A 26-year-old woman went to the emergency room with a history of 1 month on her right knee and metacarpal arthralgia, tenosynovitis and pustules on her hand. She was sexually active, with 1 partner. Her urine gonococcal nucleic acid (NAAT) amplification test was positive and we diagnosed a disseminated gonococcal infection and admitted her with intravenous ceftriaxone 2 g / d. While in the hospital, he developed an enlarged chest wall mass. A computed tomography showed an abscess in the chest wall (Figure 1), which required incision and drainage. The patient’s chest wall fluid cultures were negative, but 16S rRNA with gene sequencing confirmed the presence of Neisseria gonorrhoeae. We continued with ceftriaxone for 17 days and stopped it after the abscess had resolved.
Figure 1:
A computed tomography infusion of the breast of a 26-year-old woman, showing a complex collection of fluids with a peripheral improvement of 5.8 × 3.6 × 7 cm centered within the left dorsal muscle, with some muscle involvement subscapularis. The muscles surrounding the collection appeared to be slightly hyperemic, suggesting myositis. (A) Cross-sectional view of the abscess of the chest wall (arrow). (B) Coronal view of the abscess of the patient’s chest wall (arrow).
Neisseria gonorrhoeae is a highly infectious gram-negative diplococcus that is transmitted primarily through unprotected vaginal, anal, and oral intercourse. It is the second most common sexually transmitted bacterial infection in Canada, after Chlamydia trachomatis.1 Between 2009 and 2018, the annual incidence rate of N. gonorrhea infections in Canada increased by 190% .1
Nucleic acid amplification tests are now the recommended method for the diagnosis of N. gonorrhoeae, as it provides greater sensitivity while maintaining a high specificity, compared to the culture to detect N. gonorrhoeae in samples of genital sites and not genitals.2,3 Nucleic acid amplification tests are designed. to amplify and detect organism-specific nucleic acid sequences and do not require the presence of viable organisms in the samples.3 16S rRNA is a highly conserved gonococcal nucleic acid that, when tested, allows the identification of bacteria at the species level.2 Nucleic acid amplification tests should be performed using urine samples from the first vacuum or swabs from the vagina, cervix, urethra, rectum or another place of clinical concern.3
Given the rising rates of N. gonorrhea infections in Canada, physicians should maintain a high degree of suspicion in sexually active patients. It should focus on early diagnosis and treatment to prevent late sequelae of infection.
Footnotes
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Competitive Interest: Aditya Sharma reports that it owns shares in Entasis Therapeutics and ContraFect Corporation. No other opposing interests were declared.
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This article has been peer reviewed.
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The authors have obtained the consent of the patient.
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