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 [1] and develops within 2 to 3 weeks after a primary genital infection [2].

The clinical picture of gonococcemia will typically feature a rash, polyarthralgia, and tenosynovitis [3], 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 [4] [5]. Polyarthralgia and tenosynovitis more commonly involve the joints of the hands and feet such as wrists and ankles [6].

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 [7].

Complications

Meningitis [4], myocarditis [8], and hepatic abscess formation [9] are among the rare sequelae of gonococcemia.

Physical exam

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 [4]. Remarkable findings on the musculoskeletal exam include tenderness and erythema of the involved joints and tendon sheaths as well as limited range of motion.

Patients with gonococcal meningitis exhibit meningeal signs and mental status changes while those with gonococcal endocarditis develop tachycardia and a new murmur.

• Hemophilia A

  Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious [books.google.de]

• Fever

  […] scarlet fever What causes a strawberry toungue? Describe the progression of this. Scarlet fever -starts white and then by day 5 turns red What is associated with "sandpaper" quality or "sunburn with goosebumps"? scarlet fever T or F. [quizlet.com]

  Report of a Case A 26-year-old Negro man was admitted to USAF Hospital Andrews on May 5, 1965, for recurrent fever, polyarthralgia, and a skin eruption of nine weeks' duration. [jamanetwork.com]

  The onset of gonococcemia is often abrupt, with fever (usually 101°F-104°F [38.3°C-40°C]), skin lesions, and arthralgias and/or tenosynovitis. [visualdx.com]

  In 3 cases no or merely a slight fever occurred but chills suggested fever of a high remittent type. In 1 case the fever was low and remittent, in another a continuous, moderate increase of temperature had existed. [docksci.com]

  Frequently, these sparse, acral lesions occurring in young adults, especially women, who have fever, polyarthralgia, and tenosynovitis, are dismissed as folliculitis or regarded as manifestations of "flu," acute rheumatic fever or systemic lupus erythematosus [nejm.org]

• Pain

  There is pain on motion of her right knee and left elbow and flexion of the fingers of her right hand causes pain in the palm. You note a cutaneous lesion adjacent to her left elbow (see picture below). [etsu.edu]

  Symptoms Fever Chills, malaise Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain) Joint swelling (knees, wrists, ankles) Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps Painful tendons [health.am]

  Abdominal spread of gonococci may cause gonococcal perihepatitis ( Fitz-Hugh-Curtis syndrome ) with abdominal pain, tenderness, and, occasionally, a hepatic friction rub. [visualdx.com]

  However, you may experience: thick discharge from the penis increased vaginal discharge painful urination or burning with urination spotting between menstrual periods swollen or painful testicles painful bowel movements anal itching anal discharge sore [healthline.com]

• Chills

  Abstract A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. [ncbi.nlm.nih.gov]

  […] skip to main content column skip to left navigation skip to horizontal navigation Medical Mystery Quillen College of Medicine Medicalmystery > Archive > Last Weeks Mystery A 24-year-old previously healthy woman presents with a 2 day history of fever, chills [etsu.edu]

  [Case Reports] Int J Dermatol 2003; 42(3):208-9 Mehrany K, Kist JM, … DiCaudo DJ IJ A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. [unboundmedicine.com]

  Symptoms Fever Chills, malaise Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain) Joint swelling (knees, wrists, ankles) Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps Painful tendons [health.am]

• Malaise

  G., a woman, aged 21, a bookkeeper, admitted to the hospital, May 5, 1931, had been forced to bed, five weeks previously, by painful joints, malaise and fever. The joints affected were the left shoulder, the left ankle, the [jamanetwork.com]

  Symptoms Fever Chills, malaise Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain) Joint swelling (knees, wrists, ankles) Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps Painful tendons [health.am]

  Patients have fever, chills, and malaise and then develop multiple inflamed tendons and subsequent cutaneous manifestations. The skin lesions classically start as flat erythematous macules, which rapidly develop into hemorrhagic vesiculopustules. [derm101.com]

• Inflammation

  Epididymitis is inflammation and swelling of the epididymis, a tube at the back of the testicles. Untreated gonorrhea can also be passed from mother to baby during childbirth. [healthline.com]

  Pharyngitis (inflammation of the throat) that may cause mild to severe difficulty in swallowing may also occur in men and women with gonorrhoea. [dermnetnz.org]

  Gonococcal arthritis is inflammation of a joint due to a gonorrhea infection. Gonococcal arthritis is an infection of a joint. It occurs in people who have gonorrhea, which is caused by the bacteria Neisseria gonorrhoeae. [medlineplus.gov]

  Disseminated gonococcal infection (DGI); Disseminated gonococcemia; Septic arthritis - gonococcal arthritis Gonococcal arthritis is inflammation of a joint due to a gonorrhea infection. Gonococcal arthritis is an infection of a joint. [baptistjax.com]

  […] mechanism molecular biology pili facilitate attachment to mucosal surfaces antigenic variation IgA protease allows invasion of mucosal surfaces contains lipooligosaccharides (LOS) with strong endotoxin activity invasion of mucosal surfaces results in inflammation [medbullets.com]

• Sore Throat

  The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for Gardnerella vaginitis and several urinary tract infections. [ncbi.nlm.nih.gov]

  The patient recalled having a sore throat and a nonproductive cough before the onset of the fever a… Publisher Full Text New Search Next [unboundmedicine.com]

  She denied dysuria, vaginal discharge, sore throat, insect or animal bites, inappropriate exposure to body fluids, or history of STDs. She did have recent new tattoos. [shmabstracts.com]

  throat When gonorrhea infections aren’t treated, the bacteria can spread, causing more symptoms. [healthline.com]

• Abdominal Pain

  Abdominal spread of gonococci may cause gonococcal perihepatitis ( Fitz-Hugh-Curtis syndrome ) with abdominal pain, tenderness, and, occasionally, a hepatic friction rub. [visualdx.com]

  A 15-year-old boy with a family history of renal disease, presents with hematuria and lower abdominal pain, as his third episode in the past 2 years.His BP:145/90mmHg,HR:80/min,T:37.C RR: 14/min. [coursehero.com]

  […] stage Creamy or green, pus-like or bloody vaginal discharge Itchy or irritable vulva Painful urination (burning sensation) Lower abdominal pain may indicate pelvic inflammatory disease or peritonitis Discharge in men can be mild to severe and does recede [dermnetnz.org]

  Women usually present with pelvic and abdominal pain, fever, chills, and cervical motion tenderness. This complex of signs and symptoms is referred to as pelvic inflammatory disease (PID). [cdc.gov.tw]

  […] intercourse) Mild lower abdominal pain If the infection progresses to pelvic inflammatory disease (PID), symptoms may include the following: Lower abdominal pain: Most consistent symptom of PID Increased vaginal discharge or mucopurulent urethral discharge [emedicine.medscape.com]

• Lower Abdominal Pain

  A 15-year-old boy with a family history of renal disease, presents with hematuria and lower abdominal pain, as his third episode in the past 2 years.His BP:145/90mmHg,HR:80/min,T:37.C RR: 14/min. [coursehero.com]

  […] stage Creamy or green, pus-like or bloody vaginal discharge Itchy or irritable vulva Painful urination (burning sensation) Lower abdominal pain may indicate pelvic inflammatory disease or peritonitis Discharge in men can be mild to severe and does recede [dermnetnz.org]

  […] intercourse) Mild lower abdominal pain If the infection progresses to pelvic inflammatory disease (PID), symptoms may include the following: Lower abdominal pain: Most consistent symptom of PID Increased vaginal discharge or mucopurulent urethral discharge [emedicine.medscape.com]

  Patients may also complain of postcoital bleeding and lower abdominal pain. [intranet.tdmu.edu.ua]

• Arthritis

  Inflammatory bowel disease ( ulcerative colitis, Crohn disease ) Rubella Rubella immunization Reactive arthritis Non-gonococcal arthritis Rash and arthritis: Meningococcemia Systemic lupus erythematosus Syphilis Hepatitis Bacterial endocarditis Best [visualdx.com]

  Laboratory studies were consistent with an acute septic arthritis and the diagnosis of the gonococcal arthritis-dermatitis syndrome was entertained. Read More Disseminated gonorrhea: diagnosis through contact tracing. [pubfacts.com]

  The Acute Arthritis-Dermatitis Syndrome: The Changing Importance of Neisseria gonorrhoeae and Neisseria meningitidis. [jhu.pure.elsevier.com]

  Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" [ 1 ] and "Disseminated gonococcal infection" [ 1 ] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis [enacademic.com]

  Arthritis Rheum 1990; 33: 1438–1441. [journals.sagepub.com]

• Arthralgia

  Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" [ 1 ] and "Disseminated gonococcal infection" [ 1 ] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis [enacademic.com]

  The onset of gonococcemia is often abrupt, with fever (usually 101°F-104°F [38.3°C-40°C]), skin lesions, and arthralgias and/or tenosynovitis. [visualdx.com]

  AB - Sexually active young adults with an acute arthralgia or arthritis, with or without associated skin lesions, often have disseminated gonococcal infection (DGI). [jhu.pure.elsevier.com]

  Patients typically present with rash, arthralgias, and fever within several days to weeks of starting a medication. [sinaiem.org]

• Migratory Polyarthritis

  […] gonococcal infection"[1]) is a rare complication of mucosal Neisseria gonorrhoeae infection, or Gonorrhea, that occurs when the bacteria invade the bloodstream.[2] It is characterized by fever, tender hemorrhagic pustules on the extremities or the trunk, migratory [wikiwand.com]

  polyarthritis, tenosynovitis, and dermatitis ( pustular skin lesions). [3] See also [ edit ] Primary gonococcal dermatitis List of cutaneous conditions References [ edit ] ^ a b Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). [wikivisually.com]

  polyarthritis, and tenosynovitis.[3] It also rarely leads to endocarditis and meningitis.[4] This condition occurs in 0.5-3% of individuals with gonorrhea, and it usually presents 2–3 weeks after acquiring the infection.[5] Risk factors include female [en.wikipedia.org]

• Joint Effusion

  There were no skin lesions, nodules or joint effusions. The patient had a tunnelled central venous device in her right internal jugular vein and the insertion site had no erythema or discharge. [cmaj.ca]

  Suspected disseminated gonococcal infection When DGI is suspected, blood and joint effusions should be sent for Gram stain and culture, although negative Gram stain results and sterile cultures do not rule out disseminated disease. [intranet.tdmu.edu.ua]

• Eruptions

  The sole criterion for the selection of cases was the presence of a characteristic cutaneous eruption. The suporting evidence for the diagnosis of gonococcal disease [jamanetwork.com]

  […] one of the most common STD in the industrialized world • Neisseria gonorhoeae • Les Clapier in Paris • emerging antimicrobial resistance • 50 % infected women asymptomatic • Gonococcemia occurs 1.0 - 0.5 percent cases • Hemorrhagic vesiculopustular eruption [quizlet.com]

  Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" [ 1 ] and "Disseminated gonococcal infection" [ 1 ] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis [enacademic.com]

  English Wikipedia - The Free Encyclopedia Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" and "Disseminated gonococcal infection") is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia [thesaurus.babylon-software.com]

• Skin Rash

  […] of wrists or heels A combination of skin rash and aching, swollen tendons - sometimes known as tenosynovitis-dermatitis syndrome Signs and tests Blood culture Skin lesion culture Culture of synovial fluid from joints Urethral discharge culture Culture [health.am]

  Symptoms Fever Chills, malaise Joint pain, either single or multiple joints ( knee pain, wrist pain, ankle pain ) Joint swelling (knees, wrists, ankles) Skin rash : the classical rash associated with gonococcemia begins as flat pink to red spots (macules [amamed.com]

  Chills Fever General ill feeling (malaise) Joint pain Joint swelling Painful tendons of wrists or heels Skin rash -- flat, pink-to-red spots turn into raised, pus-filled bumps The combination of skin rash and aching, swollen tendons is sometimes known [lutheranhealthcare.org]

• Erythema

  Erythema ab igne Erythema ab igne (EAI), also known as hot water bottle rash, is a skin condition caused by long-term exposure to heat (infrared radiation). [howlingpixel.com]

  • If untreated chronic arthritis and neurologic and cardiac complication may develop • Erythema chronicum migrans ECM is the early characteristic cutaneous eruption • The spirochete can be stained in skin biopsy • Erythema chronicum migrans ECM • Days [quizlet.com]

  Remarkable findings on the musculoskeletal exam include tenderness and erythema of the involved joints and tendon sheaths as well as limited range of motion. [symptoma.com]

  Codes ICD10CM: A54.86 – Gonococcal sepsis SNOMEDCT: 5085001 – Gonococcemia Look For Subscription Required Diagnostic Pearls Subscription Required Differential Diagnosis & Pitfalls Arthritis: Rheumatic fever (see erythema marginatum ) Rheumatoid arthritis [visualdx.com]

• Cutaneous Manifestation

  The subject of cutaneous manifestations of gonococcemia is reviewed. Full Text [jamanetwork.com]

  A case of a Moraxella osloensis bacteremia mimicking a case of gonococcemia, complete with cutaneous manifestations, is presented. The importance of confirming all positive smears with inhibitory and noninhibitory culture media is stressed. [ncbi.nlm.nih.gov]

  Goldman Cutis 1978 A case of a Moraxella osloensis bacteremia mimicking a case of gonococcemia, complete with cutaneous manifestations, is presented… (More) Albert Bernard Ackerman The New England journal of medicine 1970 CHARACTERISTIC cutaneous lesions [semanticscholar.org]

  Cutaneous manifestations are described below. The arthralgia encompasses numerous, asymmetrical joints and is typically associated with sterile culture from synovial fluid. [symptoma.com]

  Cutaneous manifestations of disseminated gonococcemia. [unboundmedicine.com]

• Papule

  Erythema toxicum is characterized by blotchy red spots on the skin with overlying white or yellow papules or pustules. These lesions may be few or numerous. [howlingpixel.com]

  Pustules and papules against a background of erythema and telangiectasia Picture BACK TO TOP [tools.anwresidency.com]

  Successive crops of hemorrhagic pustules, papules, petechiae, or areas of necrosis may appear during febrile episodes. Arthralgias are asymmetric and migratory, involving at first the extensor tendons of wrists, fingers, knees, and ankles. [visualdx.com]

• Vaginal Discharge

  She denied dysuria, vaginal discharge, sore throat, insect or animal bites, inappropriate exposure to body fluids, or history of STDs. She did have recent new tattoos. [shmabstracts.com]

  However, you may experience: thick discharge from the penis increased vaginal discharge painful urination or burning with urination spotting between menstrual periods swollen or painful testicles painful bowel movements anal itching anal discharge sore [healthline.com]

  Symptoms in females include painful urination, vaginal discharge, and vaginal bleeding between periods. If untreated, the infection may lead to pelvic inflammatory disease. [fpnotebook.com]

• Urethral Discharge

  Case Report An 18-year-old male presented with complaints of greenish yellow discharge from eyes, multiple painful ulcers along with blood stained discharge in mouth, dysuria and mucopurulent urethral discharge for one week. [edoriumjournalofinfectiousdiseases.com]

  discharge culture Culture from endocervix Throat culture Anal culture Treatment There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. [health.am]

  See also: Blood culture Culture from endocervix Urethral discharge culture With proper treatment, the outcome is expected to be good. When treatment is delayed there is a greater chance of complications. [lutheranhealthcare.org]

• Dysuria

  She denied dysuria, vaginal discharge, sore throat, insect or animal bites, inappropriate exposure to body fluids, or history of STDs. She did have recent new tattoos. [shmabstracts.com]

  Snapshot A 24-year-old female graduate student presents to the student health clinic with a complaint of dysuria and pain in her right knee. On physical exam, her knee is erythematous and tender with pain elicited on passive range of motion. [medbullets.com]

  Dysuria is often present. Men with asymptomatic urethritis are an important reservoir for transmission. Endocervical infection is the most common form of uncomplicated gonorrhea in women. [cdc.gov.tw]

  In men the urethritis can range from asymptomatic or mild disease to pain, dysuria, and/or a purulent discharge, which tends to be abundant (thus the historic slang term for gonorrhea, “drip” or “clap”). Epididymitis may occur as well. [derm101.com]

As a frequent cause of medical visits in young sexually active adults [10], gonococcemia should be suspected when an individual in this population presents with at least a rash and tenosynovitis [3]. 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.

Laboratory tests

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 [5] [11]. 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 [3] [6] while asymptomatic sites may demonstrate an infection [3].

Further important studies include a complete blood count (CBC), which may reveal mild leukocytosis, and erythrocyte sedimentation rate (ESR), which can be slightly elevated.

Other

The United States Preventive Services Task Force (USPSTF) recommends screening for the presence of concurrent STDs such as chlamydia, syphilis, and HIV [12]. Additionally, women of reproductive age with STDs should have a pregnancy test.

Procedures

Patients with affected joints should undergo fluid aspiration and those suspected to have meningitis warrant a lumbar puncture.

• Chlamydia

  […] screening for chlamydia and gonorrhea. [derm101.com]

  Gonorrhea is the second most often reported sexually transmitted disease (STD) in the United States behind chlamydia. [misc.medscape.com]

  Since chlamydia frequently occurs along with gonorrhea, treatment for chlamydia is often given at the same time. A follow-up visit after treatment is important to recheck lab tests and make sure the infection is cured. [lutheranhealthcare.org]

• Chlamydia Trachomatis

  Analysis of an endocervical specimen by polymerase chain reaction was positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. [ncbi.nlm.nih.gov]

  trachomatis NAAT and Neisseria gonorrhoeae culture Negative Urine for Neisseria gonorrhoeae and Chlamydia trachomatis NAAT Negative Throat swab for Neisseria gonorrhoeae culture Negative Rectal swab for Neisseria gonorrhoeae culture Negative Transabdominal [cmaj.ca]

  so it is common to add a one-time dose of oral azithromycin or doxycycline for coverage of Chlamydia trachomatis.[5] Bacterial resistance to antibiotics is increasingly common in Neisseria gonorrhoeae, so it is often advised to check susceptibility [en.wikipedia.org]

Symptoms typically improve within 1 to 2 days of starting treatment. Your long-term outlook may not be as good if you don’t seek treatment for your symptoms or don’t follow your doctor’s recommendations for treatment. [healthline.com]

Additional treatment information Antimicrobial resistance in N. gonorrhoeae is common. Treatment failures should prompt evaluation for both patient compliance and for antimicrobial resistance. [derm101.com]

For gonococcemia, treatment is usually first given through an IV rather than by mouth. Since chlamydia frequently occurs along with gonorrhea, treatment for chlamydia is often given at the same time. [lutheranhealthcare.org]

(See Pathophysiology, Prognosis, and Presentation.) Did this answer your question? Yes No Additional feedback? (Optional) Thank you for your feedback! [medscape.com]

Expectations (prognosis) The outcome is expected to be good when compliance with therapy is maintained. [health.am]

PMID: 648166 Prognosis Harada H, Mitsuke A, Fukuzawa N, Kodama F, Hirose T, Tanaka T, Imamoto T, Tanaka H Transpl Infect Dis 2018 Dec;20(6):e12987. Epub 2018 Sep 21 doi: 10.1111/tid.12987. [ncbi.nlm.nih.gov]

Support Groups Expectations (prognosis) The outcome is expected to be good when compliance with therapy is maintained. [amamed.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

The etiologic agent, NEISSERIA GONORRHOEAE, was isolated by Neisser in 1879. Definition (CSP) acute infectious disease characterized by primary invasion of the urogenital tract; the etiologic agent is Neisseria gonorrhoeae. [fpnotebook.com]

STDs caused by bacteria can be treated with antibiotics, although the susceptibility pattern of many etiologic microbes has changed over the past few decades. Syphilis remains best managed with single-dose benzathine penicillin G. [unboundmedicine.com]

Etiology CMAJ 2017 Dec 18;189(50):E1558-E1560. doi: 10.1503/cmaj.170508. [ncbi.nlm.nih.gov]

Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder. [books.google.de]

Complement deficiency states and infection: epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency. Medicine (Baltimore) 1984; 63: 243–273. 4. Zenone T, Sartre J, Gibert C, Gallen-Labbé F. [journals.sagepub.com]

This condition is treated with cephalosporin and fluoroquinolone antibiotics.[4] Gonococcemia hemorrhagic pustule Epidemiology[edit] Neisseria gonorrhoeae is a gram negative diplococcus (also referred to as "Gonococcus") and a pathogenic bacteria.[2] [en.wikipedia.org]

Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder. [books.google.de]

Pathophysiology Both host and bacterial factors probably contribute to the pathogenesis. [dermatologyadvisor.com]

Abstinence is the only sure prevention. Other prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner is one good means of prevention. [lutheranhealthcare.org]

Prevention Abstinence is the only sure prevention. Other prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner is a good means of prevention. [health.am]

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2. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part I. J Am Acad Dermatol. 1999;41(4):511–532.
3. Lohani S, Nazir S, Tachamo N, Patel N. Disseminated gonococcal infection: an unusual presentation. J Community Hosp Intern Med Perspect. 2016;6(3):31841.
4. Ross JD. Systemic gonococcal infection. Genitourin Med. 1996;72(6):404–7.
5. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. 2005;19(4):853–61.
6. Mayor MT, Roett MA, Uduhiri KA. Diagnosis and Management of Gonococcal Infections. Am Fam Physician. 2012;86(10):931-938.
7. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003; 17(2):201-8.
8. Bunker D, Kerr LD. Acute myopericarditis likely secondary to disseminated gonococcal infection. Case Rep Infect Dis. 2015;2015:385126.
9. Lee MH, Byun J, Jung M, et al. Disseminated gonococcal infection presenting as bacteremia and liver abscesses in a healthy adult. Infect Chemother. 2015;47(1):60–3.
10. O'brien JP, Goldenberg DL, Rice PA. Disseminated gonococcal infection: A prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore) 1983;62(6):395–406.
11. Centers for Disease Control and Prevention (CDC). 2015 STD Treatment Guidelines. http://www.cdc.gov/std/tg2015/gonorrhea.htm. Accessed online December 8, 2016.
12. Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. Am Fam Physician. 2008;77(6):819-24.