Disseminated Gonococcal Infection in An Elderly Japanese Man

Abstract

We herein present the case of a 69-year-old Japanese man who had unprotected sexual contact with a local commercial sex worker in an East Asian country and was diagnosed as having disseminated gonococcal infection (DGI). The organism was confirmed to be Neisseria gonorrhoeae based on 16S rRNA sequencing and positive results for the cppB gene. This case indicates that a diagnosis of DGI should also be considered in elderly individuals. DGI potentially causes many complications, and the pathogen has recently been reported to be resistant to various antibiotics. Physicians must therefore pay more attention to the possible occurrence of DGI in various clinical settings.

Cutaneous manifestations of disseminated gonococcemia

“…Disseminated gonococcal infection (DGI) is a rare, but dreaded complication of mucosal gonorrheal infection. DGI typically manifests 2-3 weeks after acquiring primary gonococcal infection and affects approximately 0.5-3% of infected individuals [3,[7][8][9]. The gender prevalence of DGI varies depending on the study design and population characteristics, especially the proportion of participants who are men who have sex with men.…”

Gonococcal Osteomyelitis Resulting in Permanent Sequelae

“…The site of bacterial entry can be difficult to determine, since DGI often develops from an asymptomatic mucosal infection. However, pharyngeal infection has been reported to be a common cause (10). In our report, the first patient had had unprotected fellatio in Thailand, but a pharyngeal test was not taken until 9 months after the sexual contact.…”

Rare presentation of vertebral discitis, osteomyelitis and polyarticular septic arthritis due to disseminated Neisseria gonorrhea infection

“…As per CDC recommendation, all patients diagnosed with gonorrhoea should be tested for chlamydia, syphilis and HIV [9,10]. Obtaining pharyngeal and rectal samples for NAAT testing should be considered in patients with suggestive sexual practices [11].…”