Changing patterns of disseminated gonococcal infection in France: cross-sectional data 2009-2011.
OBJECTIVE
Disseminated gonococcal infections (DGIs) are rare. We describe the characteristics of DGIs in France.


METHODS
This is a 3-year retrospective analysis of DGI cases collected through two networks of microbiologists and infectious disease specialists in France between 2009 and 2011. DGI was defined either by the isolation of Neisseria gonorrhoeae from blood and synovial fluid or by the existence of a clinical syndrome consistent with DGI and the isolation of N gonorrhoeae from any site. We describe the epidemiological, clinical and microbiological characteristics and outcomes of DGIs.


RESULTS
21 patients (9 women, 12 men; 18-62 years old) were diagnosed with DGI. The number of DGI cases increased between 2009 and 2011. Two men who had sex with men were coinfected with HIV. We found 28 extragenital locations, including arthritis (14 cases), tenosynovitis (7), skin lesions (4), endocarditis (1), prostatitis (1) and pelvic inflammatory disease (1). Genital signs were present in five patients. The diagnosis was confirmed by cultures in 20 patients-blood (4), synovial fluid (11), genital (3), throat (1), urine (1)-and by molecular biology on a pharyngeal swab in 1 patient. Seven cases were resistant to fluoroquinolones. The patients were treated with ceftriaxone, associated with corticosteroids (two cases) and surgery (six cases). Four patients had joint sequelae.


CONCLUSIONS
DGIs are increasing. Men seem to be at higher risk than women. Joint involvement was common. Microbiological diagnosis was based on culture, however molecular biology using pharyngeal swabs was helpful when cultures were negative.
Department of Infectious and Tropical Diseases, Centre Hospitalier Intercommunal, , Villeneuve Saint Georges, France.
Anna
A
Belkacem
Eric
E
Caumes
Jocelyne
J
Ouanich
Vincent
V
Jarlier
Sophie
S
Dellion
Benoit
B
Cazenave
Régis
R
Goursaud
Flore
F
Lacassin
Jacques
J
Breuil
Olivier
O
Patey
D000293:Adolescent; D000328:Adult; D001170:Arthritis, Infectious / Q000453:epidemiology* / Q000382:microbiology; D016470:Bacteremia / Q000382:microbiology*; D001422:Bacterial Adhesion; D060085:Coinfection; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial; D005260:Female; D005602:France / Q000453:epidemiology; D005835:Genitalia / Q000382:microbiology; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007113:Immunity, Innate; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000276:immunology / Q000302:isolation & purification*; D010614:Pharynx / Q000382:microbiology; D015995:Prevalence; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013582:Synovial Fluid / Q000382:microbiology; D013717:Tenosynovitis / Q000453:epidemiology* / Q000382:microbiology
D004269:DNA, Bacterial
DERMATOLOGY; EPIDEMIOLOGY (CLINICAL); GONOCOCCI; NEISSERIA GONORRHOEA