From the National Microbiology Laboratory, Public Health Agency of Canada.
Published: December 2022
AI Article Synopsis
Article 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.
Service de Rhumatologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France; Center for Research in Epidemiology and Statistics, INSERM UMR 1153, Université Paris Cité, Paris, France. Electronic address:
Sexually Transmitted Diseases (STD) Control Branch, Division of Communicable Disease Control (DCDC), Center for Infectious Diseases (CID), California Department of Public Health (CDPH), Richmond, California, USA.
Gonorrhea is a sexually transmitted infection. Manifestations include asymptomatic infection and disseminated, life-threatening disease. We present two cases of mitral valve gonococcal endocarditis and discuss epidemiologic trends in disseminated gonococcal infection, acknowledging antimicrobial resistance, genetic variability in gonococcal strains, and contextual factors related to the COVID-19 pandemic and STI control.
Antimicrobial resistance in (Ng) has severely reduced treatment options, including azithromycin (AZM), which had previously been recommended as dual therapy with ceftriaxone. This study characterizes the emergence of high-level resistance to AZM (HLR-AZM) Ng in Baltimore, Maryland, USA, and describes the global evolution of HLR-AZM Ng. Whole genome sequencing (WGS) of 30 Ng isolates with and without HLR-AZM from Baltimore was used to identify clonality and resistance determinants.
* Initial treatment focused on a presumed viral syndrome; however, blood cultures later confirmed an infection, prompting a switch to targeted antibiotic therapy.
* The case underscores the need for healthcare providers to consider DGI in patients with joint pain and fever, especially those with recent high-risk sexual behavior.
