Epidemiology of Neisseria gonorrhoeae in Jordan: prevalence, incidence, and clearance from a national laboratory dataset, 2014-2025.

BACKGROUND

Gonorrhea is a global public health priority due to substantial morbidity, sustained transmission, and increasing antimicrobial resistance; however, its epidemiology in Jordan and other settings with limited surveillance and research, such as in the Middle East and North Africa, remains inadequately characterized.

METHODS

Data from 8,779 individuals aged ≥ 15 years tested for current Neisseria gonorrhoeae (NG) infection at Biolab Diagnostic Laboratories in Jordan between 2014 and 2025 were analyzed. A cross-sectional design was used to estimate prevalence, assess temporal trends, and identify factors associated with infection among all 8,779 individuals. Retrospective cohort designs were used to assess incidence among 784 individuals and, exploratorily, clearance among 5 individuals with repeat testing.

RESULTS

NG prevalence, defined as ever having a NAAT-positive test, was 0.4% (95% CI: 0.2-0.5%) overall and 0.1% (95% CI: 0.0-0.2%) among individuals tested for visa-related requirements. Corresponding point prevalence, based on one randomly selected test per individual, was 0.3% (95% CI: 0.2-0.5%) and 0.1% (95% CI: 0.0-0.2%), respectively. NG positivity was substantially higher in clinically motivated testing compared with visa-related testing and among individuals with more frequent testing. No consistent patterns were observed by age, sex, or governorate, and there was no evidence of a temporal decline. In the retrospective cohort, three incident infections were identified over 1,167 person-years of follow-up, yielding a cumulative incidence of 0.49% (95% CI: 0.16-1.53%) after two years of follow-up and an incidence rate of 2.57 per 1,000 person-years (95% CI: 0.83-7.97). In exploratory analysis, nearly all individuals with follow-up after a positive test had a subsequent negative result within 10 days.

CONCLUSIONS

Observed NG prevalence and incidence rate in Jordan were low. However, high positivity in clinically motivated testing contexts and the absence of a temporal decline indicate ongoing transmission that requires control. Strengthening surveillance, expanding targeted testing and treatment among higher-risk populations, and integrating NG antimicrobial resistance monitoring are needed to inform prevention and control efforts.