Gonococcal arthritis

Alternative names
Disseminated gonococcal infection (DGI)

Definition
Gonococcal arthritis is an infection, usually of a single joint (in 90% to 95% of cases) that occurs with gonorrhea.

Causes, incidence, and risk factors

This infection occurs in people who have been infected with gonorrhea. It affects women more frequently than men (4:1) and its highest incidence is among sexually active adolescent girls. There is also increased risk during menstruation and pregnancy.

Two forms of arthritis exist - one with skin rashes and multiple joint involvement, and a second, less common, form in which disseminated gonococcemia leads to infection of a single joint (monoarticular) and joint fluid cultures are positive.

Single joint arthritis follows generalized spread (dissemination) of the gonococcal infection. Dissemination is associated with symptoms of fever, chills, multiple joint aches (arthralgia), and rashes (1-mm to 2-cm red macules). This episode may end as a single joint becomes infected. The most commonly involved joints are the large joints such as the knee, wrist, and ankle.

Symptoms

     
  • Migrating joint pain for 1 to 4 days (polyarthralgia)  
  • Pain in the hands/wrists due to tendon inflammation (tenosynovitis)  
  • Single joint pain  
  • Fever  
  • Skin rash (lesions are flat, pink to red, may become pustular or purpuric)  
  • Pain or burning on urination  
  • Lower abdominal pain

Signs and tests

     
  • Positive cervical Gram stain (positive for gonococci)  
  • Urethral culture for gonorrhea in men  
  • Cervical culture for gonorrhea in women  
  • Rectal culture for gonorrhea in men and women  
  • Throat culture for gonorrhea  
  • Joint fluid Gram stain  
  • Synovial fluid culture for gonorrhea (culture of joint aspirate)  
  • Blood cultures should be checked in all cases of possible gonococcal arthritis

Treatment

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first aspect is to cure the infected person. The second is to locate, test and treat all sexual contacts of the infected person to prevent further spread of the disease. Mandatory reporting has been instituted and has, until recently, has held the number of cases of gonorrhea at a low level. However, the incidence of gonorrhea is once again rising.

Beginning about the time of the Vietnam war, the United States saw the appearance of strains of gonorrhea that are resistant to penicillin and tetracycline. These resistant strains have been increasing over the last few years. Because of this, a new standardized treatment regimen has now been recommended by the Centers for Disease Control and Prevention (CDC).

Instead of the standard penicillin treatment, gonorrhea is now treated by a large number of new and very potent antibiotics. Consult your health care provider to ascertain the best and most up-to-date treatment.

A follow-up visit 7 days after treatment is important to recheck cultures and confirm the cure of infection.

Expectations (prognosis)

Symptoms usually improve within 24 to 48 hours after initiation of treatment. Complete recovery is anticipated with treatment.

Complications

Untreated, there may be:

     
  • Persistent discomfort in the affected joints  
  • Infertility  
  • Other Complications of gonorrhea, such as disseminated gonorrhea (spread throughout the body)

Calling your health care provider

Call your health care provider if you experience symptoms suggestive of gonococcal arthritis.

Prevention

Prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner are considered the ideal means of prevention. The use of condoms provides the best protection against gonorrhea and other sexually transmitted diseases. Treatment of all sexual partners of a known infected person is essential to prevent further spread or reinfection.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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