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Gonococcal Arthritis

See Also
1. Gonorrhea
2. Septic Arthritis
Presentations
1. Suppurative Monoarticular Arthritis
2. Bacteremia Classic Triad (See Gonorrhea)
  1. Polyarthralgia
  2. Tenosynovitis
  3. Dermatitis
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
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
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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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 3/22/2010. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.