Increase in Disseminated Gonococcal Infections - Alaska, 2023-2024.

Disseminated gonococcal infection (DGI) is a rare but serious complication of Neisseria gonorrhoeae infection that can result in severe illness or death. In April 2024, the Alaska Section of Epidemiology (SOE) identified an increase in suspected DGI cases in Anchorage, Alaska, prompting enhanced surveillance. The state's gonorrhea surveillance system and electronic health records were used to review all likely and verified DGI cases reported to SOE during January 2023-December 2024. Thirty-five DGI cases were identified, accounting for 0.35% (eight of 2,289) of all gonorrhea cases in 2023 and 1.3% (27 of 2,079) in 2024. The median patient age was 36 years, 51% of patients were male, and 37% had a documented substance use disorder. Overall, 21 (60%) patients experienced septic arthritis, and three (9%) patients developed endocarditis; 28 (80%) patients lacked mucosal symptoms. No deaths were reported. Eighteen available isolates collected during 2020-2024, including 14 from cases reported during 2023 and 2024, underwent antimicrobial susceptibility testing and whole-genome sequencing. Laboratory analyses identified a cluster of highly related isolates with a novel multilocus sequence type (MLST-18036) and markers of increased virulence; however, no resistance to first-line therapy (ceftriaxone) was detected. Clinicians should maintain a high index of suspicion for DGI in patients at risk for gonococcal infection, even in the absence of mucosal symptoms. Prompt diagnosis and treatment, prompt case reporting, and robust partner services are critical to preventing transmission and reducing DGI morbidity.