Background: The Oakland County Health Division (OCHD) laboratory in Pontiac, Michigan participates in the Gonococcal Isolate Surveillance Project (GISP) and identified a recent increase in Neisseria meningitidis (NM) urethritis that would have otherwise been broadly classified as non-gonococcal urethritis.
Methods: Evaluation of male clients with urethritis includes urethral gram stain and urine nucleic acid amplification test (NAAT) for Neisseria gonorrhoeae (NG), Chlamydia trachomatis and Trichomonas vaginalis. Specimens with gram-negative diplococci on gram stain but negative NAAT for NG were defined as discordant. Percentages of discordant specimens were compared by year, with data available since 2011. In 2015, GISP cultures from the discordant specimens were obtained. Detailed interviews of male clients with NM isolated from urethral specimens in 2015 were performed.
Results: An increase in discordant specimens was noted: 2.78% in 2011 to 8.93% in 2015. In 2015, male clients with urethritis and discordant specimens were confirmed by culture to have infection with NM. Discordant specimens prior to 2015 most likely represent NM. The majority of clients reported only female partners and reported receipt of oral sex. The clients did not develop invasive disease. Only one reported a partner with similar symptoms.
Conclusion: The prevalence of clients with discordant specimens, presumed to be NM based on 2015 culture results, increased dramatically. This change in epidemiology would have been unrecognized if only NAAT was used for evaluation. The demographics identified in this study differ from recently reported outbreaks of invasive meningococcus, in which HIV positivity and being a man who has sex with men were risk factors. Other studies have reported an increase in NM from urogenital sites and attributed this to a change in sexual behavior, including an increase in oral sex. Evaluation of urethritis with only NAAT will miss important causes of non-gonococcal urethritis, including NM. While NM has been occasionally identified as causing urethritis, its prevalence is increasing and could go unnoticed if gram stain or culture is not performed for urethritis work up.
Laura Johnson, .1, Barbara Weberman, MT (ASCP)2, Nicole Parker, MPH2 and Pamela Hackert, MD, JD, MPH2, (1)University of Michigan School of Public Health Preventive Medicine Residency, Ann Arbor, MI, (2)Oakland County Health Division, Pontiac, MI
None N. Parker,
None P. Hackert,