Can gonorrhea cause Reiter's syndrome (reactive arthritis)?

Gonorrhea Can Cause Reactive Arthritis (Reiter's Syndrome)

Yes, gonorrhea is a recognized cause of reactive arthritis, also known as Reiter's syndrome. According to CDC guidelines, both gonococcal and nongonococcal infections may lead to aseptic "reactive" arthritis or Reiter's syndrome 1.

Pathophysiology and Risk Factors

Reactive arthritis (Reiter's syndrome) is characterized by:

• Inflammatory arthritis
• Conjunctivitis
• Urethritis

Key aspects of this condition include:

• Genetic predisposition plays a significant role - individuals with HLA-B27 genotype have a 30-50 times higher risk of developing reactive arthritis 2, 3
• The condition represents an abnormal immune response to infection rather than direct joint infection
• Microbial components may interact with class I HLA antigens in the joint 2

Infectious Triggers

Sexually transmitted infections that can trigger reactive arthritis include:

1. Gonorrhea (Neisseria gonorrhoeae):

   • Can cause both septic arthritis (through disseminated infection) and reactive arthritis 2
   • Reactive arthritis occurs after the initial infection has cleared or is being treated

2. Chlamydia trachomatis:

   • Most commonly associated trigger for reactive arthritis
   • CDC guidelines specifically mention Reiter's syndrome as a complication of chlamydial infection 1
   • Chlamydial antigen has been found in joint material from some patients 2

Clinical Presentation

The classic triad of Reiter's syndrome includes:

• Urethritis (often the initial symptom)
• Conjunctivitis
• Arthritis (typically asymmetric, affecting large joints)

Additional manifestations may include:

• Dermatologic findings (keratoderma blennorrhagicum, circinate balanitis)
• Oral lesions
• Nail changes 4

Epidemiology

• More common in men than women
• Often the first manifestation in young men with inflammatory polyarthritis 3
• May be the first manifestation of HIV infection in some cases 3
• 15-20% of patients may develop severe chronic sequelae 4

Diagnostic Approach

When evaluating a patient with suspected reactive arthritis:

1. Test for both gonorrhea and chlamydia

   • NAAT testing of urine or urethral/cervical swabs is recommended 1
   • Both infections should be ruled out even if only one is detected

2. Consider HLA-B27 testing to assess risk for chronic disease

3. Document the triad components:

   • Evidence of urethritis (discharge, dysuria)
   • Conjunctivitis or other eye inflammation
   • Joint inflammation (typically asymmetric, affecting knees, ankles, feet)

Treatment

1. Treat the underlying infection:

   • For gonorrhea: Follow current CDC treatment guidelines for gonorrhea
   • For chlamydia: Doxycycline 100 mg orally twice daily for 7 days 5

2. Manage arthritis symptoms:

   • High doses of potent NSAIDs as initial treatment 3
   • Intra-articular corticosteroid injections for large joint involvement 3

3. Partner treatment:

   • Essential to prevent reinfection 5
   • CDC recommends that all sex partners from the preceding 60 days be evaluated, tested, and treated 1

Prevention

To prevent reactive arthritis:

• Early detection and treatment of gonorrhea and chlamydia
• Partner notification and treatment
• Abstinence from sexual intercourse until after treatment completion and resolution of symptoms 1

Important Considerations

• Reactive arthritis symptoms may persist for long periods despite appropriate antibiotic treatment
• The condition may recur with subsequent infections
• Early treatment of the triggering infection may sometimes shorten the course or prevent onset of arthritis 3

Remember that while both gonorrhea and chlamydia can trigger reactive arthritis, chlamydia is the more common cause, and testing for both pathogens is essential in any patient presenting with symptoms of reactive arthritis.