Info
disseminated gonococcal infection
Epidemiology (Infect Dis Clin North Am 2005;19:853)
- N. gonorrhea; most frequent type of infectious arthritis in sexually active young adults
- Normal host as well as Pts w/ deficiencies of terminal components of complement
- ♀:♂ = 4:1 historically, but now ↑ in ♂. Occurs in <3% of N. gonorrhea infxn; ↑ incidence w/ menses, pregnancy, postpartum, SLE; ↑ incidence in MSM.
- Clinical manifestations
Additional diagnostic studies
- Synovial fluid: WBC >50k (but can be <10k), poly predominant Gram stain ⊕ in ~25%; culture ⊕ in up to 50% if done w/ Thayer-Martin media
- Blood culture:
- more likely ⊕ in arthritis-dermatitis syndrome;
- rarely in joint-localized disease
- Gram stain and culture of skin lesions occasionally ⊕
- Cervical, urethral, pharyngeal, rectal PCR or cx on Thayer-Martin media; ✓ Chlamydia
Treatment
- Ceftriaxone × 7-14 d w/ empiric doxycycline × 7 d for Chlamydia if co-infection has not been excluded (see STI)
- Joint arthroscopy/lavage may be required for purulent arthritis; rarely >1 time