Ok #IDTwitter, here is a real #IDCase for you #IDFellows: A 33 y.o. M with dysuria and history of unprotected sex with men presents for STI screening. Culture of urethral discharge demonstrates growth of Neisseria meningitidis. How would you manage this case?
It seems like this would be the wrong Neisseria for someone’s urogenital tract, right? But alas, no, N mening can cause #urethritis. Described in the 1930s and 1940s, N mening is now well documented as a cause of urethritis.
#Neisseria meningitidis is a gram-negative intracellular diplococcus that can colonize the nasopharynx. It is most commonly known as the cause of life-threatening bacterial meningitis. Check out this #MicroRounds for a refresher on its biochem tests.
#Meningococcus is frequently found colonizing the naso- and oropharynx – up to a third of people in one sample! (doi: 10.3201/eid0910.030444). Sexual contact, particularly orogenital sexual contact, can lead to urethral infection (https://wwwnc.cdc.gov/eid/article/25/1/17-1102_article)
In 2017 Bazan et al. described an outbreak of N mening urethritis among 75 men presenting to an STI clinic.
> 90% had urethral discharge. The majority identified as heterosexual and recalled oral sex.
This has raised the question of specific isolates that may be more adept at infecting the urogenital tract. In the ☝️above-cited study, all N mening isolates were from a distinct clade.
Interestingly, this is a case of sexually transmitted infection that can occur in completely monogamous relationships. Consider this in patients with purulent discharge but negative NAAT (makes you wonder how many relationships broke up from #Meningococcus urethritis🤔).
Ceftriaxone is an appropriate treatment. The addition of azithromycin can be considered (and likely would be empirically given in pt with purulent discharge). Partners should be treated with ceftriaxone as well. (table from: http://antimicrobe.org/b116.asp#r34)
Summary: #Meningococcus can cause sexually transmitted urethritis similar to #gonococcus. Mechanism ▶️transmission from carrier during oral sex. Consider in purulent urethral discharge with neg GC NAAT. Treat patient and partner with ceftriaxone. #STI #IDTwitter