Can gonorrhea cause septic arthritis?

Gonorrhea as a Cause of Septic Arthritis

Yes, Neisseria gonorrhoeae can cause septic arthritis, typically as part of disseminated gonococcal infection (DGI), which occurs in approximately 0.5-3% of patients with gonorrhea. 1

Pathophysiology and Clinical Presentation

• Gonococcal septic arthritis typically presents as either:

  • Monoarticular or pauciarticular arthritis with positive synovial fluid cultures and negative blood cultures 2
  • Polyarthralgias with skin lesions associated with gonococcal bacteremia 2

• DGI occurs when N. gonorrhoeae enters the bloodstream, leading to infection at distant sites including joints 3

• The most commonly affected joints in gonococcal arthritis include:

  • Wrist (particularly common in women) 4
  • Knee (more common in non-gonococcal septic arthritis) 4
  • Other joints such as the elbow and hip can also be affected 5, 6

Diagnostic Considerations

• Diagnosis of gonococcal arthritis is confirmed when:

  • A mucosal gonococcal infection is documented along with a typical clinical syndrome that responds to appropriate antimicrobial therapy 2
  • Positive cultures from synovial fluid or blood grow N. gonorrhoeae 6

• Diagnostic challenges include:

  • Blood cultures are often negative in classic DGI 6
  • Synovial fluid cultures may be sterile despite the presence of Gram-negative cocci on Gram stain 6
  • Cultures from mucosal sites (genital, rectal, pharyngeal) may help establish the diagnosis 3

Treatment Recommendations

• Hospitalization is indicated for patients with suppurative arthritis or when the diagnosis is uncertain 2

• Initial treatment regimen:

  • Ceftriaxone 1g IV or IM every 24 hours until clinical improvement begins 3
  • Alternative regimens for those allergic to β-lactams include ciprofloxacin 400 mg IV every 12 hours, ofloxacin 400 mg IV every 12 hours, or spectinomycin 2g IM every 12 hours 3

• After 24-48 hours of clinical improvement, therapy can be switched to oral regimens to complete a full week of treatment:

  • Cefixime 400 mg orally twice daily 3
  • Ciprofloxacin 500 mg orally twice daily (if not contraindicated) 3
  • Ofloxacin 400 mg orally twice daily (if not contraindicated) 3

• For gonococcal meningitis or endocarditis (more severe complications):

  • Ceftriaxone 1-2 g IV every 12 hours 3
  • Treatment duration: 10-14 days for meningitis, at least 4 weeks for endocarditis 3

Management of Sex Partners

• All sex partners of patients with gonococcal arthritis should be evaluated and treated according to guidelines for gonococcal infections 3

• This is crucial for preventing reinfection and further transmission 3

Prognosis and Outcomes

• Gonococcal septic arthritis generally has a better prognosis compared to non-gonococcal septic arthritis 5

• With appropriate antibiotic treatment and drainage procedures:

  • Complete recovery of function without residual deficit is common 5
  • Joint damage is less common compared to other bacterial causes of septic arthritis 5

• Early diagnosis and prompt initiation of appropriate antimicrobial therapy are essential for optimal outcomes 6

Special Populations

• Neonates can develop gonococcal sepsis, arthritis, and meningitis as rare complications of neonatal gonococcal infection 3

• In children, gonococcal infection is most frequently associated with sexual abuse and requires special diagnostic and treatment considerations 3

• Older adults with gonococcal arthritis may present atypically and should still be evaluated for sexually transmitted infections regardless of age 6

Bold text indicates the most important recommendation based on the evidence.

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