The prevalence and incidence of active syphilis in women in Morocco, 1995-2016: Model-based estimation and implications for STI surveillance

Abstract

BackgroundEvolving health priorities and resource constraints mean that countries require data on trends in sexually transmitted infections (STI) burden, to inform program planning and resource allocation. We applied the Spectrum STI estimation tool to estimate the prevalence and incidence of active syphilis in adult women in Morocco over 1995 to 2016. The results from the analysis are being used to inform Morocco’s national HIV/STI strategy, target setting and program evaluation.MethodsSyphilis prevalence levels and trends were fitted through logistic regression to data from surveys in antenatal clinics, women attending family planning clinics and other general adult populations, as available post-1995. Prevalence data were adjusted for diagnostic test performance, and for the contribution of higher-risk populations not sampled in surveys. Incidence was inferred from prevalence by adjusting for the average duration of infection with active syphilis.ResultsIn 2016, active syphilis prevalence was estimated to be 0.56% in women 15 to 49 years of age (95% confidence interval, CI: 0.3%-1.0%), and around 21,675 (10,612–37,198) new syphilis infections have occurred. The analysis shows a steady decline in prevalence from 1995, when the prevalence was estimated to be 1.8% (1.0–3.5%). The decline was consistent with decreasing prevalences observed in TB patients, fishermen and prisoners followed over 2000–2012 through sentinel surveillance, and with a decline since 2003 in national HIV incidence estimated earlier through independent modelling.ConclusionsPeriodic population-based surveys allowed Morocco to estimate syphilis prevalence and incidence trends. This first-ever undertaking engaged and focused national stakeholders, and confirmed the still considerable syphilis burden. The latest survey was done in 2012 and so the trends are relatively uncertain after 2012. From 2017 Morocco plans to implement a system to record data from routine antenatal programmatic screening, which should help update and re-calibrate next trend estimations.

Trends in Adult Chlamydia and Gonorrhea Prevalence, Incidence and Urethral Discharge Case Reporting in Morocco over 1995–2015—Estimates Using the Spectrum-Sexually Transmitted Infection Model

“…These declines are furthermore in line with Spectrum-STI prevalence trend estimates for adult syphilis, 6 , 21 and the reported declines in HIV incidence (after a peak at 2002–2004) in Morocco. 5 , 22 – 24 These trends coincide with expansion of the HIV/STI response and services in Morocco over the last 2 decades, including for FSW.…”

Syphilis prevalence trends in adult women in 132 countries – estimations using the Spectrum Sexually Transmitted Infections model

“…Figure 2 shows the Spectrum-STI trend estimates for two of the countries where national Spectrum-STI workshops have been held 22 – 25 . In Morocco (Fig.…”

“…The Spectrum syphilis database draws on data from a variety of sources including the Global AIDS Monitoring System and is the most global comprehensive database on syphilis now. Experience from country workshops 22 , 25 – 27 , however, suggests that there are additional data available within countries. Country outreach can also improve data quality, for example, by providing information on the specific diagnostic test types.…”

“…The Spectrum-STI global syphilis database is a comprehensive compilation of syphilis prevalence data from a number of sources including the Global AIDS Monitoring system (GAM) database 14 , databases compiled by WHO and by IHME, data identified from other literature reviews 12 , 14 – 21 and data shared during country applications of the Spectrum-STI tool 22 – 27 (see details in SI2 ). The version used in the present analysis includes data identified and compiled as of 2 nd May 2018.…”

Syndromic Management of Female Sexually Transmitted Infections at Primary Care Level in Tunisia (Monastir 2007-2017)

“…In the Maghreb, most studies have focused on the key population and women requesting abortion whose criteria for diagnosing STIs were based on laboratory results (endocervical, urine and vaginal sample)(9-13).Only, few studies used the data from clinical surveillance to establish the trend and prevalence of some curable STIs in the general population (14,15).…”