Article Text
Abstract
Objective Invasive meningococcal disease (IMD) outbreaks in men who have sex with men (MSM) have been associated with meningococcal colonisation of the urethra and rectum, but little is known about this colonisation or co-colonisation with the closely related gonococcus. Whole genome sequencing (WGS) was employed to explore these phenomena.
Methods Meningococci isolated from the urogenital tract and rectum (n=23) and coincident gonococci (n=14) were analysed by WGS along with contemporary meningococci from IMD (n=11). All isolates were obtained from hospital admissions in Brighton, UK, 2011–2013. Assembled WGS were deposited in the PubMLST/neisseria database (http://pubmlst.org/neisseria) and compared at genomic loci common to gonococci or meningococci.
Results As expected, most meningococci from IMD were encapsulated and belonged to hyperinvasive lineages. So too were meningococci found in the urogenital tract and rectum, contrasting to those asymptomatically carried in the nasopharynx where such meningococci are rare. Five hyperinvasive meningococcal lineages and four distinct gonococcal genotypes were recovered, including multiresistant ST-1901 (NG MAST-1407) gonococci.
Conclusions These data were consistent with a predisposition for potentially virulent encapsulated hyperinvasive meningococci to colonise the urethra and rectum, which suggests their involvement in MSM IMD outbreaks. The coincidence of multiresistant gonococci raises wider public health concerns.
- NEISSERIA GONORRHOEA
- NEISSERIA MENINGITIS
- INFECTIOUS DISEASES
- MENINGITIS
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Footnotes
Handling editor Jackie A Cassell
Contributors OBH, MCJM and JPa designed the study; KC, JPe, DWE, FC and GD collected the isolates and provided sample metadata; OBH and KC did the laboratory work and DNA extractions; OBH did the bioinformatics analyses; OBH, MCJM and JPa analysed the data. OBH prepared the figures and the first draft of the manuscript, which was revised by all the authors.
Funding This work was funded by the Wellcome Trust and the Oxford Martin School (087622/Z/08/2 and H2RXJo00). Additional funding was also provided by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (HPRU-2012-10041) and the NIHR Oxford Biomedical Research Centre. DWE is an NIHR Clinical Lecturer.
Competing interests None declared.
Ethics approval Urogenital N. meningitidis isolates were obtained during background work for a gonorrhoea study15 ‘Using whole genome sequencing to investigate gonorrhoea’ (REC Reference (14/LO/0435) that had received approval from the Brighton and Sussex Research Ethics Committee. Individual consent for the use of anonymised bacterial isolates was not required.
Provenance and peer review Not commissioned; externally peer reviewed.