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