By NewsDesk  @infectiousdiseasenews

The Los Angeles County Health Department is calling on physicians and other healthcare providers to be alert for disseminated gonococcal infections (DGI).

Neisseria
Image/CDC

This comes after a December letter from Director, Division of STD Prevention at the CDC, Gail Bolan, M.D., which reporting concerns of a troubling rise in DGIs.

CDC has received increasing reports of DGI, an uncommon, but severe, complication of untreated gonorrhea. CDC is working with the Michigan Department of Health and Human Services on a cluster of DGI cases, where the majority of cases have reported amphetamine and some opioid injection drug use.

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Health officials call on providers to:

  • Consider the diagnosis of DGI in patients with septic arthritis or with polyarthralgia, tenosynovitis, petechial/pustular skin lesions, along with symptoms of bacteremia.
  • Take a sexual history in patients with symptoms/signs suggestive of DGI.
  • Collect specimens for NAATs and culture from both mucosal sites (e.g. urogenital, rectal, or pharyngeal) and culture from disseminated sites (e.g., skin, synovial fluid, blood, or CSF) prior to treatment of suspect cases.
  • Test all patients with suspected DGI for HIV, syphilis, and chlamydia as appropriate.
  • Report suspect cases within 1 working day without waiting for laboratory confirmation.
  • Treat patient per CDC guidelines and treat or refer sex partner(s) for evaluation and treatment.

DGI occurs when the sexually transmitted pathogen Neisseria gonorrhoeae invades the bloodstream and
spreads to distant sites in the body. Infection leads to clinical manifestations like septic arthritis,
polyarthralgia, tenosynovitis, petechial/pustular skin lesions, bacteremia, or, on rare occasions,
endocarditis or meningitis. Cultures from disseminated sites of infection are often negative and mucosal sites of infection (e.g. urogenital, rectal, or pharyngeal) are often asymptomatic and not tested before empiric antimicrobial treatment is started despite having a higher diagnostic yield. As a result, DGI is usually a clinical diagnosis without microbiologic confirmation, which likely contributes to underdiagnosis and delays in treatment and reporting.