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Background: Urogenital infections associated with Neisseria meningitidis (Nm) are much rarer than infections associated with Neisseria gonorrhoeae (Ng). On urethral Gram stain, both Nm and Ng appear as Gram-negative intracellular diplococci. We describe an outbreak of urethral Nm cases among male STD clinic patients in Columbus Ohio.
Methods: We combined medical chart data from patients seen between January and September 2015 with data captured for CDC’s Gonococcal Isolate Surveillance Project (GISP). Through GISP, urethral swabs are systematically collected from male patients for Gram stain and culture. Urine was collected for Ng diagnosis via nucleic acid amplification testing (NAAT). Molecular characterization was performed on Nm isolates using whole genome sequencing.
Results: Of 293 men with evidence of Gram-negative intracellular diplococci, n=241 (82%) were confirmed via NAAT to have Ng, whereas n=52 (18%) were NAAT-negative for Ng and confirmed to be Nm via microbiology, PCR, PorA typing and MLST. All Nm isolates were non-groupable, ST-11 and part of CC-11/ET-37. The majority of both Nm and Ng cases were Black (85% and 71%, respectively) and heterosexual (100% and 76%, respectively). Fewer men with Nm vs. Ng were HIV-positive (2% vs. 6% prevalence). All Nm cases (100%) and nearly all Ng cases (94%) reported engaging in oral sex. Almost all Nm and Ng cases were symptomatic (98% and 97%, respectively). No community increase in invasive meningococcal disease was observed.
Conclusions: Urogenital Nm infections among STD patients have not been well characterized, but existing reports suggest that urethritis is rarely associated with Nm. We had no confirmed Nm cases in 2014, but 52 confirmed cases between January and September 2015. Given that Nm frequently colonizes the oropharynx, oral sex may be an underappreciated risk factor for transmission of this organism, although transmission through vaginal or anal sex cannot be ruled out without additional investigation.