II. Presentations: Two distinct presentations
- Gonococcal Arthritis
- Suppurative Monoarticular, Oligoarticular or Polyarticular presentations
- Seeding of joint from bacteremia
- Requires joint wash-out
- Bacteremia Classic Triad: Dermatitis-Arthritis Syndrome (See Gonorrhea)
- Polyarthralgia (joints are typically not purulent, and do not require wash-out)
- Tenosynovitis
- Dermatitis (distal extremity necrotic lesions)
- Malaise
III. Signs
IV. Labs
- Broad-based cultures with lab notification of Gonorrhea suspicion
- Cervix or urine Gonorrhea PCR
- Rectal culture or PCR
- Throat Culture or PCR
- Eye Culture
- Blood Cultures
-
Arthrocentesis for Synovial Fluid
- Clear to opaque Synovial Fluid
- Synovial Fluid WBC: 30,000 to 100,000 (>80% PMNs)
- Gram Stain Positive in <25% of cases
- Culture positive in <50% of cases
V. Management
- Antibiotic management should be based on culture
- Initial empiric management
- Ceftriaxone (Rocephin) 1 gram IV q24 hours for at least 7 days AND
- Chlamydia management if not excluded (not indicated for Gonorrhea treatment without Chlamydia as of 2020)
- Doxycycline 100 mg twice daily for 7 days (preferred as of 2020) OR
- Azithromycin 1 g orally for 1 dose
- Cyr (2020) MMWR Morb Mortal Wkly Rep 69(50): 1911-6 [PubMed]
- Alternative empiric antibiotic options
- Cefotaxime 1 g q8 hours IV
- Ceftizoxime 1 g q8 hours IV
- Spectinomycin 2 g q12 h IM (not available in U.S.)
- Continue IV antibiotics until clinical improvement
VI. References
- Swadron and Shoenberger in Herbert (2018) EM:Rap 18(12): 1
- (2018) Sanford Guide, accessed on IOS 12/1/2018