Meningococcal Urethritis: Old and New

Burns, Bethany L; Rhoads, Daniel D.

doi:10.1128/jcm.00575-22

Cited by 9 publications

(11 citation statements)

References 65 publications

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“…Antimicrobial resistance in N. meningitidis is considered to be acquired by transmission of genetic material from N. gonorrhoeae, such as the gonococcal aniA-norB locus ( 14 ). However, US_NmUC meningococci isolated in the United States were susceptible to the third-generation cephalosporin ceftriaxone, ciprofloxacin, and rifampin, whereas ≈75%–85% of US_NmUC meningococci were nonsusceptible (intermediate susceptibility) to penicillin G ( 34 , 35 ).…”

Section: Resultsmentioning

confidence: 99%

“…An outbreak of meningococcal urethritis predominantly among MSM was reported in multiple cities in the United States ( 10 ). Causative agents were identified as CC11 N. meningitidis isolates with several unique features and classified as US N. meningitidis urethritis clade (US_NmUC) ( 11 – 14 ). The capsular polysaccharide ( cps ) locus in US_NmUC meningococci is disrupted by insertion sequence (IS) 1301 that replaced ccsA , cssB , and cssC genes and part of the csc gene causing loss of encapsulation ( 12 ).…”

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confidence: 99%

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Detection of Novel US Neisseria meningitidis Urethritis Clade Subtypes in Japan

Takahashi,

Morita,

Yasuda

et al. 2023

Emerg. Infect. Dis.

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Neisseria meningitidis causes invasive meningococcal diseases and has also been identified as a causative agent of sexually transmitted infections, including urethritis. Unencapsulated sequence type 11 meningococci containing the gonococcal aniA-norB locus and belonging to the United States N. meningitidis urethritis clade (US_NmUC) are causative agents of urethral infections in the United States, predominantly among men who have sex with men. We identified 2 subtypes of unencapsulated sequence type 11 meningococci in Japan that were phylogenetically close to US_NmUC, designated as the Japan N. meningitidis urethritis clade (J_NmUC). The subtypes were characterized by PCR, serologic testing, and whole-genome sequencing. Our study suggests that an ancestor of US_NmUC and J_NmUS urethritis-associated meningococci is disseminated worldwide. Global monitoring of urethritis-associated N. meningitidis isolates should be performed to further characterize microbiologic and epidemiologic characteristics of urethritis clade meningococci.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Detection of Novel US Neisseria meningitidis Urethritis Clade Subtypes in Japan

Takahashi,

Morita,

Yasuda

et al. 2023

Emerg. Infect. Dis.

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“…As an example, a significant portion (≈20%) of epidemiologically unlinked, presumed Neisseria gonorrhoeae urethral infections in Columbus, Ohio from 2015 to 2016 were determined to be caused by Nm UC with clinical presentation mirroring that of gonococcal urethritis ( 13 – 15 ). Nm UC is unique in causing urethritis outbreaks ( 16 ) and case clusters, which have been identified in 14 states in the United States ( 17 ), the United Kingdom ( 18 , 19 ), and Vietnam ( 20 ). Other mucosal infections (neonatal conjunctivitis) ( 21 ) and cases of invasive disease caused by clade isolates also have been identified ( 17 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Acquisition of Gonococcal AniA-NorB Pathway by the Neisseria meningitidis Urethritis Clade Confers Denitrifying and Microaerobic Respiration Advantages for Urogenital Adaptation

et al. 2023

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“…N. gonorrhoeae and N. meningitidis are human-specific pathogens that usually occupy distinct anatomical sites, the urogenital and oropharyngeal tracts, respectively ( 14 ). However, the gonococcus occasionally colonizes the nasopharynx where it can acquire AMR genes from commensal Neisseria ( 2 , 3 ), while some strains of N. meningitidis asymptomatically colonize the urethra and cause a syndrome indistinguishable from gonococcal disease ( 15 ). This provides opportunities for the exchange of plasmids between the two pathogens; indeed, in the laboratory, pConj and p bla can be transferred by conjugation from N. gonorrhoeae into N. meningitidis and subsequently between meningococcal strains ( 10 , 11 , 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

Evolution and exchange of plasmids in pathogenic Neisseria

Yee,

Elsener,

Cehovin

et al. 2023

mSphere

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Neisseria gonorrhoeae causes sexually transmitted infection (STI) gonorrhoea and is on the WHO critical list due to increasing antimicrobial resistance (AMR). The bacterium can carry a conjugative plasmid, pConj, which prevents the use of tetracycline or doxycycline for treating gonorrhea, and is responsible for spread of a β-lactamase plasmid, p bla ; over 90% of gonococcal isolates also harbor a small cryptic plasmid, pCryp. We systematically analyzed the presence of these plasmids in other Neisseria spp., including Neisseria meningitidis , which causes sepsis/meningitis. pConj is the most frequently found plasmid in the meningococcus and is in many clonal complexes. The plasmid is associated with meningococcal carriage rather than disease, indicating that pConj imposes fitness costs during systemic disease. Phylogenetic analyses reveal that pConj is genetically diverse in N. meningitidis , indicating that it shares a long evolutionary history with the meningococcus and that the plasmid has been transferred at least twice from N. meningitidis to N. gonorrhoeae . Following the first transfer, gonococcal isolates carrying the plasmid underwent clonal expansion and disseminated pConj to other gonococcal lineages. The second introduction was associated with an altered conjugation machinery which reduces conjugation efficiency. Therefore, in contrast to chromosomal resistance which has evolved through introduction of genes from commensals, gonococcal plasmid-mediated resistance has arisen through transfer from another pathogen, N. meningitidis . Further antibiotic pressure from the use of doxycycline for post-exposure prophylaxis against STIs is likely to promote plasmid-mediated AMR in both N. gonorrhoeae and N. meningitidis . IMPORTANCE Horizontal gene transfer (HGT) is a major influence in driving the spread of antimicrobial resistance (AMR) in many bacteria. A conjugative plasmid which is widespread in Neisseria gonorrhoeae , pConj, prevented the use of tetracycline/doxycycline for treating gonococcal infection. Here, we show that pConj evolved in the related pathogen, Neisseria meningitidis , and has been acquired by the gonococcus from the meningococcus on multiple occasions. Following its initial acquisition, pConj spread to different gonococcal lineages; changes in the plasmid’s conjugation machinery associated with another transfer event limit spread in the gonococcal populations. Our findings have important implications for the use of doxycycline to prevent bacterial sexually transmitted disease which is likely to exacerbate the spread of AMR through HGT in pathogenic bacteria.

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Meningococcal Urethritis: Old and New

Cited by 9 publications

References 65 publications

Detection of Novel US Neisseria meningitidis Urethritis Clade Subtypes in Japan

Detection of Novel US Neisseria meningitidis Urethritis Clade Subtypes in Japan

Acquisition of Gonococcal AniA-NorB Pathway by the Neisseria meningitidis Urethritis Clade Confers Denitrifying and Microaerobic Respiration Advantages for Urogenital Adaptation

Evolution and exchange of plasmids in pathogenic Neisseria

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