• 1.

    Kirby Institute, 2018. HIV, Viral Hepatitis and Sexually Transmissible Infections in Australia: Annual Surveillance Report 2018. Sydney, Australia: Kirby Institute, UNSW.

    • Search Google Scholar
    • Export Citation
  • 2.

    Sexual Health & Blood Borne Virus Unit (SHBBVU), 2018. Surveillance Update for Notifiable Sexually Transmitted Infections and Blood-Borne Viruses in the Northern Territory (NT). Darwin, Australia: Centre for Disease Control, Department of Health, NT Government. 911.

    • Search Google Scholar
    • Export Citation
  • 3.

    Bardin T, 2003. Gonococcal arthritis. Best Pract Res Clin Rheumatol 17: 201208.

  • 4.

    Barr J, Danielsson D, 1971. Septic gonococcal dermatitis. Br Med J 1: 482485.

  • 5.

    Holmes K, Sparling P, Stamm W, Piot P, Wasserheit J, Corey L, Cohen M, 2008. Sexually Transmitted Diseases. 4th ed. New York, NY: McGraw-Hill.

  • 6.

    Klausner JD, 2019. Disseminated Gonococcal Infection. Available at: https://www.uptodate.com/contents/disseminated-gonococcal-infection. Accessed February 13, 2019.

    • Search Google Scholar
    • Export Citation
  • 7.

    Rice PA, 2005. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am 19: 853861.

  • 8.

    Thiery G, Tankovic J, Brun-Buisson C, Blot F, 2001. Gonococcemia associated with fatal septic shock. Clin Infect Dis 32: E92E93.

  • 9.

    Tuttle CS, Van Dantzig T, Brady S, Ward J, Maguire G, 2015. The epidemiology of gonococcal arthritis in an Indigenous Australian population. Sex Transm Infect 91: 497501.

    • Search Google Scholar
    • Export Citation
  • 10.

    Paynter J, Goodyear-Smith F, Morgan J, Saxton P, Black S, Petousis-Harris H, 2019. Effectiveness of a group B outer membrane vesicle Meningococcal vaccine in preventing hospitalization from gonorrhea in New Zealand: a retrospective cohort study. Vaccines (Basel) 7: 111.

    • Search Google Scholar
    • Export Citation
  • 11.

    Australian Institute of Health and Welfare (AIHW), 2016. 2016 Census QuickStats. Canberra: AIHW. Available at: http://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/036. Accessed March 3, 2019.

    • Search Google Scholar
    • Export Citation
  • 12.

    AIHW, 2011. 2011 census QuickStats. Canberra: AIHW. Available at: http://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2011/quickstat/0. Accessed February 12, 2019.

    • Search Google Scholar
    • Export Citation
  • 13.

    Centre for Disease Control, Northern Territory Government, 2018. Health Library Services ePublications. Available at: https://digitallibrary.health.nt.gov.au/prodjspui/handle/10137/506. Accessed February 14, 2019.

    • Search Google Scholar
    • Export Citation
  • 14.

    Smith EL, Hodgetts KE, Ralph AP, Anstey NM, 2019. Case report: severe disseminated gonococcal infection with polyarticular gout: two cases in older travelers. Am J Trop Med Hyg 100: 209212.

    • Search Google Scholar
    • Export Citation
  • 15.

    RHDAustralia (ARF/RHD writing group), National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2012. Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease. 2nd ed. Darwin, Australia: Menzies School of Health Research.

    • Search Google Scholar
    • Export Citation
  • 16.

    Australian Bureau of Statistics, 2013. Australian Aboriginal and Torres Strait Islander Health Survey: First results, Australia, 2012–2013. Cat. No. 4727.0.55.001. Canberra, Australia: ABS.

    • Search Google Scholar
    • Export Citation
  • 17.

    AIHW, 2017. Aboriginal and Torres Strait Islander Health Performance Framework 2017: Supplementary Online Tables. Cat. no. WEB 170. Canberra: AIHW. Available at: https://www.aihw.gov.au/reports/indigenous-health-welfare/health-performance-framework/contents/tier-1-health-status-and-outcomes/1-09-diabetes. Accessed June 9, 2019.

    • Search Google Scholar
    • Export Citation
  • 18.

    Vincent FB, Bourke P, Morand EF, Mackay F, Bossingham D, 2013. Focus on systemic lupus erythematosus in Indigenous Australians: towards a better understanding of autoimmune diseases. Intern Med J 43: 227234.

    • Search Google Scholar
    • Export Citation
  • 19.

    Anstey NM, Bastian I, Dunckley H, Currie BJ, 1993. Systemic lupus erythematosus in Australian aborigines: high prevalence, morbidity and mortality. Aust N Z J Med 23: 646651.

    • Search Google Scholar
    • Export Citation
  • 20.

    SHBBVU, 2016. NT Guidelines for the Management of Sexually Transmitted Infections in the Primary Health Care Setting. Darwin, Australia: Centre for Disease Control, Department of Health, NT Government.

    • Search Google Scholar
    • Export Citation
  • 21.

    Amir O, Nguyen VD, Barnett BJ, 2003. Acute human immunodeficiency virus infection presenting as disseminated gonococcal infection. South Med J 96: 284286.

    • Search Google Scholar
    • Export Citation
  • 22.

    Ross SC, Densen P, 1984. Complement deficiency states and infection: epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency, Medicine (Baltimore) 63: 243273.

    • Search Google Scholar
    • Export Citation
  • 23.

    Mitchell SR, Nguyen PQ, Katz P, 1990. Increased risk of neisserial infections in systemic lupus erythematosus. Semin Arthritis Rheum 20: 174184.

    • Search Google Scholar
    • Export Citation
  • 24.

    Chaturvedi S, Boyd R, Krause V, 2018. Acute post-streptococcal glomerulonephritis in the northern territory of Australia: a review of data from 2009 to 2016 and comparison with the literature. Am J Trop Med Hyg 99: 16431648.

    • Search Google Scholar
    • Export Citation
  • 25.

    Morgan DS, Fisher D, Merianos A, Currie B, 1996. An 18 year clinical review of septic arthritis from Tropical Australia. Epidemiol Infect 117: 423428.

    • Search Google Scholar
    • Export Citation
  • 26.

    Therapeutic Guidelines, 2014. Bone and Joint Infections. Version 15. West Melbourne, Australia: Therapeutic Guidelines Limited. 365380.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Characteristics and Impact of Disseminated Gonococcal Infection in the “Top End” of Australia

View More View Less
  • 1 Northern Territory Centre for Disease Control, Darwin, Australia
Restricted access

The “Top End” of Australia is presently experiencing a gonorrhea epidemic. Gonococcal infection is usually limited to mucosal tissues but can lead to disseminated gonococcal infection (DGI), joint destruction, and severe sepsis. This study aimed to explore the epidemiology, presentation, management, and health-care impact of DGI in the Top End of the Northern Territory. Health records of patients diagnosed with proven, probable, or possible DGI between January 2010 and September 2018 were analyzed retrospectively. One hundred six cases of DGI were identified. Ninety-four patients (88.7%) were Indigenous Australian. The incidence of proven and probable DGI in the Indigenous population was 27.1 per 100,000 person-years, compared with 7.1 in the Top End population overall. Of 7,540 laboratory-proven gonococcal notifications, 1.3% (n = 97) were complicated by DGI. The highest incidence was in the 15–19-year age-group. Thirteen cases (12.3%) occurred in patients younger than 15 years. High rates of comorbid alcohol misuse, diabetes, systemic lupus erythematosus, rheumatic fever, and complement deficiency were observed. The “classic triad” of tenosynovitis, dermatitis, and polyarthralgia was rare. Ninety-four patients (88.7%) presented with purulent arthritis. Disseminated gonococcal infection was estimated to cause at least 10.0% of nonpenetrating septic arthritis in the Top End and 1,234 days of hospitalization during the study period. DGI is an important cause of morbidity in the Top End, particularly in the young, remote Indigenous Australian population. Clinical presentation varies from classical teaching. Urgent action in the health and community sector is required, particularly for at-risk populations, to prevent further debilitating and costly complications of gonococcal infection.

Author Notes

Address correspondence to Johanna M. Birrell, Northern Territory Centre for Disease Control, P.O. Box 40596, Darwin, Australia. E-mail: johanna.birrell@tdhb.org.nz

Financial support: The research is supported by the Australian National Health and Medical Research Council grant number 1131932 (The HOT NORTH initiative) for the ability to disseminate the findings of our work and study.

Authors’ addresses: Johanna M. Birrell, Manoji Gunathilake, Sally Singleton, Shellee Williams, and Vicki Krause, Northern Territory Center for Disease Control, Darwin, Australia, E-mails: johanna.m.birrell@gmail.com, manoji.gunathilake@nt.gov.au, sally.singleton@nt.gov.au, shellee.williams@nt.gov.au, and vicki.krause@nt.gov.au.

Save