What are the symptoms and treatment options for Disseminated Gonococcal Infection (DGI)?

From the Guidelines

Disseminated gonorrhea should be treated with ceftriaxone 1 g intravenously every 24 hours for at least 7 days, as recommended by the most recent guidelines 1. This treatment approach is based on the latest evidence from the CDC's Gonococcal Isolate Surveillance Project, which has shown that ceftriaxone is the most effective antibiotic for treating gonorrhea, including disseminated cases 1. The use of ceftriaxone is preferred over other antibiotics due to its high efficacy and the increasing resistance of Neisseria gonorrhoeae to other antibiotics, such as cefixime and fluoroquinolones 1. In addition to ceftriaxone, patients with disseminated gonorrhea should also be tested and treated for potential co-infections, such as chlamydia, with azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days 1. It is essential to note that patients with disseminated gonorrhea should be hospitalized and closely monitored for any complications, such as endocarditis or meningitis, and that all sexual partners from the past 60 days should be notified, tested, and treated 1. Follow-up testing is crucial to ensure that the infection has been eliminated and that the patient is no longer at risk of transmitting the disease to others 1. Some key points to consider when treating disseminated gonorrhea include:

• The importance of prompt and effective treatment to prevent long-term complications and reduce the risk of transmission to others
• The need for hospitalization and close monitoring for patients with disseminated gonorrhea
• The use of ceftriaxone as the preferred antibiotic for treating gonorrhea, including disseminated cases
• The importance of testing and treating for potential co-infections, such as chlamydia
• The need for follow-up testing to ensure that the infection has been eliminated.

From the FDA Drug Label

For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended. The FDA drug label does not answer the question about disseminated gonorrhea specifically, but it does provide information on the treatment of uncomplicated gonococcal infections.

• The recommended dose for uncomplicated gonococcal infections is a single intramuscular dose of 250 mg of ceftriaxone.
• However, disseminated gonorrhea is not explicitly mentioned in the provided drug label, and therefore, no conclusion can be drawn about its treatment. 2

From the Research

Disseminated Gonorrhea Overview

• Disseminated gonorrhea is a condition where the bacteria Neisseria gonorrhoeae spreads from the primary mucosal site to distant parts of the body, presenting with signs of systemic illness 3, 4.
• The incidence of gonorrhea has risen sharply over the last decade in the United States, with 172 reported cases per 100,000 people over the past year 3.
• Disseminated gonorrhea can present with nonspecific symptoms, including arthralgia, cutaneous lesions, or tenosynovitis, making diagnosis challenging 3, 4.

Clinical Manifestations and Diagnosis

• Disseminated gonorrhea may present as isolated septic arthritis without mucosal involvement or systemic symptoms, highlighting the importance of clinician awareness and a high index of suspicion 4.
• Diagnosis is based on a degree of high clinical suspicion and serology, with treatment including ceftriaxone and azithromycin in the emergency department 3.
• The spectrum of disease can be classified into stages and clinical subgroups, with N. gonorrhoeae strains causing DGI in the U.S. having been highly sensitive to penicillin in the past 5.

Treatment and Prevention

• Recommended treatment protocols for localized gonorrhea and DGI have been reviewed, with revisions in beliefs about the need for high-dose intravenous penicillin for effective initial therapy of GCA 5.
• The 2020 CDC Gonorrhea Treatment Recommendations and the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines recommend 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites, with cotreatment with doxycycline if coinfection with chlamydia has not been excluded 6, 7.
• Early diagnosis and prompt treatment of DGI are crucial to prevent complications of sepsis, joint destruction, and prolonged hospital stay 4.