Culture-negative hand abscesses in immunocompetent individuals

Area of Science:

• Infectious Diseases
• Microbiology
• Dermatology

Background:

• Gonococcal infection, caused by Neisseria gonorrhoeae, is a prevalent sexually-transmitted infection (STI) primarily affecting older males.
• Typical symptoms include fever, dysuria, and urethral discharge, but disseminated infections can lead to severe conditions like septic arthritis and meningitis.
• Uncommon presentations, such as subcutaneous abscesses, can complicate diagnosis.

Purpose of the Study:

• To highlight unusual clinical presentations of gonococcal infections in older males.
• To emphasize the importance of thorough patient history and diagnostic methods in culture-negative cases.
• To advocate for the use of specific molecular diagnostic tests for Neisseria gonorrhoeae.

Main Methods:

• Case report of two older male patients presenting with multiple subcutaneous hand and wrist abscesses.
• Review of clinical presentation, diagnostic challenges, and treatment outcomes.
• Evaluation of the utility of gonococcal polymerase chain reaction (PCR) testing.

Main Results:

• Both patients presented with atypical subcutaneous abscesses of the hands and wrists, not typical of common gonococcal infections.
• Routine cultures were negative or inconclusive, underscoring diagnostic difficulties.
• Gonococcal PCR testing proved valuable in confirming the diagnosis when conventional methods were insufficient.

Conclusions:

• Gonococcal infection should be considered in older males presenting with unusual skin or soft tissue abscesses, even with negative routine cultures.
• Competent history-taking is essential for identifying potential risk factors.
• Gonococcal PCR testing offers a sensitive and rapid alternative or adjunct to culture for diagnosing Neisseria gonorrhoeae, especially in equivocal or urgent situations.