Introduction
Neisseria meningitidis (known as the meningococcus) is an obligate human commensal bacterium which frequently colonises the upper respiratory tract. Invasive variants are responsible for mengingococcal sepsis and meningococcal meningitidis, outbreaks of which been well described in MSM in the last 20 years. Variants of this lineage are now known to have acquired some determinants of genital infection from Nesseria gonorrhoeae leading to increased incidence of genital meningococcal infection. As it is clinically and microscopically indistinguishable from Neisseria gonorrhoeae, patients have often been treated for gonorrhoea presumptively before the culture results reveal the true cause. The likely route of infection is oro-genital sex from asymptomatic pharyngeal carriage.

Symptoms

Symptomatic cases can present with:

• Vaginal discharge
• Acute cervicitis
• Salpingitis
• Purulent urethral discharge at the penis
• Dysuria at the penile urethra

Diagnosis
Neisseria meningitidis is diagnosed by a series of speciation tests from colonies grown on agar cultures intended for gonococcal isolation. It is deliberately not detected on the GC NAAT tests. You do not need to do any additional tests to look for meningococcal infection: the lab do this if the culture shows Neisseria species.

Management

 Discuss all cases with a senior clinician

It is not clear whether asymptomatic cases need treatment, this decision should be based on individual patient factors and the reason a culture swab was taken.

For symptomatic cases, treatment should be offered. Antibiotic susceptibility should have been reported along with the culture result. Oral ciprofloxacin is effective, although many patients will already have been treated presumptively with ceftriaxone which is also effective.

There is no need for any general public health action such as notification and chemoprophylaxis for household contacts as genital tract infection is not thought to predispose to invasive disease. However treating current sexual contacts may reduce the chance of symptomatic reinfection.