A landmark 61-year meta-analysis of gonorrhea prevalence across sub-Saharan Africa reveals three essential insights for policymakers and clinicians. First, the 3.2% general population prevalence masks extreme variation across settings and populations—aggregate figures obscure where disease burden actually concentrates. Second, key populations face disproportionate infection: female sex workers show 11.5% urogenital prevalence, men who have sex with men 8.3% anorectal prevalence, and symptomatic men reach 51.5%—over 15 times the general rate.
Third, diagnostic gaps drive undiagnosed transmission. Many infected individuals, particularly asymptomatic cases, remain undetected and untreated, perpetuating chains of transmission. Compounding these gaps, rising antimicrobial resistance threatens treatment efficacy. Public health responses must prioritize expanded diagnostic capacity, targeted screening in high-burden populations, antimicrobial stewardship, and equity-focused prevention strategies to interrupt transmission pathways and protect vulnerable communities.
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