Which sexually transmitted diseases (STDs) can cause joint effusions?

From the Guidelines

Gonococcal arthritis caused by Neisseria gonorrhoeae is the most notable STD that can cause joint effusions, typically presenting as an asymmetric arthritis affecting knees, wrists, and ankles, as supported by the most recent guidelines 1. Several sexually transmitted diseases (STDs) can cause joint effusions, including:

• Gonococcal arthritis caused by Neisseria gonorrhoeae, which typically presents as an asymmetric arthritis affecting knees, wrists, and ankles
• Reactive arthritis (formerly known as Reiter's syndrome) that can develop following chlamydial infections, causing joint effusions typically in the lower extremities
• Syphilis, caused by Treponema pallidum, which can lead to joint involvement during its secondary and tertiary stages
• HIV infection, which may cause HIV-associated arthritis with joint effusions
• Viral hepatitis B and C, which can be sexually transmitted and may cause arthritis with joint effusions as part of their extrahepatic manifestations The treatment depends on the specific pathogen, with gonococcal arthritis requiring ceftriaxone 1g IV/IM daily for 7-14 days, often with joint drainage for larger effusions, as recommended by the guidelines 1. Key points to consider in the management of STD-related joint effusions include:
• Prompt diagnosis and treatment to prevent long-term joint damage and improve quality of life
• Use of antibiotics, such as ceftriaxone, doxycycline, or azithromycin, depending on the causative pathogen
• Consideration of joint drainage and NSAIDs for symptom management
• Awareness of the potential for immune-mediated mechanisms and direct invasion of the synovium, leading to fluid accumulation in the joint space, as noted in the guidelines 1.

From the Research

Sexually Transmitted Diseases that can Cause Joint Effusions

• Gonococcal arthritis, caused by Neisseria gonorrhoeae, can lead to joint effusions, as well as other symptoms such as polyarthralgia, tenosynovitis, and skin lesions 2
• Syphilis, caused by Treponema pallidum, can also cause joint effusions, particularly in the secondary stage of the disease, although this is less common 3, 4
• Other sexually transmitted diseases, such as chlamydia and HIV, can also cause joint symptoms, including arthralgia and arthritis, although joint effusions are not typically a primary symptom 5, 3

Characteristics of Joint Effusions in STDs

• In gonococcal arthritis, joint effusions are typically purulent and require aspiration, as well as antibiotic treatment 2
• In syphilis, joint effusions are less common, but can occur in the secondary stage of the disease, and may be accompanied by other symptoms such as rash and fever 3, 4
• In other STDs, such as chlamydia and HIV, joint symptoms are often part of a larger syndrome, such as reactive arthritis or Reiter's syndrome, and may not typically include joint effusions 5, 3

Diagnosis and Treatment of Joint Effusions in STDs

• Diagnosis of joint effusions in STDs typically involves a combination of clinical evaluation, laboratory tests, and imaging studies 2, 3
• Treatment of joint effusions in STDs typically involves antibiotic therapy, as well as aspiration of the affected joint and other supportive measures 2, 6