Disseminated Gonococcal Infections (DGI) in Manitoba, Canada: 2013 to 2020

Abstract

Background: Gonorrhea, when left untreated, can enter the blood and cause disseminated gonococcal infections (DGIs). Disseminated gonococcal infections, which can include dermatitis, tenosynovitis, migratory polyarthralgia, and arthritis, have been increasing in Manitoba (MB), Canada, since 2013. Endocarditis, a rare DGI, was identified in 3 MB patients in 2018 and 2019.Methods: Antimicrobial resistance, molecular types, and resistance-associated mutations were determined for MB DGI isolates (n = 103) identified from 2013 to 2020 using phenotypic and genotypic methods. Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) of residual nucleic acid amplification testing samples (n = 13) from 2019 and 2020 were also determined. Results:The increase in DGI in MB in 2019 and 2020 was due to the NG-MAST 11508 molecular type with porB-2206, a persistent PorB protein structure type "A" allele. These isolates had low-level resistance to erythromycin and tetracycline.Conclusions: Molecular surveillance of gonorrhea and, in particular, gonococcal strains resulting in DGI is imperative to monitor clonal transmission within populations. These data can be used to alert public health of emerging issues and support public health interventions.

Evaluation of surveillance system changes to improve detection of disseminated gonococcal infections in Virginia, 2018-2021

“…The CDC recommends that specimens from exposed mucosal and sterile sites should be collected and all confirmed isolates sent to reference laboratories for antimicrobial susceptibility testing (AST) 5 . Other recent studies of DGI have been able to incorporate AST for some isolates; thus far, all remained susceptible to ceftriaxone 7,8,12,23 . Unfortunately, we were unable to incorporate AST into our surveillance efforts.…”

“…5 Other recent studies of DGI have been able to incorporate AST for some isolates; thus far, all remained susceptible to ceftriaxone. 7,8,12,23 Unfortunately, we were unable to incorporate AST into our surveillance efforts. Most local laboratories lack the capacity to perform such testing, the state public health laboratory in Virginia does not routinely conduct STI testing, and the process of forwarding specimens to a reference laboratory is often not feasible for local providers.…”