Gonococcal Arthritis

Aka: Gonococcal Arthritis, Septic Joint due to Gonorrhea, Disseminated Gonococcal Infection, Dermatitis-Arthritis Syndrome

II. Presentations: Two distinct presentations

  1. Suppurative Monoarticular Arthritis
    1. Seeding of joint from bacteremia
    2. Requires joint wash-out
  2. Bacteremia Classic Triad: Dermatitis-Arthritis Syndrome (See Gonorrhea)
    1. Polyarthralgia (joints are typically not purulent, and do not require wash-out)
    2. Tenosynovitis
    3. Dermatitis (distal extremity necrotic lesions)

III. Signs

  1. Joints affected in order of involvement
    1. Knees (Most often involved)
    2. Elbows
    3. Ankles
    4. Wrists
    5. Hands or feet
  2. Rarely affected joints
    1. Shoulders
    2. Hips

IV. Labs

  1. Broad-based cultures with lab notification of Gonorrhea suspicion
    1. Cervix or urine Gonorrhea PCR
    2. Rectal culture
    3. Throat Culture
    4. Eye Culture
    5. Blood Cultures
  2. Arthrocentesis for Synovial Fluid
    1. Clear to opaque Synovial Fluid
    2. Synovial Fluid WBC: 30,000 to 100,000 (>80% PMNs)
    3. Gram Stain Positive in <25% of cases
    4. Culture positive in <50% of cases

V. Management

  1. Antibiotic management should be based on culture
  2. Initial empiric management
    1. Ceftriaxone (Rocephin) 1 gram IV q24 hours for at least 7 days AND
    2. Chlamydia management if not excluded (not indicated for Gonorrhea treatment without Chlamydia as of 2020)
      1. Doxycycline 100 mg twice daily for 7 days (preferred as of 2020) OR
      2. Azithromycin 1 g orally for 1 dose
      3. Cyr (2020) MMWR Morb Mortal Wkly Rep 69(50): 1911-6 [PubMed]
        1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
  3. Alternative empiric antibiotic options
    1. Cefotaxime 1 g q8 hours IV
    2. Ceftizoxime 1 g q8 hours IV
    3. Spectinomycin 2 g q12 h IM (not available in U.S.)
  4. Continue IV antibiotics until clinical improvement

VI. References

  1. Swadron and Shoenberger in Herbert (2018) EM:Rap 18(12): 1
  2. (2018) Sanford Guide, accessed on IOS 12/1/2018

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Related Studies

Ontology: Gonococcal joint infection (C0153216)

Concepts Disease or Syndrome (T047)
ICD9 098.50, 098.5
ICD10 A54.42
SnomedCT 186930001, 266139005, 186926004, 44743006
English Gonococcal joint infection NOS, GONOCOCCAL ARTHRITIS, gonococcal infection of a joint, gonococcal infection of joint (diagnosis), gonococcal infection of joint, Gonococcal joint infection, Arthritis gonococcal, gonococcal arthritis, Gonococcal: [joint infection NOS] or [rheumatism], Gonococcal: [joint infection NOS] or [rheumatism] (disorder), Rheumatism - gonococcal, Gonococcal joint infection NOS (disorder), Gonococcal arthritis (disorder), Gonococcal arthritis, Gonococcal infection of joint, Gonococcal rheumatism, Gonococcal infection of joint (disorder), Gonococcal infection of joint, NOS, Gonococcal infection of joint NOS
Italian Artrite gonococcica, Infezione gonococcica delle articolazioni
Dutch gonokokkeninfectie van gewricht, gonokokkenartritis
German Gelenkinfektion infolge Gonokokken, Arthritis infolge Gonokokken, Arthritis durch Gonokokken
Portuguese Infecção gonocócica articular, Artrite gonocócica
Spanish Infección gonocócica articular, infección gonocócica articular, SAI, infección gonocócica articular, SAI (trastorno), artritis gonocócica, infección articular gonocócica (trastorno), infección articular gonocócica, infección gonocócica de la articulación, reumatismo gonocócico, Artritis gonocócica
Japanese 淋菌性関節炎, 関節の淋菌感染, ﾘﾝｷﾝｾｲｶﾝｾﾂｴﾝ, ｶﾝｾﾂﾉﾘﾝｷﾝｶﾝｾﾝ
French Infection gonococcique d'une articulation, Arthrite gonococcique
Czech Gonokoková artritida, Gonokoková infekce kloubu
Hungarian gonococcalis arthritis, ízület gonococcalis fertőzése
Derived from the NIH UMLS (Unified Medical Language System)

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