A report published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report describes an increase in cases of urogenital Neisseria meningitides at Sentinel Clinics in Columbus, Ohio and Oakland County, Michigan.
Jose A Bazan, DO, of the Columbus Public Health, Columbus, Ohio and Ohio State University College of Medicine in Columbus and colleagues said in the report that while Neisseria meningitidis is not as common as Neisseria gonorrhoeae (Ng), the condition is linked with urethritis,cervicitis, proctitis and pelvic inflammatory disease.
The two clinics are part of the CDC’s Gonococcal Isolate Surveillance Project, where urethral isolates from the first 25 men diagnosed with Ng are checked for antibiotic resistance.
Researchers reported that in 2013 there were 2 cases of Neisseria meningitidis; in 2014 there were 8, and in in 2015 between January and October there were 15 in Oakland County. In Columbus, the researchers reported no cases between January and November 2014, 2 possible cases in December 2014, and then between January and September 2015 there were 52 cases confirmed by Analytic Profile Index Neisseria-Haemophilus (API NH) (BioMérieux) testing and sodC polymerase chain reaction (PCR).
“Fifty-two urethral isolates from Columbus and 12 from Oakland County were sent to CDC for molecular characterization. All Columbus isolates were non-groupable by slide agglutination serogrouping and serogroup specific PCR. Multilocus sequence typing demonstrated that all isolates were ST-11 and part of the CC-11/ET-37 clonal complex. Eleven of the 12 Oakland County isolates exhibited the same genetic profile as the Columbus isolates,” researchers reported.
Patient characteristics were similar at both sites, Dr Bazan and colleagues said. Patients in Columbus had a median age of 30; Oakland County was 29. Ninety-nine percent were heterosexual, and almost all had received oral sex. “Because N meningitidis colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Neisseria meningitidis infections,” researchers said. In Columbus, 84% of men had 2 or more sex partners during the last three months. That number was lower for Oakland, with 56% reporting 2 or more sex partners over the last 60 days.
Dr Bazan and colleagues reported that an N meningitidis clonal strain (non-groupable, ST-11 and CC-11/ET-37) are infecting mainly heterosexual men in Columbus and Oakland clinics, and that because it is being sexually transmitted, researchers are recommending that sexual partners also be treated. Dr Bazan and colleagues said that the infection should be treated the same way as Ng, with 1 injected intramuscular 250 mg dose of ceftriaxone and one 1 gram oral dose of azithromycin.
“Until more data are available on transmission and sequelae, sex partners of patients with Neisseria meningitidis urethritis should be treated as they would be for exposure to urogenital Ng. Increases in N meningitidiis urethritis cases above baseline should be reported to CDC,” Dr Bazan and colleagues concluded.
1. Bazan JA, Peterson AS, Kirkcaldy RD et al. Notes from the field: increase in Neisseria meningitidis–associated urethritis among men at two sentinel clinics — Columbus, Ohio, and Oakland County, Michigan, 2015. MMWR. 2016; 65(21):550–552.