Disseminated gonorrhea

We discussed a case about a young woman with hx of STIs (syphilis and chlamydia s/p treatment), subacute hx of migratory polyarthralgias, who presented with fevers and acute arthritis / tenosynovitis of her left index finger + thumb. She was found to have gram negative diplococci bacteremia and diagnosed with disseminated gonorrhea.

Framework for arthritis

  • Categorize differentials based on non-inflammatory vs inflammatory, as well as mono- / oligo- / polyarticular.

CDC screening recommendations

  • Men: those at high risk (MSM)
  • Women: can be asymptomatic -> complications of STIs (eg PID, infertility)
    • < 25 yrs old    AND
    • ≥ 25 yrs old + STI risk factors

Preferred screening / diagnostic testing

  • Uncomplicated: NAAT (urine, genitals / throat / rectal swab)
  • Disseminated: Blood, joint, abscess, and/or CSF cultures

Gonorrhea treatment

  • CDC reports increasing azithromycin resistance
  • Ceftriaxone is first line

!Bonus learning! Chlamydia treatment

  • Also increasing azithromycin resistance
  • Doxycycline 100mg BID x7 days is first line

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