Prevalence of Neisseria meningitidis by Molecular Testing in Urine Specimens From Men in Ohio

Meningococcal urethritis is recognized as an emerging disease. However, its contemporary prevalence is unknown, and no molecular diagnostic tests are commercially available. With the widespread transition to molecular methods for sexually transmitted infection screening, high-throughput well-validated molecular methods for Neisseria meningitidis detection in urine may be useful for surveillance and diagnosis.

We tested for N meningitidis using polymerase chain reaction (PCR) in 1005 residual urine specimens from male patients submitted for standard-of-care gonorrhea/chlamydia testing. Patients were designated "symptomatic" if an International Classification of Diseases, Tenth Revision code matching urethritis, dysuria, or urethral discharge was noted or "random" if not. A sodC-targeted PCR was adapted on the Panther Fusion system (Hologic) for initial testing; orthogonal metA-targeted PCR was used for confirmation of initial positive results.

The overall prevalence (95% confidence interval) of N meningitidis was 1.5% (0.8%-2.5%) when considering initial results, and 0.5% (0.2%-1.2%) when considering only samples with successful confirmation. An initial detection of meningococcus more frequently confirmed as positive from patients in the symptomatic compared with the random cohort (100% vs 9.1%; P = .004). The positive and negative percentage agreement (95% confidence interval) of sodC PCR with metA PCR as reference were 100% (47.8%-100%) and 91.7% (85.2%-95.9%), respectively. Only 1 of 15 patients who were sodC positive had meningococcal urethritis diagnosed by culture.

Our molecular prevalence study revealed that meningococcal urethritis is likely underdiagnosed in Ohio men, with 1 case for every 4-11 men with urogenital gonorrhea. With further optimization and validation, molecular testing may become a viable diagnostic or surveillance method for meningococcal urethritis.