Ten Years of Disseminated Gonococcal Infections in North Carolina: A Review of Cases From a Large Tertiary Care Hospital

Abstract

In this case series, we summarize clinical manifestations of 12 case-patients with disseminated gonococcal infections diagnosed at a tertiary care hospital between 2010 and 2019 and highlight difficulties diagnosing this infection to inform surveillance.

Evaluation of Surveillance System Changes to Improve Detection of Disseminated Gonococcal Infections in Virginia, 2018 to 2021

“…Our methods and findings are also similar to those recently undertaken in North Carolina (0.05%–0.15%) and California (0.24%) 11,12 . It is important to note that only the most severe cases of DGI are likely to be detected; milder symptoms may go unrecognized, and clinical diagnosis requires a high index of suspicion 13 …”

“…Demographic and clinical data collected from medical records of confirmed DGI cases in Virginia showed similar trends to other recent studies both within the United States and internationally, indicating a shift away from populations historically most at risk of DGI such as women and younger individuals 6,15 . Within the last 5 years, reports from across the United States found that the majority of cases occurred among men (mirroring trends in reported gonorrhea cases) and have an older-age distribution than the average for gonorrhea 7,8,12,13,16,17 . Similarly, studies from France and England both found that DGI cases skewed male and slightly older 18,19 .…”

“…In terms of hospitalizations and clinical manifestations of DGI, our findings again concur with other recent studies. 8,13,18,20 Of note, we found that 74% of confirmed cases were hospitalized, likely a reflection of only the most severe cases being identified by clinicians. The most common manifestations noted in our review of medical charts were septic arthritis and bacteremia.…”

“…11,12 It is important to note that only the most severe cases of DGI are likely to be detected; milder symptoms may go unrecognized, and clinical diagnosis requires a high index of suspicion. 13 Although the risk factors for gonorrhea in general are well understood, the same is not true for the predictors of DGI. It may occur more frequently among persons with untreated gonococcal infections, which is of particular concern given recent disruptions to STD screening and care services in the United States because of the COVID-19 pandemic.…”

“…6,15 Within the last 5 years, reports from across the United States found that the majority of cases occurred among men (mirroring trends in reported gonorrhea cases) and have an older-age distribution than the average for gonorrhea. 7,8,12,13,16,17 Similarly, studies from France and England both found that DGI cases skewed male and slightly older. 18,19 These demographic shifts may reflect the changing epidemiology of gonorrhea in general over the last several decades, with both gonorrhea and DGI increasingly occurring among male individuals and persons in older-age groups, living with HIV, using drugs, and with other comorbidities.…”