An increase in Neisseria meningitidis (Nm)-associated urethritis among men at two U.S. sexual health clinics warrants raised awareness among clinicians, according to investigators affiliated with the CDC’s Gonococcal Isolate Surveillance Project.
During January-September 2015, a total of 52 cases of urethritis were confirmed in male patients at a Columbus, Ohio clinic, and were found to be caused by Nm by Analytic Profile Index Neisseria-Haemophilus (API NH) testing and sodC polymerase chain reaction (PCR). During the same time period, an Oakland County, Mich., clinic documented 15 cases of urethritis in male patients, also caused by Nm. Both clinics are participant sites in CDC’s Gonococcal Isolate Surveillance Project, through which urethral isolates from the first 25 men evaluated each month with Ng urethritis undergo antibiotic susceptibility testing.
Nm urogenital infections are less common than infections caused by Neisseria gonorrhoeae (Ng), but have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis. The CDC reports that, because Nm colonizes the nasopharynx, men who receive oral sex can acquire urethral Nm infections.
Among all of the confirmed cases at both clinics, 99% of patients reported heterosexual orientation, and 97% had symptomatic urethritis. Oral sex was reported by 100% of Columbus patients and by 93% of Oakland County patients. Also, 84% of Columbus patients reported two or more sex partners within the preceding 90 days, while 56% of Oakland County patients reported two or more partners within the preceding 60 days. Up to 90% of patients were treated with an appropriate treatment for Nm urethritis for presumed Ng infection with the CDC-recommended regimen.
“Until more data are available on transmission and sequelae, sex partners of patients with Nm urethritis should be treated as they would be for exposure to urogenital Ng,” the researchers concluded. “Increases in Nm urethritis cases above baseline should be reported to CDC.”
Find the full report in Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6521a5).