Health Care Provider Advisory: Management of Disseminated Gonorrhea

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Epidemiology

  • Since May there have been reports of cases diagnosed with disseminated gonorrhea including sepsis and joint involvement in the Kenora and Sioux Lookout area.
  • Overall gonorrhea (all cases) rates for the Kenora area have not increased but it is noted that gonorrhea rates did increase in the Dryden area in March and June.
  • Manitoba Public Health has also noted an increase in rates of gonorrhea and disseminated gonorrhea.

Risk factors

The most common risk factors for gonorrhea cases in the Kenora area are: unprotected sex, intercourse with opposite sex, multiple contacts and new contact in past 6 months, repeat STI, under-housed/homeless, substance use/IVDU.

Challenges

For these cases there are significant challenges:

  • Difficulty in locating the cases; especially those who are homeless or under-housed.
  • Inadequate treatment; treatment is over a course of weeks and sometimes requires IM or IV
    treatment.

If you suspect disseminated gonorrhea

  • Notify the NWHU with any suspect cases
  • Counsel regarding:
    • importance of completing treatment
    • risk of reinfection and the need to get partners tested/treated
    • need for test of cure
    • options to get support and other services if need be
  • Collect as much information as possible regarding how to reach the individual (where they are staying, alternate phone numbers, where they work, social media profile, etc.).
  • If starting on treatment series, ensure a plan to get the series completed.
  • NAAT and culture specimens from urogenital and extragenital mucosal sites, as applicable, should be collected, in addition to culture specimens from disseminated sites of infection.

Case management

  • Referring to an infectious disease specialist is recommended for disseminated gonorrhea.
  • Treating disseminated gonorrhea requires a series of daily doses of antibiotics administered IM or IV (see Public Health Agency of Canada in resources).
  • Ensure plan for treatment – this can include the NWHU or other healthcare providers.
  • Test of cure
    • Recommended 3-7 days upon treatment completion (culture), or 2-3 weeks (NAAT). Ideally, a culture was taken from the same source as the initial test, but TOC decisions should be based on various factors such as treatment compliance, clinical improvement, risk of re-exposure and feasibility. Culture is best.
  • Contact tracing should be done for all cases of disseminated gonorrhea or PID– this can be done by the testing provider or public health

References

Please contact me if you have any questions or concerns,

Contact:
Gillian Lunny
Manager, Sexual Health and Harm Reduction
Northwestern Health Unit
(807) 468-3147

Health Care Provider Advisory – Management of Disseminated GonorrheaDownload
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