Neisseria gonorrhoeae in Kenya: A Systematic Review and Meta-Analysis of Prevalence, Resistance and Mitigation Strategies.

INTRODUCTION

Gonorrhoea remains a leading sexually transmitted infection worldwide, with an estimated 82 million new cases being reported annually. In Kenya, epidemiological and antimicrobial resistance data are fragmented and under-represent high-risk populations, hampering targeted interventions.

OBJECTIVE

To estimate the pooled prevalence of Neisseria gonorrhoeae and assess patterns of antimicrobial resistance in Kenya between 2019 and 2024.

METHODOLOGY: We searched PubMed, Google Scholar, OpenAlex and Research4Life following PRISMA guidelines, yielding 1116 records. Two reviewers independently screened studies against predefined inclusion criteria. Prevalence and resistance data were extracted, and a random-effects meta-analysis was performed to compute pooled estimates with 95% confidence intervals. Heterogeneity among studies was assessed using the I2 statistic.

RESULTS

Eleven studies comprising 5170 participants met inclusion criteria. The pooled prevalence of N. gonorrhoeae was 22.5% (95% CI: 17.2-27.8). Key risk factors included sex work, low educational attainment and multiple sexual partners. Resistance rates were highest for tetracycline (98.0%), ciprofloxacin (96.7%) and penicillin (94.7%) and lowest for azithromycin (2.0%), cefixime (2.6%) and ceftriaxone (1.3%).

CONCLUSION

N. gonorrhoeae poses an urgent public health threat in Kenya. Strengthening surveillance, expanding access to reliable diagnostics and enforcing antibiotic stewardship are critical. Exploration of alternative therapies including phage therapy, alongside accelerated vaccine research, will be essential for sustainable disease control.