腦膜炎雙球菌引起之男性尿道炎

許智凱、張廷瑞、陳世亮

台南市立醫院 泌尿科

Neisseria Meningitidis: A Rare Pathogen of Urethritis in Young Man

Chih-Kai Hsu, Ting-Jui Chang, Shih-Liang Chen

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

Background:

Urethral discharge, dysuria, and exposure to a sexually transmitted infection are frequent presentations of urethritis in the male population. Sexually transmitted urethritis is classified as either gonococcal urethritis that infected with Neisseria gonorrhea, or nongonococcal urethritis. We presented a case of symptomatic urethritis that is rarely caused by Neisseria Meningitidis.

Case Report:

A 27 years-old young man had purulent discharge from urethra and voiding pain for 3 days. He had no systemic disease or under immunocompromised condition. No overseas travelling or wild animal contacted in past 3 months, but hetero-sexual intercourse without condom used about 1 month ago. Bacterial culture collected from urethral discharge and urine all showed Neisseria Meningitidis. He received combination treatment with single dose IM Ceftriaxone and oral Doxycycline for 7 days. There’s no bacterial meningitis signs like headache, neck stiffness, back pain, fever nor respiratory symptoms was observed during the whole course. Patient was recovered well after antibiotic treatment completed.

Discussion:

In the studies of acute urethritis in male, 30% were found to be infected with N. gonorrhea. In nongonococcal urethritis, C. trachomatis was detected in 48.1%. In nonchlamydial nongonococcal urethritis, N. meningitides was only accounted for 3.9%, and 1.4% in the overall patients with acute urethritis infection. Neisseria meningitidis, often referred to as meningococcus, is a Gram-negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia. Bacterial meningitis in children and young adults, causing developmental impairment and death in about 10% of cases. About 10% of adults are carriers of the bacteria in their nasopharynx and spreading through saliva and respiratory secretions during coughing, sneezing, kissing, chewing on toys and even freshwater. Under this transmitted pathway, maybe oral sex can be the answer why meningococcus could cause urethritis in this young man. In our case and the literature reviewed, the clinical symptoms had no differs from gonococcal urethritis, but CNS and respiratory tract co-infection should be carefully warned.