Gonococcal arthritis

Answer 1

Definition

Gonococcal Arthritis is inflammation of a joint (usually just one) due to a gonorrhea infection.

See also: Non-gonococcal bacterial arthritis

Alternative Names

Disseminated gonococcal infection (DGI)

Causes, incidence, and risk factors

Gonococcal arthritis is a bacterial infection of a joint. It occurs in people who have gonorrhea. It affects women more often than it affects men, and is most common among sexually active adolescent girls.

Two forms of gonococcal arthritis exist:

• One involves skin rashes and multiple joints, usually large joints such as the knee, wrist, and ankle
• The second, less common form involves spread of the bacteria through the blood (disseminated gonococcemia), which leads to infection of a single joint

Symptoms

• Fever
• Lower abdominal pain
• Migrating joint pain for 1 to 4 days
• Pain in the hands or wrists due to tendon inflammation
• Pain or burning on urination
• Single joint pain
• Skin rash (lesions are slightly raised, pink to red, may later contain pus or appear purple)

Signs and tests

Blood cultures should be checked in all cases of possible gonococcal arthritis.

Tests will be done to check for a gonorrhea infection. This may involve taking samples of tissue, stool, joint fluids, or other body material and sending them to a lab for examination under a microscope. Examples of such tests include:

• Cervical gram stain
• Culture of joint aspirate
• Joint fluid gram stain
• Throat culture
• Urine test for gonorrhea

Treatment

The gonorrhea infection must be treated. For detailed information about treating this disease, see gonorrhea.

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first 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. Some locations allow you to take counseling information and treatment to your partner(s) yourself. In other locations, the health department will contact your partner(s).

A new standardized treatment routine is recommended by the Centers for Disease Control and Prevention (CDC). Your health care provider will determine the best and most up-to-date treatment. A follow-up visit 7 days after treatment is important, if the infection was complicated, to recheck blood tests and confirm the cure of infection.

Expectations (prognosis)

Symptoms usually improve within 1 to 2 days of starting treatment. Full recovery can be expected.

Complications

Untreated, this condition may lead to persistent joint pain.

For information on other gonorrhea-related complications, see gonorrhea.

Calling your health care provider

Call your health care provider if you have symptoms of gonorrhea or gonococcal arthritis.

Prevention

Not having sexual intercourse (abstinence) is the only absolutely sure method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any sexually transmitted disease (STD) can reduce risk. Monogamous means you and your partner do not have sex with any other people.

You can greatly lower your risk of catching an STD by using a condom every time you have sex. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. For instructions on how to use a condom, see Safe sex.

Treatment of all sexual partners is essential to prevent re-infection.

References

Bamberger DM. Gonorrhea. In: Rakel P, Bope ET, eds. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa: Saunders Elsevier: 2008: chap 184.

Bauer HM, Wohlfeiler D, Klausner JD, et al. California Guidelines for Expedited Partner Therapy for Chlamydia trachomatis and Neisseria gonorrheae. Sexually Transmitted Diseases. 2008; 35(3):314-319.

Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance, 2007. Atlanta, GA: U.S. Department of Health and Human Services; December 2008. Accessed April 5, 2009.

Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR. 2007;56(14):332-336. Accessed April 5, 2009.

U.S. Preventive Services Task Force. Screening for gonorrhea: recommendation statement. Ann Fam Physician. 2005;3(3):263-267. Accessed April 5, 2009.

Answer 2

Definition

Gonococcal arthritis is inflammation of a joint (usually just one) due to a gonorrhea infection.

See also: Non-gonococcal bacterial arthritis

Alternative Names

Disseminated gonococcal infection (DGI)

Causes, incidence, and risk factors

Gonococcal arthritis is an infection of a joint. It occurs in people who have gonorrhea caused by the bacteria Neisseria gonorrhoeae. It affects women more often than men, and it is most common among sexually active adolescent girls.

Two forms of gonococcal arthritis exist:

• One involves skin rashes and many joints, usually large joints such as the knee, wrist, and ankle
• The second, less common form involves the spread of the bacteria through the blood (disseminated gonococcemia), which leads to infection of a single joint

Symptoms

• Fever
• Lower abdominal pain
• Joint pain for 1 to 4 days
• Pain in the hands or wrists due to tendon inflammation
• Pain or burning during urination
• Single joint pain
• Skin rash (sores are slightly raised, pink to red, and may later contain pus or appear purple)

Signs and tests

Blood cultures should be checked in all cases of possible gonococcal arthritis.

Tests will be done to check for a gonorrhea infection. This may involve taking samples of tissue, stool, joint fluids, or other body material and sending them to a lab for examination under a microscope. Examples of such tests include:

• Cervical gram stain
• Culture of joint aspirate
• Joint fluid gram stain
• Throat culture
• Urine test for gonorrhea

Treatment

The gonorrhea infection must be treated. For detailed information about treating this disease, see gonorrhea.

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first 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.

Some locations allow you to take counseling information and treatment to your partner(s) yourself. In other locations, the health department will contact your partner(s).

A standardized treatment routine is recommended by the Centers for Disease Control and Prevention (CDC). Your health care provider will determine the best and most up-to-date treatment. A follow-up visit 7 days after treatment is important, if the infection was complicated, to recheck blood tests and confirm that the infection was cured.

Expectations (prognosis)

Symptoms usually improve within 1 to 2 days of starting treatment. Full recovery can be expected.

Complications

Untreated, this condition may lead to persistent joint pain.

For information on other gonorrhea-related complications, see gonorrhea.

Calling your health care provider

Call your health care provider if you have symptoms of gonorrhea or gonococcal arthritis.

Prevention

Not having sexual intercourse (abstinence) is the only absolutely sure method of preventing gonorrhea. A monogamous sexual relationship with a person who you know does not have any sexually transmitted disease (STD) can reduce your risk. Monogamous means you and your partner do not have sex with any other people.

You can greatly lower your risk of infection with an STD by using a condom every time you have sex. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. For instructions on how to use a condom, see: Safe sex.

Treating all sexual partners is essential to prevent re-infection.

References

Ohl CA. Infectious arthritis of native joints. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 102.

Shrestha RK, Englund K. Infectious disease. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010:section 8.

Workowski KA, Berman S: Centers for Disease Control and Prevention (CDC). SExually transmitted diseases treatment guidelines. 2010. MMWR Recomm Rep. 2010; 59(RR-12):1-110.

Reviewed By

Review Date: 06/09/2011

Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.