Disseminated gonococcal infection is a systemic illness that begins with a mild or absent prodromal phase which progresses to polyarthralgias, tenosynovitis, and skin lesions (pustular or petechial rash).  In some cases, this can ultimately manifest as a purulent arthritis and even pericarditis, endocarditis, or meningitis!

Diagnosis

• Synovial fluid culture and gram stain are only positive less than 40% of the time
• Be sure to inform your lab that you want to evaluate for gonorrhea as this requires special testing
• Blood cultures frequently negative too
• Make sure to collect specimens from mucosal sites (i.e. cervical, rectal, urethral or pharyngeal) as these are more often positive
• Clinical correlation!

Treatment

For “dermatitis-arthritis syndrome”:

• IV ceftriaxone every 24 hours +/- azithromycin for suspected chlamydia infection
• Can change to oral antibiotics if improvement of effusion and rash after IV treatment (i.e oral cefixime for at least 7 days)
• Typically see rapid improvement after initiation of IV antibiotics

For purulent arthritis:

• Likely will need longer course of IV antibiotics and repeat joint aspirations for re-accumulation. Rarely requires surgical drainage.

For all:

• Advise the patient to inform all partners of need for treatment and screen for other STIs

References:

·      SSexually transmitted diseases treatment guidelines, 2015. Workowski KA, Bolan GA, Centers for Disease Control and Prevention

Current Diagnosis & Treatment Emergency Medicine, 7e. Chapter 42. Infectious Disease Emergencies. Jon Jaffe, MD; Taylor Ratcliff, MD

·      Current Diagnosis & Treatment of Sexually Transmitted Diseases. Chapter 16. Gonorrhea. Heidi Swygard, MD, MPH; Arlene C. Sena, MD, MPH; Peter Leone, MD; Myron S. Cohen, MD

Photo:

https://www.footscientific.com/ball-of-foot-pain/ankle-arthritis-foot-sc...