How did the STD get there, Doc??


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!



  • 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!




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





·      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