The California Department of Public Health (CDPH) is urging health care providers to expand testing for gonorrhea and Disseminated Gonococcal Infection (DGI) following a surge of new infections over the past few years. DGI is a sometimes-fatal complication of gonorrhea that presents with pain and swelling of joints, arthralgias, and petechial or pustular rash.

CDPH suspects the increase in cases is due to a decrease in STD screening, testing and treatment during the COVID-19 pandemic. In 2020, CDPH reported a roughly doubling of DGI cases versus the previous year. In 2021, those cases continued to increase and included four deaths that were likely attributed to DGI. Most DGI cases in California have occurred among adults aged 30-50 years old (which is an age group not typically screened for gonorrhea). CDPH also reports a disproportional number of DGI infections amongst Hispanic/Latinx individuals, which make up the largest ethnic group in California.

CDPH is recommending the following to health care providers in all settings:

1. Increased testing for gonorrhea for all sexually active individuals who use illicit drugs (especially methamphetamine) at all possible exposure sites (urogenital, pharyngeal and rectal).
2. Regardless of known exposure, test for gonorrhea in all sexually active patients who experience signs of symptoms consistent with DGI, as well as performing a culture of blood and sites of localized infection.
3. High-risk individuals (sexually active females under the age of 25, pregnant patients, men who have sex with men, HIV patients, and those who are immunocompromised) should continue to be routinely screened for gonorrhea and other sexually transmitted diseases.  

Health care providers should report all suspected, probable or confirmed case of DGI to their local health department within one business day.

For more information, see the letter from CDPH.