Infectious Disease Book

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Gonococcal Arthritis

Aka: Gonococcal Arthritis
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  1. See Also
    1. Gonorrhea
    2. Septic Arthritis
  2. Presentations
    1. Suppurative Monoarticular Arthritis
    2. Bacteremia Classic Triad (See Gonorrhea)
      1. Polyarthralgia
      2. Tenosynovitis
      3. Dermatitis
  3. Signs
    1. Joints affected in order of involvement
      1. Knees (Most often involved)
      2. Elbows
      3. Ankles
      4. Wrists
      5. Hands or feet
    2. Rarely affected joints
      1. Shoulders
      2. Hips
  4. Labs: Arthrocentesis for Synovial Fluid
    1. Clear to opaque Synovial Fluid
    2. Synovial Fluid WBC: 30,000 to 100,000 (>80% PMNs)
    3. Gram Stain positive in <25% of cases
    4. Culture positive in <50% of cases
  5. Management
    1. Antibiotic management should be based on culture
    2. Parenteral antibiotics (may require 10 days)
      1. Rocephin
      2. Doxycycline (or Spectinomycin in pregnancy)
    3. Continue IV antibiotics until clinical improvement

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