From the Guidelines
Gonorrhea arthritis requires prompt treatment with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days to prevent permanent joint damage and reduce morbidity. This condition is a serious joint infection caused by the bacterium Neisseria gonorrhoeae, which can lead to severe complications if left untreated 1. The recommended treatment regimen is based on the most recent guidelines, which prioritize combination therapy to ensure effective treatment of the infection and potential co-infections 1.
Key considerations in the treatment of gonorrhea arthritis include:
- Prompt initiation of antibiotic therapy to prevent permanent joint damage and reduce morbidity
- Use of ceftriaxone and azithromycin or doxycycline as the first-line treatment regimen
- Alternative treatment options for patients with severe penicillin allergy, such as spectinomycin or fluoroquinolones if susceptibility is confirmed
- Importance of joint drainage for significant effusions and supportive measures like rest, elevation, and pain management with NSAIDs
It is essential to note that gonorrhea arthritis typically affects large joints like knees, ankles, and wrists, and occurs when the bacteria spread through the bloodstream from the initial genital, rectal, or pharyngeal infection 1. Without proper treatment, permanent joint damage can occur, making early diagnosis and appropriate antibiotic therapy essential for full recovery. Patients should abstain from sexual activity until treatment is complete, and partners should be tested and treated to prevent reinfection 1.
From the Research
Gonorrhea Arthritis Overview
- Gonorrhea arthritis, also known as gonococcal arthritis, is a rare but potentially serious complication of gonorrhea infection 2.
- It occurs when the bacteria Neisseria gonorrhoeae disseminate through the bloodstream and infect the joints, causing inflammation and pain.
- The disease is more common in sexually active women, and symptoms may include polyarthralgia, tenosynovitis, arthritis, constitutional symptoms, and skin lesions.
Diagnosis and Treatment
- Diagnosis of gonorrhea arthritis is often challenging, as the primary mucosal infection may be asymptomatic 2.
- Sampling of blood, synovial fluid, skin lesions, and genitourinary tract should be performed before starting antibiotics, and culture of N. gonorrhoeae is essential for definite diagnosis and determination of drug susceptibility 2.
- Treatment typically involves a third-generation cephalosporin, such as ceftriaxone, which has been shown to be effective in treating gonorrhea arthritis 3, 4.
- The Centers for Disease Control and Prevention (CDC) recommend a single 500 mg intramuscular dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea, with concurrent treatment with doxycycline if chlamydial infection has not been excluded 4, 5.
Antibiotic Resistance and Treatment Failures
- Gonorrhea has developed resistance to all first-line recommended therapies, making antimicrobial resistance a major public health concern 5.
- Azithromycin, part of the previous dual-drug treatment regimen, has shown a rapid rise in resistance, while ceftriaxone minimal inhibitory concentrations (MICs) have remained stable in the United States 5.
- Treatment failures have been reported internationally, highlighting the need for continued surveillance and monitoring of antimicrobial resistance 5.