Disseminated infection remains ‘infrequent but serious’ complication of gonorrhea
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Although disseminated gonococcal infection rates are relatively low, researchers said it remains a serious complication of gonorrhea.
“Rates of reported gonorrhea have increased in the United States since 2009, with over 600,000 cases reported in 2019,” CDC epidemiologist Emily J. Weston, MPH, told Healio. “Although thought to be an infrequent complication, gonococcal infection can disseminate, leading to severe sequelae such as septic arthritis, tenosynovitis/dermatitis syndrome, bacteremia or, on rare occasions, endocarditis or meningitis.”
Weston said most studies of disseminated gonococcal infection (DGI) have been based on case studies or small outbreaks, and that there are limited population-level estimates. For their study, Weston and colleagues partnered with an established active surveillance network to identify laboratory-confirmed cases of DGI at a population level and to estimate the burden of disease and antimicrobial susceptibility to CDC-recommended treatment.
They performed retrospective surveillance among residents in two areas of the Active Bacterial Core surveillance (ABCs) system of the CDC’s Emerging Infections Program — a collaboration between the CDC, state and local health departments and academic institutions — and prospective surveillance in three ABCs areas between 2017 and 2019.
They identified 77 DGI cases approximately 0.13 cases per 100,000 population which accounted for 0.06% of all reported gonorrhea cases in the three surveillance areas. This rate, Weston said, shows that “DGI remains an infrequent but serious complication of gonorrhea.”
The team found that most DGI cases occurred among male (64%) and non-Hispanic Black participants (68%), whose ages ranged from 16 to 67 years. They also found that almost all DGI cases were based on an infection identified in the blood (54.6%) or joint (40.3%), although infections were also identified in the cervix, rectum, vagina, genitals and oropharynx and in urine. However, the researchers noted that none of these isolates were available for further testing.
“As rates of gonorrhea increase in the U.S., providers should be aware of the changing epidemiology and clinical presentation of DGIs,” Weston said. “If there is clinical suspicion for DGI, specimens from urogenital and mucosal sites of exposure — for example, pharynx, vagina, rectum — should be collected and processed using nucleic acid amplification testing.”
In addition, Weston said that to facilitate antimicrobial susceptibility testing, culture specimens from disseminated sites of infection — skin lesions, synovial fluid — should also be collected.
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