Background: Disseminated gonococcal infection (DGI) is rare [0.5-3% of Neisseria gonorrhoeae (NG) cases]; surveillance for DGI is limited. A cluster of seven DGI cases were identified from one Central California county (6/2014-5/2015), prompting review of clinical characteristics, assessment for epidemiologic linkages, and whole genome sequencing (WGS) to identify relatedness of four available isolates.
Methods: Clinical and epidemiologic data were obtained through review of case reports and medical records from statewide surveillance data systems. DGI was defined as having clinical manifestations of disease and either positive NG cultures from sterile sources (proven DGI) or positive cultures or nucleic acid tests (NAT) from mucosal sites of infection (probable DGI). All NG cases in this county are investigated and DGI specimens were submitted to the local public health laboratory. Matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF-MS) and WGS were performed at the California Department of Public Health Microbial Diseases Laboratory.
Results: Seven DGI cases were observed; five had proven DGI with positive blood (n=3) or joint cultures (n=2) and two had probable DGI with positive anogenital NAT (n=2). There were six males and one non-pregnant female, aged 31–60 years, primarily heterosexual (n=6) and white (n=6). Patients presented with poly/monoarthralgia (n=7), constitutional symptoms (n=4), tenosynovitis (n=2), rash (n=2), and/or purulent arthritis (n=2). Treatment varied but all patients received ceftriaxone and recovered fully. No epidemiologic linkage was found. WGS was performed on four isolates; which separated into two unrelated clades (Sequence Type – 1601 and 9363); comparison of high quality single nucleotide polymorphisms (hqSNPs) did not reveal direct transmission links.
Conclusions: Seven DGI cases were identified in a California county. Disease investigation and WGS did not establish a common epidemiologic connection. WGS supported epidemiologic data. The addition of WGS could strengthen and broaden disease investigation and enhance characterization of transmission dynamics and sexual networks.