Surveillance for Disseminated Gonococcal Infections, Active Bacterial Core Surveillance (ABCs)—United States, 2015–2019

Abstract

Background Disseminated gonococcal infections (DGI) are thought to be uncommon; surveillance is limited and case reports are analyzed retrospectively or in case clusters. We describe the population-level burden of culture-confirmed DGI through the Active Bacterial Core surveillance (ABCs) system. Methods During 2015–2016, retrospective surveillance was conducted among residents in two ABCs areas and prospectively in three ABCs areas during 2017–2019. A DGI case was defined as isolation of Neisseria gonorrhoeae (Ng) from a normally sterile site. A case report form was completed for each case and antimicrobial susceptibility testing (AST) was performed on available isolates. Results During 2015–2019, 77 DGI cases were identified (~a rate of 0.13 cases per 100,000 population) and accounted for 0.06% of all reported gonorrhea cases in the three surveillance areas. Most DGI cases were male (64%), non-Hispanic Black (68%), and ranged from 16–67 years; blood (55%) and joint (40%) were the most common sterile sites. Among 29 isolates with AST results during 2017–2019, all were susceptible to ceftriaxone. Conclusions DGI is an infrequent complication of Ng; since Ng can quickly develop antimicrobial resistance, continued DGI surveillance, including monitoring trends in antimicrobial susceptibility, could help inform DGI treatment recommendations.

Ten Years of Disseminated Gonococcal Infections in North Carolina: A Review of Cases From a Large Tertiary Care Hospital

“…11,19 There was a slight male predominance among the cases, and all the cases occurred in adults younger than 45 years. Our findings are consistent with recent literature showing a slight male predominance among DGI cases, 20,21 and a similar trend is evident across the state, where male individuals accounted for 64% of DGI cases between March 2020 and December 2021. 11 This may be due to the fact that the reported incidence of gonorrhea overall is higher among male individuals and people younger than 45 years, both in North Carolina and in the United States.…”

Genomic analysis of 1710 surveillance-based Neisseria gonorrhoeae isolates from the USA in 2019 identifies predominant strain types and chromosomal antimicrobial-resistance determinants

“…Overall, 44.9 % (767/1710) of isolates were susceptible/nonresistant to all antibiotics studied (CIP, TET, PEN, AZM, CFM and CRO) as defined by either [1] having MIC below the CLSI resistance breakpoint (CIP, TET, PEN) or [2] having a MIC considered susceptible based on the CLSI susceptibility breakpoint (AZM) or [3] having an MIC cutoff one dilution lower than (CRO <0.125 µg ml −1 ) or equal to (CFM<0.250 µg ml −1 ) the CLSI susceptibility breakpoint as defined in other GISP analyses (). Overall, 55.1 % (943/1710) of isolates had elevated MICs above these cutoffs to one or more antibiotics.…”

“…Even with additional monitoring in Las Vegas at that time (including culture-independent molecular testing for mosaic penA 60.001 of 257 remnant NAAT specimens from southern Nevada), no other isolate which carried the penA 60.001 or which had a CRO MIC 1.0 µg ml −1 ) was identified [44]. The identification of the isolate with CRO MIC 1.0 µg ml −1 in Las Vegas, of course, reaffirmed CDC of the necessity for [1] continued national culture-based surveillance and antibiotic susceptibility testing [2], a documented protocol for rapid, coordinated public health response and surveillance at a local jurisdiction in response to identification of an isolate of concern, and [3] continued development of rapid, molecular assays for GC identification, strain typing and detection of AR markers in light of GC’s rapid evolution.…”

“…Symptomatic infections commonly occur as urethritis in men; pharyngeal, rectal or cervical infections are often asymptomatic. Additionally, GC can cause rare ocular infections and disseminated gonococcal infections (DGI) [2, 3]. Left untreated gonorrhoea can result in increased risk of contracting HIV, pelvic inflammatory disease, infertility, ectopic pregnancy, etc [4–6].…”

Disseminated Gonococcal Infections—Lessons Learned From an Ongoing California Public Health Investigation

“…As we continue to surveil for DGI in CA, the burden of DGI nationwide comes into focus, with case clusters and series recently reported in Michigan 17 and South Carolina 18 . Disseminated gonococcal infection cases may soon be on the rise elsewhere, or may already be occurring under the surveillance radar 19 . Based on our experience with DGI in CA, we hope that providers, DIS, public health programs, and community partners can benefit from the clinical, disease investigation, and surveillance/epidemiology “lessons learned” presented here (and summarized in Table 1) as we work toward (1) improving DGI detection systems and (2) ensuring—for the sake of individual patients and public health—that DGI patients and their partners are managed appropriately, thereby reducing DGI morbidity/mortality and minimizing forward transmission of gonococcal infections.…”