Assessing N. gonorrhoeae prevalence and testing capacity for new treatment rollout: a scoping review for Cambodia, Thailand, Vietnam and South Africa.

backgroundNeisseria gonorrhoeae, a major cause of sexually transmitted bacterial infections, poses a significant public health challenge, particularly due to rising antimicrobial resistance (AMR). Regions such as South-East Asia and Africa may face substantial and possibly rising burdens of gonorrhoea, though the full extent remains unclear due to limited diagnostic testing, underreporting, and gaps in aetiological and antimicrobial resistance surveillance - especially in countries lacking population-based prevalence estimates. Addressing deficiencies in data from these regions, particularly those with limited diagnostic infrastructure that are underrepresented in population-based studies, is critical for advancing global sexually transmitted infections (STIs) management and the implementation of new treatments.

methodsThis scoping review focused on the prevalence and reported resistance patterns of N. gonorrhoeae across four target countries: Cambodia, Thailand, Vietnam and South Africa. A systematic literature search using PubMed and WHO reports from 2019 to 2023 was conducted, with studies screened based on predefined inclusion and exclusion criteria. Data on prevalence, susceptibility profiles, and laboratory methodologies were extracted and analysed.

resultsOf the 217 articles identified, 29 were included, with South Africa contributing 83% of the studies. No eligible studies were identified from Cambodia. Prevalence rates varied, with the highest observed in one study among men with urethral discharge syndrome in South Africa (87.6% CI95% 85.2-89.9%). Antibiotic susceptibility data were limited to a small subset of articles (4/29, 13.8%), with resistance ranging from ≈78% for ciprofloxacin to ≈1% for cefixime. Laboratory methods primarily employed nucleic acid amplification testing, with limited use of phenotypic testing anywhere, hindering comprehensive AMR monitoring.

conclusionThis scoping review confirms substantial data gaps on N. gonorrhoeae prevalence and antimicrobial resistance across the studied regions, with Cambodia contributing no eligible studies and Thailand and Vietnam remaining underrepresented in published literature. National programs and international partners should prioritise sentinel culture capacity and standardised antimicrobial susceptibility testing and genotypic testing to inform treatment guidelines, detect emerging resistance patterns, and inform public health interventions in these high-burden regions. CLINICAL TRIAL NUMBER: Not applicable.