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California study explores possible risk factors for disseminated gonorrhea
June 25, 2026
CATIE
- Gonorrhea that spreads beyond the throat or genital tract is called disseminated gonorrhea
- Researchers in California studied data from more than 900 people with gonorrhea
- Heterosexual sex, age and use of methamphetamine were linked to disseminated gonorrhea
The bacteria that cause gonorrhea (N. gonorrhoeae) can incite inflammation and symptoms that most commonly affect the mucosal tissues—throat, anus, penis, vagina—as these are usually the point of first contact with such bacteria. However, in some cases, if left undiagnosed or untreated, these germs can enter the blood and spread to more distant places, causing complications such as nodules on the skin, inflammation of the lining of the heart, painful inflammation of joints, and, in very rare cases, inflammation of the tissues lining the brain. When gonorrhea spreads to distant tissues, it is disseminated. Cases of disseminated gonorrhea can be potentially serious.
A team of researchers in California has been studying the impact of disseminated gonococcal infection (DGI) in that state. The researchers found that between July 2020 and May 2024 there were more than 400 cases of DGI, with eight people dying from complications.
To better understand the risk factors associated with DGI, the research team amassed information on people who had been diagnosed with DGI and people with uncomplicated gonorrhea. The researchers divided participants into two groups: cases (with DGI) and controls (with uncomplicated gonorrhea), selected at random from a database:
- cases – involved data from 119 people with DGI
- controls – involved data from 786 people who had uncomplicated gonorrhea
In analyzing the data, researchers took into consideration issues such as gender, race/ethnicity, gender of sex partners, HIV status, prior diagnoses of common sexually transmitted infections (chlamydia, syphilis or gonorrhea), and self-reported use of drugs.
Results
The researchers found the following differences between the two populations studied:
- people with DGI tended to be older than people with uncomplicated gonorrhea (42 vs. 29 years)
- people with DGI were more likely to be heterosexual, particularly men who had sex with women
- people with DGI were more likely to disclose using drugs; in particular, they were about six times more likely to disclose current use of methamphetamine
There were no statistically significant differences in HIV status between people with DGI and those with uncomplicated gonorrhea.
Bear in mind
The researchers stated: “These findings have important implications for clinicians and public health programs, particularly because taking a comprehensive sexual history and performing routine gonorrhea screening may not always be prioritized [for populations at risk of DGI].” They added that early in the course of disease, particularly when gonorrhea has affected sites outside of the ano-genital tract, people may initially be symptom free. It is possible that missed opportunities for assessing individual behaviour and, when appropriate, screening for gonorrhea “could lead to missed gonorrhea diagnoses and the potential for complications like DGI.”
Advice for clinicians
The researchers gave the following advice to healthcare providers: “Clinicians should remain vigilant to the possibility of DGI in patients with compatible syndromes—including arthritis with dermatitis, migratory polyarthralgia, tenosynovitis, and septic arthritis—even when occurring in individuals older than age 25 years or [who are] not gbMSM.”
The team noted that historically “although females have been reported to be at risk for DGI (perhaps due to biochemical changes associated with menstruation, pregnancy, and postpartum states), most of the DGI cases in California have occurred in men.” This suggests that the population affected by DGI may be changing, as has been hinted at by the U.S. Centers for Disease Control and Prevention (CDC).
The researchers noted that due to financial constraints it is not possible for public health clinics to screen all populations (heterosexual, over the age of 25 years) identified in this study for DGI. However, it may be possible to expand routine screening for gonorrhea in select populations. For instance, in the state of California, “routine gonorrhea screening is now recommended for all people using substances (especially methamphetamine) regardless of sexual orientation based on observed disproportionate impacts of DGI in this population.”
These recommendations have the potential to bring more people who use methamphetamine into the healthcare system and, at a minimum, help reduce rates of gonorrhea in this population.
The present study had limitations—it lacked detailed sociodemographic information on some issues, such as housing status and access to healthcare. The number of DGI cases was relatively small, limiting statistical analysis. However, other studies in the U.S. have found groups of people with DGI in other states where older age and/or substance use have been factors.
About meth and the immune system
Other studies have found that dependence on methamphetamine can weaken the immune system, perhaps by doing the following:
- affecting sleep patterns and reducing levels of crucial T-cells
- reducing the level of chemical messenger molecules used to communicate between the brain and the immune system
- weakening the ability of the immune system to fight infections
- accelerating the aging of the immune system
Researchers have found that meth use can increase inflammation within the rectum, increasing the risk of acquiring HIV and other germs. The drug also appears to amplify the ability of HIV-infected cells to produce more virus particles.
—Sean R. Hosein
Resources
Canada raises dose of preferred antibiotic for gonorrhea – CATIE News
Gonorrhea guide: Key information and resources – Public Health Agency of Canada
Sexually transmitted and blood-borne infections: Guides for health professionals – Public Health Agency of Canada
Large clinical trial finds zoliflodacin promising for uncomplicated urogenital gonorrhea — CATIE News
Scientists in France assess antibiotic resistance in people who use doxycycline post-exposure prophylaxis (doxyPEP) – CATIE News
New antibiotic (gepotidacin) looks promising for gonorrhea – CATIE News
TreatmentUpdate 245 – CATIE
Doxycycline for STI prevention shows significantly decreased rates of chlamydia and syphilis in a major clinic – CATIE News
Doxycycline to help prevent bacterial STIs – CATIE
REFERENCES:
- Johnson KA, Fernando R, Plotzker R, et al. Characteristics associated with disseminated gonococcal infections vs uncomplicated gonorrhea: A California case-control study, 2021-2022. Clinical Infectious Diseases. 2026 Mar 17;82(3):e612-e615.
- Ram S and Rice P. Chapter 161. Gonococcal infections. In: Longo DL, Fauci AS, Kasper KL, Hauser SL, Jameson JL, Loscalzo J, Holland SM, Langford CA, eds. Harrison’s Principles of Internal Medicine, 22e New York, NY: McGraw-Hill; 2025.
- Miller DR, Bu M, Gopinath A, et al. Methamphetamine dysregulation of the central nervous system and peripheral immunity. Journal of Pharmacology and Experimental Therapeutics. 2021 Dec;379(3):372-385.
- Wood EK, Huang E, Sano ER, et al. Greater fatigue, disturbed sleep, persistent memory problems, and reduced CD4+ T cell and B cell percentages in adults with a history of methamphetamine dependence. Journal of Neuroimmunology. 2025 May 15; 402:578567.
- Takemura Y, Tanifuji T, Okazaki S, et al. Epigenetic clock analysis in methamphetamine dependence. Psychiatry Research. 2022 Nov; 317:114901.
- Hernandez-Santini AC, Mitha AN, Chow D, et al. Methamphetamine facilitates pulmonary and splenic tissue injury and reduces T cell infiltration in C57BL/6 mice after antigenic challenge. Scientific Reports. 2021 Apr 15;11(1):8207.
- Lawson KS, Prasad A, Groopman JE. Methamphetamine enhances HIV-1 replication in CD4+ T-cells via a novel IL-1β auto-regulatory loop. Frontiers in Immunology. 2020 Feb 7; 11:136.
- Fulcher JA, Shoptaw S, Makgoeng SB, et al. Brief Report: Recent methamphetamine use is associated with increased rectal mucosal inflammatory cytokines, regardless of HIV-1 serostatus. JAIDS. 2018 May 1;78(1):119-123.
- Carrico AW, Hunt PW, Neilands TB, et al. Stimulant use and viral suppression in the era of universal antiretroviral therapy. JAIDS. 2019 Jan 1;80(1):89-93.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/california-study-explores-possible-risk-factors-for-disseminated-gonorrhea
For more information visit CATIE's Information Network at www.catie.ca
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