have had a miscarriage, respectively, and 17.4 per cent prevalence in symptomatic men.
Chlamydia trachomatis is mostly spread through vaginal, oral and anal sex, and often has no symptoms, making it difficult to detect. It does not necessarily trigger unpleasant side effects, like pain or discharge, so “people carry the infection for a long time without treatment in the region, and are thus more likely to pass it to others,” explains WCM-Q epidemiologist, Hiam Chemaitelly. She partly blames limited access to treatment and sexual health services for the relatively high level of infection.
The consequences of chlamydia can be dire, especially for women, as symptomless infections can lead to scarring and obstruction of the fallopian tubes, which can cause infertility and ectopic pregnancies, a leading cause of death for women in the first trimester. Babies born to infected mothers are at risk of low weight and of developing pneumonia or serious eye infections. In men, infection can lead to painful urination, discoloured discharge, and could affect their fertility.
Chlamydia infection is largely underreported in the Middle East. Smolak says physicians often prescribe antibiotics if patients complain of pelvic pain, and almost never order a test or explain that chlamydia could be to blame. Positive test results could cause marital problems or shame. “This is why chlamydia is always below the surface, and is not usually diagnosed or discussed,” he says.
Hussein Gohar, a fellow of the Royal College of Obstetricians and Gynaecologists and head of a women’s health clinic in Cairo, Egypt, says he is surprised by the reported levels of infection. Gohar, who wasn’t involved in the review, says it would be difficult to ascertain the quality of the methodologies used in all the screened studies. Further randomized prospective studies are necessary, he adds.
“This is a very disturbing finding, which should ring alarm bells for the need of sex education at schools, to make contraceptives more readily available, and to set up proper screening clinics,” Gohar says.
Smolak, A. et al. Epidemiology of Chlamydia trachomatis in the Middle East and North Africa: A systematic review, meta-analysis, and meta-regression. Lancet Glob. Health https://doi.org/10.1016/S2214-109X(19)30278-7 (2019).