Gonorrhoea is a sexually transmitted infection with rising incidence. An infection with the bacterium can be asymptomatic, localised, or it can disseminate into a generalised infection. The pathogen is increasing in prevalence. In the UK, gonorrhoea diagnoses have increased 7.5 percent from 79,268 diagnoses in 2022 to 85,223 diagnoses in 2023. Cases in the U.S. are similarly on the rise.
Although extremely rare, gonococcal infections can cause endocarditis, an inflammation of the heart’s inner lining. Gonococcal endocarditis carries a high mortality rate of up to 20 percent, according to Medscape.
A recent case of a 52-year-old sexually active man in Kentucky illustrates how this type of infection can occur as well as demonstrating the potential severity of such infections.
In this case,the man presented to the emergency department with acute pain and weakness in his right leg. These symptoms were preceded by fever, sweating, and arthralgia. The patient had a history of substance use disorder, with his last drug injection occurring one week before his hospital visit.
Following hospital admission, the patient was declared afebrile, with normal blood pressure, although he was recorded as having a heart rate of 111 beats per minute, indicating tachycardia.
Furthermore, the patient exhibited mild tachypnoea, breathing at 26 breaths per minute, and an oxygen saturation of 96 percent at room temperature. A grade 3-4 systolic heart murmur was noted during auscultation.
A physical examination of the patient’s affected leg revealed that it was severely impaired in function. A computerised tomography angiography showed a significant occlusion in the femoral artery. In addition, laboratory tests revealed a marked leucocytosis, with a high white blood cell count.
Treatment took the form of anticoagulation therapy with heparin for acute limb ischemia from infective endocarditis. Antibiotic therapy was also administered due to sepsis, which lasted for 17 days. In recent years, the causative bacterium has successively acquired antimicrobial resistance to each antimicrobial agent used and recommended for treatment.
The bacterium Neisseria gonorrhoeae was identified in the thrombotic material extracted from the leg during surgery. N. gonorrhoeae typically infects mucosa of exposed anatomic sites, such as the urogenital tract, rectum, pharynx, and conjunctivae.
The case highlights the challenges of pathogen detection. In suspected N. gonorrhoeae infections, only approximately 28 percent of blood cultures are positive after three days, complicating the timely adjustment of empirical antibiotic therapy. With the Kentucky case, the medics adopted alternative diagnostic methods in identifying the pathogen from arterial thrombus.
