| Source The National Library of MedicineGonococcal Arthritis
A gonococcal infection, usually of a single joint (in 90% to 95%
of cases), that occurs during an infection with gonorrhea.
Causes, incidence, and risk factors of Gonococcal Arthritis
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 of Gonococcal
Arthritis
- 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 or lesion
- flat rash (macular)
- pink to red
- with time rash may become pustular or purpuric
- vaginal or urethral discharge
- pain or burning on urination
- lower abdominal pain
Signs and tests for Gonococcal
Arthritis
- 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 of Gonococcal
Arthritis
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 and test all sexual contacts and to treat them to
prevent further spread of the disease. That is why mandatory reporting has been instituted
and has, until recently, held the number of cases of gonorrhea at a low level. However,
the incidence 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 (CDC).
Instead of the standard penicillin treatment, gonorrhea is now treated by a large
number of new and very potent antibiotics. You should check with your health care provider
at the time of treatment to ascertain the best and most up-to-date treatment at the time.
A follow-up visit 7 days after treatment to recheck cultures and confirm the cure of
infection is important.
Expectations (prognosis) for Gonococcal Arthritis
Symptoms usually improve within 24 to 48 hours after initiation
of treatment. Complete recovery is anticipated with treatment.
Complications of Gonococcal
Arthritis
Untreated, there may be:
- persistent discomfort in the joint(s)
- infertility
- other gonorrhea complications, such as disseminated gonorrhea (spread throughout the
body)
Prevention of Gonococcal
Arthritis
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.
More information about arthritis prevention
Update Date: 2/20/2002
Updated by: Camille Kotton, M.D., Infectious Diseases Division,
Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA. Review
provided by VeriMed Healthcare Network.
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