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

Abstract

Background Disseminated gonococcal infection (DGI), a complication of untreated gonorrhea, is rarely reported through routine surveillance. We sought to improve local surveillance system capacity to estimate and monitor the incidence of DGI in Virginia. Methods We modified surveillance protocols to identify possible DGI cases using information extracted from gonorrhea case reports and performed provider follow-up using standardized case report forms to confirm DGI diagnosis and collect clinical information. Suspect cases included those with a laboratory report indicating sterile site of specimen collection (e.g. blood, synovial fluid) and/or intravenous (IV) treatment. We performed descriptive analyses to summarize characteristics of suspect and confirmed DGIs and estimated incidence. Results After piloting protocols in 2018-2019, we identified 405 suspect DGI cases from 29,294 gonorrhea cases reported in 2020-21 (1.4%). We initiated investigations for 298 (73.6%) of the suspect cases, received provider responses for 105 (25.9%), and confirmed 19 (4.7%) DGI cases. Positive laboratory reports from non-mucosal sites were the most reliable predictor of confirmed DGI status, but most were not confirmed as DGI even when provider follow-up was successful. The confirmed and estimated incidence of DGI was 0.06% and 0.22% respectively. Sixteen (84%) of the confirmed cases were over 25 years of age, 3 (16%) were HIV-positive, and approximately half were male and non-Hispanic black. The majority (15, 74%) were hospitalized, and common manifestations included septic arthritis and bacteremia. Conclusions We improved surveillance for DGI in Virginia while incurring minor programmatic costs. Additional efforts to improve the completeness and quality of surveillance data for DGI are needed.