Gonorrhea is a sexually transmitted disease (STD) caused by N. gonorrhea, which can infect the genital tract, rectum, or pharynx. One complication of this STD is the spread of the bacterial pathogen to the blood and other sites. This is known as gonococcemia, which is also referred to as disseminated gonococcal infection. Disseminated disease affects up to 3% of individuals with gonorrhea  and develops within 2 to 3 weeks after a primary genital infection .
The clinical picture of gonococcemia will typically feature a rash, polyarthralgia, and tenosynovitis , although not all three have to be present for the diagnosis. Cutaneous manifestations are described below. The arthralgia encompasses numerous, asymmetrical joints and is typically associated with sterile culture from synovial fluid  . Polyarthralgia and tenosynovitis more commonly involve the joints of the hands and feet such as wrists and ankles .
The risk factors for gonococcemia include the female gender, multiple sexual partners, pregnancy, menses, low socioeconomic status, intravenous drug use, HIV, hypocomplementemia, and systemic lupus erythematosus .
The patient's vital signs are notable for a low-grade fever. With regards to the rash, the skin lesions are characterized as vesicular, maculopapular, pustular or vesicular and they appear on the limbs, palms, soles, and trunk . Remarkable findings on the musculoskeletal exam include tenderness and erythema of the involved joints and tendon sheaths as well as limited range of motion.
As a frequent cause of medical visits in young sexually active adults , gonococcemia should be suspected when an individual in this population presents with at least a rash and tenosynovitis . Moreover, it is paramount to diagnose and treat these patients promptly to prevent complications. The workup is composed of the patient's history and risk factors, physical exam, and the appropriate studies.
The microbial diagnostic tools include culture and/or nucleic acid amplification tests (NAATs) of samples obtained from the genital tract, extragenital sites, blood, synovial fluid, skin, and cerebrospinal fluid if applicable  . Also, blood and joint fluid specimens should be assessed with a Gram stain.
With regards to the results, negative findings do not rule out the diagnosis of gonococcemia. For example, joint aspirates, skin lesions, and blood cultures are commonly sterile in these patients   while asymptomatic sites may demonstrate an infection .
Further important studies include a complete blood count (CBC), which may reveal mild leukocytosis, and erythrocyte sedimentation rate (ESR), which can be slightly elevated.
The United States Preventive Services Task Force (USPSTF) recommends screening for the presence of concurrent STDs such as chlamydia, syphilis, and HIV . Additionally, women of reproductive age with STDs should have a pregnancy test.