Background Recent research suggests that Neisseria meningitidis (Nm) OMV serogroup B vaccination protects against gonorrhea (caused by Neisseria gonorrhoeae, Ng). Since 2015, we have monitored a large cluster of urethritis cases caused by a uropathogenic, non-groupable Nm clade (US NmNG urethritis clade). The US NmNG urethritis clade encodes for MenB-4C vaccine antigens (FHbp, NhbA, NadA), but whether natural infection reduces subsequent risk of urethral gonorrhea is unknown.

Methods We constructed a dataset combining surveillance and medical record data from men diagnosed with US NmNG clade urethritis (n=128) in a local STD clinic. We used time-to-event analyses of clinic visits between 1/2015 and 4/2018 to examine prospective urethral gonorrhea risk. As gonorrhea is a common event in STD patients, we compared subsequent gonorrhea acquisition for men with US NmNG clade urethritis at baseline to men with Ng urethritis (n=255), chlamydial urethritis (n=253), or no infection (n=257) at baseline.

Results Participants were primarily Black (65%) and heterosexual (82%), with a median age of 28 years. At baseline, 13% had prior gonorrhea history. Only one participant had prior MenB vaccination. Half (49%) of men returned for STD screening at least once during the follow-up period. Men with US NmNG clade urethritis at baseline had similar gonorrhea risk as men with Ng at baseline (HR: 1.03, 95% CI: 0.60–1.76). Results were not meaningfully different when assessing extragenital gonococcal infections, or after adjustment for time since baseline, age, race, sexual orientation, prior gonorrhea infection, and sexual behavior (number of partners, condom use, and oral sex). In contrast, those with US NmNG clade urethritis had increased gonorrhea incidence compared to men with chlamydial urethritis (HR: 2.02, 95% CI: 1.11–3.69) and men with no infection at baseline (HR: 3.84, 95% CI: 1.87–7.91).

Conclusion Natural infection with US NmNG urethritis clade does not appear to protect men against subsequent acquisition of gonorrhea.

Disclosure No significant relationships.