Gonorrhea is one of the most commonly encountered sexually transmitted diseases (STDs) worldwide and is most frequently diagnosed in younger sexually active males and females [1] [2] [3] [4]. Humans are the only known host of Neisseria gonorrhoeae, and transmission through a sexual intercourse with an infected individual (who is often asymptomatic) is the mode of infection [1] [3]. After the development of a localized infection (urethritis, cervicitis, pharyngitis etc.), bacterial spread through the blood stream can cause a disseminated gonococcal infection (DGI), and gonococcal arthritis is one of the manifestations [2] [3]. Risk factors for this complication include multiple sexual partners, intravenous drug use, pregnancy, menstruation at the time of infection, immunosuppression caused by human immunodeficiency virus (HIV) infection, systemic lupus erythematosus (SLE), or complement deficiency, but also African American ancestry [3] [4] [5]. Gonorrhea is the most common cause of septic arthritis in young adults, and the initial signs and symptoms of gonococcal arthritis are fever, chills, and asymmetric polyarthralgia involving the knees, ankles, and elbows [1] [2] [3] [4] [6]. In addition, tenosynovitis, most commonly involving the smaller extensor tendons of the hand and feet, is seen in 50-60% of cases [4] [6]. However, this stage may be completely absent in some patients, and immediate progression to the suppurative stage of gonococcal arthritis, characterized by a joint swelling and arthritis of only one or two joints (known as septic arthritis), can be observed [2] [3] [5]. The knee, the wrist, the ankle and sometimes the elbow exhibit such changes in most cases [4]. Because gonococcal arthritis stems from DGI, other manifestations, such as dermatitis, and in rare cases, endocarditis and meningitis, might concomitantly develop [2] [3].

• Fever

  [ 713.6 ] Staphylococcus 711.0 Streptococcus 711.0 syphilis (see also Syphilis) 094.0 [ 711.4 ] syringomyelia 336.0 [ 713.5 ] thalassemia (see also Thalassemia) 282.40 [ 713.2 ] tuberculosis (see also Tuberculosis, arthritis) 015.9 [ 711.4 ] typhoid fever [icd9data.com]

  Three presented during the initial "bacteremic stage" with polyarthralgia, fever, skin lesions and sterile synovial fluid. [ncbi.nlm.nih.gov]

  At that time, it was observed during a course of fever therapy for syphilis that the gonococcal arthritis also present had improved. 1 Further studies confirmed this original observation and fever became the accepted form of therapy. [annals.org]

  Gonorrhea is the most common cause of septic arthritis in young adults, and the initial signs and symptoms of gonococcal arthritis are fever, chills, and asymmetric polyarthralgia involving the knees, ankles, and elbows. [symptoma.com]

• Chills

  Patients with the septic form characteristically had, early in the course of their illness, chills and fever, polyarthritis, skin lesions of gonococcemia and relatively little joint effusion. [nejm.org]

  Gonorrhea is the most common cause of septic arthritis in young adults, and the initial signs and symptoms of gonococcal arthritis are fever, chills, and asymmetric polyarthralgia involving the knees, ankles, and elbows. [symptoma.com]

  Fever and chills Joints are painful or tender especially during movement Limited range of movement of the joint Skin lesions What are the possible causes? The bacterium Neisseria gonorrhoeae is responsible for gonorrhea. [firstaidcprvictoria.ca]

  Symptoms of infectious arthritis include Intense pain in the joint Joint redness and swelling Chills and fever Inability to move the area with the infected joint One type of infectious arthritis is reactive arthritis. [icdlist.com]

  Symptoms may include: red and swollen joints joints that are tender or painful, especially when you move restricted joint range-of-motion fever chills skin lesions In infants, symptoms may include: difficulty feeding irritability crying fever spontaneous [healthline.com]

• Intravenous Drugs

  Comorbid conditions included intravenous drug use (n = 8) and systemic lupus erythematosus (n = 3). The knee was the most commonly affected joint. [ncbi.nlm.nih.gov]

  Risk factors for this complication include multiple sexual partners, intravenous drug use, pregnancy, menstruation at the time of infection, immunosuppression caused by human immunodeficiency virus (HIV) infection, systemic lupus erythematosus (SLE), [symptoma.com]

  The most common cause of arthritis in these joints is intravenous drug use. [5] Usually only one joint is affected. [en.wikipedia.org]

  He has no other past medical history, denies intravenous drug abuse, and has had no sick contacts. Vital signs are: T 38.5 C, BP 135/85, P 78, RR 16. Physical exam reveals swelling on the dorsum of the left hand and a warm erythematous right knee. [medbullets.com]

• Reiter Syndrome

  Nearly half of 39 patients admitted with a diagnosis of acute gonococcal arthritis were subsequently recognized as having acute Reiter syndrome. [ncbi.nlm.nih.gov]

  These symptoms were consistent to the features of Reiter syndrome. Bacterial culture of urine was negative, as were rheumatoid factor（RF）and HLA-B27 antigens. [webview.isho.jp]

  Reactive arthritis ----- 2 categories 1 after genitourinary involvement ( URETHRITIS ) is the REITERs syndrome--- along with urethritis, conjunct, and arthritis patients have keratoderma blenorrhagicum ( Clear vesicles on palms and soles, closely resemble [usmleforum.com]

  “Reactive” (sterile) arthritis, formerly known as Reiter’s syndrome, may occur following chlamydial genital infection or bacterial gastroenteritis caused by campylobacter, salmonella, and other agents. [clinicaladvisor.com]

  syndrome : - less common in women; - presents with the triad of urethritis, conjunctivitis, and axial arthritis; - onset is subacute, without fever; - hyperkeratotic skin lesions in palms and soles are typical; - Clinical Presentation: - migratory arthritis [wheelessonline.com]

• Malaise

  There followed progressive malaise and diminished appetite. Painful palms ensued. Inasmuch as her symptoms and overall condition worsened, she returned to The Emergency Department for reassessment. [hopkinsarthritis.org]

  Our patient's initial presentation with urethritis, accompanied by fever, malaise and polyarthritis is classic [ 1, 11 ]. [jbji.net]

  Nonspecific constitutional symptoms may include myalgias, fever, and malaise. Septic arthritis form Joint symptoms begin within days to weeks of gonococcal infection. [odlarmed.com]

  Essential Core Tested Community Questions (4) Sorry, this question is for PEAK Premium Subscribers only (M2.ID.4691) A 24-year-old man presents to the clinic with a one week history of pain in his left hand and stiffness in his right knee, with associated malaise [medbullets.com]

  Fever, chills and malaise It is important to remember that patients presenting with disseminated gonococcal infection may not show any localised signs and or symptoms at the primary site of mucosal infection. [dermnetnz.org]

• Dermatitis

  A patient with popliteal cyst involvement and gonococcal arthritis-dermatitis syndrome is the subject of this report. [ncbi.nlm.nih.gov]

  Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. [odlarmed.com]

  Patients can present with triad of "arthritis-dermatitis" syndrome of tenosynovitis, dermatitis, polyarthralgias without purulent arthritis or with purulent arthritis. [emdaily.cooperhealth.org]

• Pustular Rash

  Gonococcal septic arthritis usually occurs as part of the syndrome of disseminated gonococcal infection, in which patients have some combination of urethritis, tenosynovitis, septic arthritis, and a hemorrhagic and pustular rash. [rheumatologyadvisor.com]

• Arthritis

  However, this stage may be completely absent in some patients, and immediate progression to the suppurative stage of gonococcal arthritis, characterized by a joint swelling and arthritis of only one or two joints (known as septic arthritis), can be observed [symptoma.com]

  Based on our experience gonococcal arthritis should be a consideration in the differential diagnosis of chronic monoarticular arthritis. [ncbi.nlm.nih.gov]

• Joint Effusion

  Patients with the septic form characteristically had, early in the course of their illness, chills and fever, polyarthritis, skin lesions of gonococcemia and relatively little joint effusion. [nejm.org]

  joint effusion in large joint such as hip can be used in guiding aspirations MRI indications detects joint effusion, and may detect adjacent bone involvement such as osteomyelitis Studies Serum labs WBC >10K with left shift ESR >30 ESR is often elevated [orthobullets.com]

  effusions associated with disseminated gonococcal infection are often sterile & may involve immune or hypersensitivity mechanisms - n. gonorrhoeae is found in < 50% of purulent joints and in < 20% of blood cultures from pts w/ disseminated gonococcal [wheelessonline.com]

  effusion, warmth, tenderness, decreased range of motion, and marked erythema. [odlarmed.com]

  In « suppurative form » : septic arthritis (joint swelling and effusion) is frequent: it occurs in 50% of DGI patients. Arthritis is frequently monoarticular. The most commonly involved joint are the knees, wrists, ankles and fingers. [panafrican-med-journal.com]

• Arthralgia

  The gonococcal arthritis-dermatitis syndrome includes tenosynovitis, arthralgias, arthritis, skin lesions, and constitutional symptoms. [ncbi.nlm.nih.gov]

  In SLE, any organ system can be involved, with the most common complaints of fever, arthralgia, and arthritis to be the presenting symptoms which can be difficult to differentiate from a Gonococcal infection. [pediatric-infectious-disease.imedpub.com]

  Migratory arthralgias are the most common presenting symptom in persons with DGI and are usually polyarticular. The arthralgias are typically asymmetric and tend to involve the upper extremities more than the lower extremities. [odlarmed.com]

• Joint Swelling

  In this instance, our patient was a 16-year-old girl suffering from persistent polyarthralgia with joint swelling presenting with brief flare-ups for a period of 1 year. [ncbi.nlm.nih.gov]

  However, this stage may be completely absent in some patients, and immediate progression to the suppurative stage of gonococcal arthritis, characterized by a joint swelling and arthritis of only one or two joints (known as septic arthritis), can be observed [symptoma.com]

  In addition to joint swelling and pain, an untreated gonorrhea infection can lead to other more serious health complications, including: pelvic inflammatory disease (a serious infection of the uterus lining, ovaries, and fallopian tubes that can lead [healthline.com]

  She subsequently developed pain in the left wrist and left knee associated with mild swelling. On exam today, she has joint swelling over the left wrist and a small left knee effusion. [rheumatology.org]

• Migratory Polyarthritis

  Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. [odlarmed.com]

  polyarthritis, tenosynovitis, and dermatitis. [9] Migratory arthritis has an asymmetric distribution, most commonly affecting wrists, ankles, and elbows. [emedicine.medscape.com]

  This patient has disseminated gonococcal infection (DGI) with classic symptoms of tenosynovitis, characteristic skin lesions and a migratory polyarthritis. [rheumatology.org]

Having in mind the specific features and the evident risk factors of this STD, the diagnosis of arthritis caused by Neisseria gonorrhoeae can be made after a thorough clinical workup. A detailed patient history is the first step, which will assess the course and progression of symptoms and identify if any of the mentioned risk factors are present, meaning that an assessment of prior sexual contacts is necessary. Secondly, if a complete physical examination reveals joint-related changes, sufficient evidence are obtained to make a presumptive diagnosis. Microbiological studies are the cornerstone in confirming Neisseria gonorrhoeae as the underlying cause of arthritis, and blood cultures, as well as Gram staining of the obtained samples, yield a very good rate of identification [1] [2] [3] [6] [7]. Additionally, the introduction of more advanced methods, such as the nucleic acid amplification test (NAAT), have shown to be even better compared to blood cultures [2] [3]. Aspiration of synovial fluid can be performed in patients who present with evident signs of arthritis, which will reveal an inflammatory white blood cell count (10 000 to 100 000 cells/mm3), while the inoculation of aspirated fluid onto specific media for cultivation often confirm the presence of Neisseria gonorrhoeae in the setting of negative blood cultures [4] [5]. Because patients are highly likely to suffer from some other STD in addition to gonorrhea, a complete STD panel testing is recommended.

• Staphylococcus Aureus

  Gram-positive cocci (85.1%), particularly Staphylococcus aureus (47.5%), was the most common infective agent, followed in frequency by beta hemolytic streptococcal infection (28.7%) and Gram-negative bacillary infection (13.9%). [ncbi.nlm.nih.gov]

  Staphylococcus aureus 、Haemophilus influenzae B型菌、グループ A Streptococcus 、Streptococcus pneumoniae 、Kingela kingae 、Neisseria meningiditis 、Salmonella spp. が小児における関節炎を引き起こす重要な嫌気性菌である。なかでも Staphylococcus aureus が全年齢層における敗血症性関節炎の原因となる一番重要な病原体である。 [genome.jp]

  Al-Nammari SS, Bobak P, Venkatesh R (2007) Methicillin resistant Staphylococcus aureus versus methicillin sensitive Staphylococcus aureus adult haematogenous septic arthritis. [link.springer.com]

  aureus and neisseria gonorrhea immunocompromised patients staphylococcus aureus and pseudomonas aeruginosa transition to organism-specific antibiotic therapy based once obtain culture sensitivities outcomes treatment can be monitored by following serum [orthobullets.com]

  Staphylococcus aureus is the most common organism. This has not changed for decades, however, methicillin-resistant Staphylococcus aureus (MRSA) is clearly increasing in frequency. [rheumatologyadvisor.com]

Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S. [ncbi.nlm.nih.gov]

A new standardized treatment routine is recommended by the Centers for Disease Control and Prevention (CDC). Your health care provider will determine the best and most up-to-date treatment. [lutheranhealthcare.org]

The routine treatment also had been recommended by Centers of Disease Control and Prevention or CDC. Then your health care provider will decide what the best treatment for you. [fitnesstreatments.com]

Prognosis The prognosis for patients with gonococcal arthritis is excellent provided that there is prompt medical treatment through the appropriate antibiotics and joint drainage. [healthhype.com]

Coverage of each disorder includes more details on treatment and prognosis. [books.google.de]

Outlook (Prognosis) Symptoms usually improve within 1 to 2 days of starting treatment. Full recovery can be expected. Possible Complications Untreated, this condition may lead to persistent joint pain. [dxline.info]

Gonococcal arthritis responds well to antibiotics and prognosis is good when appropriate therapy is quickly initiated. Destructive arthritis may be observed in HIV patients or in chronic infections due to inappropriate treatment. [panafrican-med-journal.com]

A three-phase bone scan was performed, which demonstrated increased uptake in the right sternoclavicular junction of undetermined etiology (Fig 3). [healio.com]

Etiology Pathogen Neisseria gonorrhoeae ( N. gonorrhoeae, gonococcus ) Gram-negative, intracellular, aerobic, diplococci Transmission Risk factors Multiple sexual partners Low socioeconomic status Lack of barrier protection (e.g., condomless sex ) Men [amboss.com]

[…] patients, including IV drug users risk factors age > 80 years medical conditions diabetes rheumatoid arthritis cirrhosis HIV history of crystal arthropathy endocarditis or recent bacteremia IV drug user recent joint surgery Pathophysiology pathoanatomy 3 etiologies [orthobullets.com]

However, the short duration of symptoms, accompanied by flu-like symptoms and rash make an infectious etiology more likely. [rheumatology.org]

GONOCOCCAL INFECTIONS Etiology Caused by Neisseria gonorrhoeae. Epidemiology Since 1997, there has been a gradual but steady increase in reported cases of gonococcal infection. [canada.ca]

Three factors that should be considered are regional epidemiology, the anatomical site of the primary infection, and the possible coexistence of other infectious agents. [ncbi.nlm.nih.gov]

Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology Since 1997, there has been a gradual but steady increase in reported cases of gonococcal infection. Most affected are males 20–24 years of age and females 15–19 years of age. [canada.ca]

Epidemiology The epidemiology is described above. Prognosis See above. Special considerations for nursing and allied health professionals. NA What's the evidence? Gupta, MN, Sturrock, RD, Field, M. [clinicaladvisor.com]

Introduction Classification Neisseria Gram-negative diplococci often intracellular within neutrophils Epidemiology incidence the second most common bacterial sexually-transmitted infection after Chlamydia location genital tract risk factors unprotected [medbullets.com]

Pathophysiology The pathophysiology of bacterial (or fungal) arthritis differs according to the route of entry; that is: Hematogenous (either in the course of a primary bacteremic illness, including endocarditis, or from another focus such as urinary [clinicaladvisor.com]

Pathophysiology The highly infectious N. gonorrhoeae bacteria enter the body by invading the thin mucosal lining of the genitalia, rectum, mouth or throat. can colonize mucosal surfaces of the urethra (tube connecting the urinary bladder to the genitals [healthhype.com]

Pathophysiology N gonorrhoeae is a highly infectious organism capable of colonizing diverse mucosal surfaces. The risk of infection from a single contact is estimated at 60-90% among women and 20-50% among men. [odlarmed.com]

O’Brien JP, Goldenberg DL, Rice PA (1983) Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. [link.springer.com]

Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore). 1983; 62(6):395-406. PubMed | Google Scholar Schwebke JR, WittingtonW, Rice RJ et al. [panafrican-med-journal.com]

The second is to locate, test, and treat all sexual contacts of the infected person to prevent further spread of the disease. A new standardized treatment routine is recommended by the Centers for Disease Control and Prevention (CDC). [lutheranhealthcare.org]

Read also: Common Symptoms and Treatments for Foot Osteoarthritis Preventions You should not have sexual activity that becomes the only method in preventing the gonorrhea. [fitnesstreatments.com]

Prevention Not having sexual intercourse (abstinence) is the only absolutely sure method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any sexually transmitted disease (STD) can reduce risk. [dxline.info]

Prevention Not having sexual intercourse (abstinence) is the only sure method to prevent gonorrhea. A monogamous sexual relationship with a person who you know does not have any sexually transmitted disease (STD) can reduce your risk. [stlukes-stl.com]

The Centers for Disease Control and Prevention (CDC) reports that there are 820,000 new infections in the United States each year. [healthline.com]

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6. Mayor MT, Roett MA, Uduhiri KA. Diagnosis and management of gonococcal infections. Am Fam Physician. 2012;86(10):931-938.
7. Ng L-K, Martin IE. The laboratory diagnosis of Neisseria gonorrhoeae. Can J Infect Dis Med Microbiol. 2005;16(1):15-25.