Disseminated Gonococcal Infection – 10/16/17

Epidemiology
  • Young (< 40 years old)
  • Women (because they are usually asymptomatic)
  • 0.5-3% of people infected with N. gonorrheae
  • Common cause of acute arthritis in young people

Clinical Manifestations

  • 1) triad of tenosynovitis (migratory), dermatitis (painless lesions – usually pustular or vesiculopustular), and polyarthralgias (small or large joints – usually asymmetric)
  • 2) purulent arthritis without skin lesions – usually one joint affecting knees, wrist, or ankles

Evaluation

  • Clinical suspicion – thorough history of physical
  • Blood cultures
  • Specimen from mucosal sites – urogenital, rectal, pharyngeal
  • Synovial fluid – only positive 50% of the time – NAAT testing better than cultures

Treatment

  • Ceftriaxone 7-14 days (can give IM if non-purulent arthritis)
  • Remember to co-treat for chlamydia with azithromycin

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