Patients with disseminated gonococcal infection lack usual symptoms
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Many patients associated with a disseminated gonococcal infections outbreak in California lacked usual symptoms and were not included in the screening groups, according to an outbreak assessment published in Clinical Infectious Diseases.
“An infectious disease physician reported a cluster of disseminated gonococcal infection (DGI) cases to the California Department of Public Health in October 2020, which led to a public health investigation (PHI),” the California Department of Public Health (CDPH) told Healio. “This PHI resulted in CDPH confirming an uptick of DGI cases in California starting around July 2020.”
As part of the public health response to increased reports of DGI, the CDPH used gonorrhea surveillance data reported to the agency to identify all DGI cases in a geographically bound region. From there, standardized case report forms were used to collect epidemiologic risk factors and clinical information obtained from provider/laboratory reports, medical records and patient interviews.
From July 1, 2020, to July 31, 2021, the health department identified 149 patients with DGI among 63,338 total gonorrhea infections reported, representing 0.24% of gonorrhea cases. According to the study, 15 (36%) of these patients used methamphetamine and nearly 25% experienced homelessness.
The study also identified clinical characteristics, including that 61% lacked urogenital, pharyngeal or rectal symptoms; two patients died in the hospital; and among 47 isolates from patients with antimicrobial susceptibility testing results available, all were susceptible to ceftriaxone and cefixime.
CDPH told Healio that many of the patients with DGI in this outbreak visited the ED multiple times before being correctly diagnosed. Because of this, as well as the “significant morbidity” associated with DGI, the CDPH said that health care providers should remain alert for DGI, especially for patients who report joint pain, and obtain a good sexual history even for older patients presenting with symptoms suggestive of DGI.
“If a health care provider notices an unusually large number of what is normally a rare manifestation of sexually transmitted infections, they should report them to their public health department — it’s possible that this may be the tip of the iceberg and may not have been recognized until later if the infectious disease specialist had not reached out to us.”
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