Atypical infections caused by pathogenic Neisseria species N. meningitidis and N. gonorrhoeae

SUMMARY Atypical pathogenic Neisseria infections, including disseminated gonococcal infection, primary meningococcal conjunctivitis, and urogenital meningococcal infection, are clinically important yet under-recognized syndromes that challenge traditional species-disease paradigms. The increasing use of whole-genome sequencing has revealed adaptive convergence within the Neisseria genus, providing new insights into the evolution, pathophysiology, and tissue tropism of these infections. This review aims to outline current epidemiological, clinical, and genomic evidence to define transmission, risk factors, and molecular determinants underpinning disease. Improved understanding of these conditions is essential to optimize diagnosis, treatment, and public health guidance.