Urethritis Caused by <i>Neisseria meningitidis</i>: A Case Report
| Author | Wenjia Quan | en |
| Author | Yingpo Qiu | en |
| Author | Yahong Qu | en |
| Issued Date | 2026-05-31 | en |
| Abstract | Introduction: Male genital tract infections (MGTIs) are important contributors to male factor infertility. Although they are typically caused by classic pathogens such as Chlamydia trachomatis and Neisseria gonorrhoeae, urogenital infections caused by Neisseria meningitidis are rare. However, the global expansion of a specialized N. meningitidis urethral clade (US-NmUC), characterized by the loss of the polysaccharide capsule and the acquisition of the aniA-norB gene cluster, poses a unique clinical challenge because it can share ecological niches with N. gonorrhoeae and evade standard nucleic acid amplification tests (NAATs). Case Presentation: A 29-year-old man presented with a 2-day history of acute urinary frequency, urgency, and dysuria. He was afebrile, had an unremarkable medical history, and denied recent travel, high-risk sexual activity, and recent orogenital contact. Gram staining of urethral secretions revealed abundant leukocytes and Gram-negative diplococci that were morphologically indistinguishable from N. gonorrhoeae. However, standard real-time fluorescence polymerase chain reaction tests for N. gonorrhoeae, C. trachomatis, and Ureaplasma urealyticum were negative. Conventional culture on chocolate agar, automated identification using the VITEK 2 Compact system, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) definitively identified the isolate as N. meningitidis. Antimicrobial susceptibility testing showed resistance to penicillin, ampicillin, ciprofloxacin, and sulfamethoxazole/trimethoprim, with susceptibility to ceftriaxone, meropenem, azithromycin, and minocycline. The patient was treated successfully with a single intramuscular dose of ceftriaxone (500 mg) plus oral azithromycin (1 g). Symptoms improved within 2 days and resolved completely within 7 days, with negative follow-up culture results. At the 1-month follow-up, there was no recurrence and no evidence of partner infection. Conclusions: This case highlights an important diagnostic blind spot: exclusive reliance on gene-specific NAATs for sexually transmitted infections may fail to detect atypical urogenital pathogens, such as N. meningitidis. Conventional bacterial culture and mass spectrometry remain indispensable for accurate clinical diagnosis. Identification of this strain may indicate possible geographic expansion of the US-NmUC lineage in Southeast China, warranting enhanced molecular and genomic surveillance. Clinicians should also consider comprehensive partner management, including screening of the oropharyngeal mucosa of sexual partners, to interrupt transmission from the primary reservoir. | en |
| DOI | https://doi.org/10.5812/jjm-171349 | en |
| URI | https://brieflands.com/journals/jjm/articles/171349 | en |
| Keyword | Neisseria Meningitidis | en |
| Keyword | Male Genital Tract Infection | en |
| Keyword | Urethral Clade | en |
| Keyword | NAAT | en |
| Keyword | Case Report | en |
| Publisher | Brieflands | en |
| Title | Urethritis Caused by <i>Neisseria meningitidis</i>: A Case Report | en |
| Type | Case Report | en |