epidemiologyЭпидемиология и ВакцинопрофилактикаEpidemiology and Vaccinal Prevention2073-30462619-0494«Numicom» LLC10.31631/2073-3046-2020-19-3-64-68epidemiology-1033Research ArticleОБЗОРREVIEWМенингококковый уретрит — дополнительный источник менингококковой инфекции?Meningococcal Urethritis: an additional Source of Meningococcal Disease?КостюковаН. Н.KostyukovaN. N.

Костюкова Наталья Николаевна - доктор медицинских наук, профессор, ведущий научный сотрудник ФНИЦ эпидемиологии и микробиологии им. Н.Ф. Гамалеи».

Москва.

Natalya N. Kostyukova - Dr. Sci. (Med.), Professor, Leading Researcher at N. F. Gamaleya National Rerearch Center of Epidemiology and Microbiology.

Moscow.

nathakos@mail.ruБехалоВ. А.BehaloV. A.

Бехало Владимир Андреевич - кандидат медицинских наук, ведущий научный сотрудник ФНИЦ эпидемиологии и микробиологии им. Н.Ф. Гамалеи.

Москва.

Vladimir A. Behalo - Cand. Sci. (Med.), Leading Researcher at N. F. Gamaleya National Rerearch Center of Epidemiology and Microbiology.

Moscow.

bekhalo@gamaleya.orgНИЦ эпидемиологии и микробиологии им Н.Ф. Гамалеи Минздрава РоссииРоссияN.F. Gamaleya National Rerearch Center of Epidemiology and MicrobiologyRussian Federation2020140720201936468Copyright © Костюкова Н.Н., Бехало В.А., 20202020Костюкова Н.Н., Бехало В.А.Kostyukova N.N., Behalo V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epidemvac.ru/jour/article/view/1033

Актуальность. Начиная с середины прошлого века появлялись сообщения о выделении Neisseria meningitidis из нижних отделов урогенитального тракта и анального канала, как с признаками, так и без признаков воспаления. Во второй декаде XXI века число таких сообщений значительно возросло, причем большинство описанных случаев было вызвано новым генетическим кладом менингококка. Цель. Обзор посвящен острым менингококковым уретритам, их возможной эпидемиологической значимости и свойствам возбудителя. Результаты. Особое внимание уделено вспышкам менингококковых уретритов, вызванных генетическим кладом «USNmCU», возникшим в нескольких штатах США в 2013-2016 гг. Изоляты от больных были бескапсульными и принадлежали к клональному комплексу СС-11, наиболее вирулентному среди штаммов серогрупп B, C, Y, W. Доказана орогенитальная передача штаммов клада. Предполагается, что в результате генетических рекомбинаций при совместном нахождении с N. gonorrhoeae на слизистых оболочках N. meningitidis приобрела гены, обеспечивающие анаэробный рост, способствующий колонизации урогенитального тракта. Предполагается, что уретритогенный менингококковый клад есть результат адаптации капсульного штамма менингококка серогруппы С клонального комплекса СС-11, ответственного за вспышки генерализованной менингококковой инфекции в сообществах мужчин-гомосексуалистов. Эти уретритогенные штаммы рассматривают как эмергентный клад N. meningitidis. Способность штаммов этого клада передаваться при прямом половом контакте неизвестна. Выводы. Эпидемиологическая значимость уретритов, вызванных новым кладом, в распространении менингококковой инфекции пока неясна. Обосновано дальнейшее изучение этой проблемы в нашей стране.

Background. Beginning with the middle of the XX century some observations about cases of meningococcal urethritis have appeared. The number of articles for such subjects has promptly increased in the last decade of XXI. The epidemiological features of meningococcal urethritis are slightly understood. Aims. A review of the latest publications on meningococcal urethritis is presented. Particular attention is given to outbreaks of meningococcal urethritis caused by the new genetic clade USNmCU of N.meningitidis, which occurred in several US states in 2013-2016. Conclusions. The isolates from patients were non-capsulated and belonged to the CC-11 clonal complex, the most virulent among N.meningitidis strains of serogroups B, C, Y, W. The orogenital transmission of clade strains has been proven. It is assumed that N.meningitidis acquired genes for anaerobic growth as a result of genetic recombination during co-presence with N. gonorrhea on the mucous membranes and became to be able to colonize the urogenital tract. The urethritogenic meningococcal clade is the result of the adaptation of the capsular strain of meningococcus serogroup C of the clonal complex CC-11, which is responsible for outbreaks of generalized meningococcal infection in MSM communities. The urethritogenic strains are considered as representatives of the emergent clade of N. gonorhoeae. Their ability to be transmitted through direct sexual contact is unknown. The epidemiological role of the clade in the spread of meningococcal infection is discussed. It is necessary to develop the researches concerning the epidemiological features of meningococcal urethritis and its additional role as the source of meningococcal disease. 

менингококковая инфекцияисточники менингококковой инфекцииуретритыменингококковые уретритыmeningococcal infectionsources of meningococcal diseaseurethritismeningococcal urethritisReferencesКостюкова Н. Н., Бехало В. А. Менингококковое носительство: эпидемиология, возбудитель, формирование иммунной защиты. Эпидемиология и Вакцинопрофилактика, 2017;(5):87–97.Kostyukova NN, Bekhalo VA. Meningococcal carriage: epidemiology, causative agent, inducing of immune protection. Epidemiology and Vaccinal prevention. 2017;(5):87-97. (in Russ.).Taubin HL, Landsberg L. Gonococal meningitis. New Engl. J. Med. 1971;285(9):504–505.Taubin HL, Landsberg L. Gonococal meningitis. New Engl. J. Med. 1971;285(9):504-505.Faur YC, May PC. Isolation of Neisseria meningitidis from patients in a gonorrhea screen program: four year survey in New York City. Am. J. Publ. Health, 1981;71(1):53-58.Faur YC, May PC. Isolation of Neisseria meningitidis from patients in a gonorrhea screen program: four year survey in New York City. Am. J. Publ. Health, 1981;71(1):53-58.Bazan JA,Turner AN, Kirkcaldy RD, et al. Large cluster of Neisseria meningitidis urethritis in Columbus, Ohio, 2015. Clin. Infect. Dis., 2017;65(1):92-99.Bazan JA,Turner AN, Kirkcaldy RD, et al. Large cluster of Neisseria meningitidis urethritis in Columbus, Ohio, 2015. Clin. Infect. Dis., 2017;65(1):92-99.Приказ Минздрава РФ от 20.08.2003 № 415 «Об утверждении протокола ведения больных «гонококковая инфекция».Order of the Ministry of Healthcare of the Russian Federation of 08.20.2003 No. 415 «On approval of the protocol for the management of patients «gonococcal infection». (in Russ.).Faur YC, Weisburd MH, Wilson ME. Isolation of Neisseria meningitidis from the genito-urinary tract and anal canal. J. Clin. Microbiol. 1975;2(3):178-182.Faur YC, Weisburd MH, Wilson ME. Isolation of Neisseria meningitidis from the genito-urinary tract and anal canal. J. Clin. Microbiol. 1975;2(3):178-182.Givan KF, Thomas BW, Johnston AG. Isolation of Neisseria meningitidis from urethra, cervix and anal canal: further observations. Brit. J. Vener. Dis. 1977;83:109-112.Givan KF, Thomas BW, Johnston AG. Isolation of Neisseria meningitidis from urethra, cervix and anal canal: further observations. Brit. J. Vener. Dis. 1977;83:109-112.Wilson APR, Wolff J, Atia W. Acute urethritis due to Neisseria meningitidis groupa acquired by orogenital contact. Genitourin. Med., 1989,65:122-123.Wilson APR, Wolff J, Atia W. Acute urethritis due to Neisseria meningitidis groupA acquired by orogenital contact. Genitourin. Med., 1989,65:122-123Maini M, French P, Prince M. Urethritis due to Neisseria meningitidis in a London genitourinary medicine center population. Int. J. STD AIDS. 1992;3(6):423-425.Maini M, French P, Prince M. Urethritis due to Neisseria meningitidis in a London genitourinary medicine center population. Int. J. STD AIDS. 1992;3(6):423-425.Bazan JA, Peterson AS, Kirkscaldy RD, et al. Notes from the field: increase of Nm-associated urethtitis among man at two central clinics - Columbus, Ohio, and Oakland City, Michigan. 2015. MMWR, 2016;65(21):550-552.Bazan JA, Peterson AS, Kirkscaldy RD, et al. Notes from the field: increase of Nm-associated urethtitis among man at two central clinics - Columbus, Ohio, and Oakland City, Michigan. 2015. MMWR, 2016;65(21):550-552.Dovan-Livengood JM, Miller JK, Martin LE, et al. Genetic basis for nongroupable Neisseria meningitidis. J. Infect. Dis. 187(10):1626-1628.Dovan-Livengood JM, Miller JK, Martin LE, et al. Genetic basis for nongroupable Neisseria meningitidis. J. Infect. Dis. 187(10):1626-1628.Rethless AC, Kretz CB, Chang H-Y, et al. Expansion of a urethritis-associated Neisseria meningitdis clade in the United States with concurrent aquistion of N. gonorhoeae alleles. BMC genomics.2018.23(2):326.Rethless AC, Kretz CB, Chang H-Y, et al. Expansion of a urethritis-associated Neisseria meningitdis clade in the United States with concurrent aquistion of N. gonorhoeae alleles. BMC genomics.2018.23(2):326.Taha M-Kh, Claus H, Veryier F, et al. Evolutionary events associated with an outbreak of meningococcal disease in men who have sex with men. PLoS One. 2016 May 11;11(5):e0154047. doi: 10.1371/journal.pone.0154047. eCollection 2016.Taha M-Kh, Claus H, Veryier F, et al. Evolutionary events associated with an outbreak of meningococcal disease in men who have sex with men. PLoS One. 2016 May 11;11(5):e0154047. doi: 10.1371/journal.pone.0154047. eCollection 2016.Tzeng YL, Bazan JA, Turner AN, et al. Emergence of a new Neisseria meningitdis clonal complex11 lineage 11.2 clade as an effective urogenital pathogen. PNAS 2017;114(16):4237-4242.Tzeng YL, Bazan JA, Turner AN, et al. Emergence of a new Neisseria meningitdis clonal complex11 lineage 11.2 clade as an effective urogenital pathogen. PNAS 2017;114(16):4237-4242.Toh E, Gangaja Dh, Batteiger BE, et al. Neisseria meningitdis ST11 complex isolates associated with nongonococcal urethritis, Indiana, USA, 2015-2016. Emerg. Infect. Dis. 2017;23(2):336-339.Toh E, Gangaja Dh, Batteiger BE, et al. Neisseria meningitdis ST11 complex isolates associated with nongonococcal urethritis, Indiana, USA, 2015-2016. Emerg. Infect. Dis. 2017;23(2):336-339.McIntosh DV, Garey V, Tonneato D, et al. Prevention of rare diseases: how revolutionary techniques can help vulnerable individuals - the example of serogroup B meningococcal infection. Ther. Adw. Vaccines. 2015;3(1):13-23.McIntosh DV, Garey V, Tonneato D, et al. Prevention of rare diseases: how revolutionary techniques can help vulnerable individuals - the example of serogroup B meningococcal infection. Ther. Adw. Vaccines. 2015;3(1):13-23.Blackwel lC, Young H, Bain ShSR. Isolation of Neisseria meningitdis and Neisseria catharralis from the genitorurinary tract and anal canal. Brit. J. Vener. Dis. 1978;54(1):41-44.Blackwel lC, Young H, Bain ShSR. Isolation of Neisseria meningitdis and Neisseria catharralis from the genitorurinary tract and anal canal. Brit. J. Vener. Dis. 1978;54(1):41-44.Kratz MM, Weiss D, Ridpath A, et al. Community-based outbreak of Neisseria meningitdis serogroup C infection in men who have sex with men, New York City, New York, USA. Emerg. Infect. Dis. 2015;21(8):1379-1386.Kratz MM, Weiss D, Ridpath A, et al. Community-based outbreak of Neisseria meningitdis serogroup C infection in men who have sex with men, New York City, New York, USA. Emerg. Infect. Dis. 2015;21(8):1379-1386.Nadura S, Foo Ch, Ngo V, et al. Outbreak of serogroup meningococcal disease primarily affecting men who have sex with men - Southern California, 2016. MMMWR, 2016;65(35):939-940.Nadura S, Foo Ch, Ngo V, et al. Outbreak of serogroup meningococcal disease primarily affecting men who have sex with men - Southern California, 2016. MMMWR, 2016;65(35):939-940.Folaramni TA, Kretz CB, Kamiya H, et al. Increased risk for meningococcal disease among men who have sex with men in the United States. Clin. Infect, Dis. 2017;65:756-763.Folaramni TA, Kretz CB, Kamiya H, et al. Increased risk for meningococcal disease among men who have sex with men in the United States. Clin. Infect, Dis. 2017;65:756-763.Urra E, Alkorta M, Sota M, et al. Orogenital transmission of Neisseria meningitdis serogroup C, confirmed by genotyping technique. Eur. J. Clin. Microbiol. Infect. Dis. 2005;24, iss.1:51-53.Urra E, Alkorta M, Sota M, et al. Orogenital transmission of Neisseria meningitdis serogroup C, confirmed by genotyping technique. Eur. J. Clin. Microbiol. Infect. Dis. 2005;24, iss.1:51-53.Васильева М.Ю., Ковалык И.П. Менингококковый уретрит. Случай из практики. В: Тезисы научн. работ II Всероссийского Конгресса дерматовенерологов, СПб, 25-28 сент. 2007, с. 125.Vasilieva MYu, Kovalyk IP. Meningococcal urethtitis. A practice case. In: The Thesises of II All-Russian dermatologists Congress, 2007, St-Petersburg: 125. (in Russ.).Jannic A, Mammeri H, Larcher L, et al. Orognital transmission of Neisseria meningitdis causing acute urethritis in men who have sex with men. Emerg. Infect, Dis. 2019;25(1):175-176.Jannic A, Mammeri H, Larcher L, et al. Orognital transmission of Neisseria meningitdis causing acute urethritis in men who have sex with men. Emerg. Infect, Dis. 2019;25(1):175-176.Johnwich KO, Zhou J, Law DRS, et al. Invasive potencial of noncapsulated disease isolates of Neisseria meningitdis. Infect. Immun. 2012;80(7):2346-2353.Johnwich KO, Zhou J, Law DRS, et al. Invasive potencial of noncapsulated disease isolates of Neisseria meningitdis. Infect. Immun. 2012;80(7):2346-2353.McNamara A, Topaz N, Wang X, Hariri S, et al. High risk for invasive meningococcal disease among patients receiving Eculizumab (Soliris) despite of meningococcal vaccine. MMWRep. 2017;66(27):734-737.McNamara A, Topaz N, Wang X, Hariri S, et al. High risk for invasive meningococcal disease among patients receiving Eculizumab (Soliris) despite of meningococcal vaccine. MMWRep. 2017;66(27):734-737.Гонококковая инфекция. Клинические рекомендации. 2019.Gonococcal infection. Clinical recommendations. 2019. (in Russ.).

The authors declare that there are no conflicts of interest present.