Gonococcal arthritis (GA) is an uncommon but severe complication of untreated Neisseria gonorrhoeae infection. It represents a severe form of Disseminated Gonococcal Infection (DGI), where the bacteria spread from the initial mucosal site—such as the cervix, urethra, or throat—into the bloodstream. This systemic spread allows the organism to travel to distant parts of the body, causing inflammation and infection within the joints. GA is a serious condition that requires prompt medical attention.
Typical Incubation Period and Progression
Gonococcal arthritis is a secondary manifestation, developing after the initial local infection has been established. The progression from the initial mucosal infection to DGI typically occurs over days to weeks. The time from sexual contact to the onset of DGI symptoms can range widely, from one day to three months, but usually manifests within one to three weeks.
The initial infection is frequently asymptomatic, particularly in women, which delays diagnosis and increases the risk of systemic spread. Once the bacteria enter the bloodstream, they settle in the synovium, the lining of the joints, triggering the inflammatory response characteristic of arthritis.
Recognizing Disseminated Infection Symptoms
The presentation of DGI generally falls into two distinct clinical syndromes that can sometimes overlap. The first and most common is the arthritis-dermatitis syndrome, which presents with a characteristic triad of symptoms. This triad includes tenosynovitis (inflammation of the tendon sheaths, often affecting the wrists, fingers, ankles, and toes) and migratory polyarthralgia (joint pain that moves from one joint to another).
Patients also typically experience a characteristic skin rash (dermatitis). The rash is frequently painless and consists of small, raised lesions that can be pustular or vesicular, commonly appearing on the trunk and extremities. The second form is localized purulent arthritis, which involves a single, severely painful, and swollen joint, most often the knee, ankle, or wrist, without the widespread rash or tenosynovitis.
Diagnostic Procedures for Confirmation
Confirming a diagnosis of GA requires clinical evaluation and targeted laboratory testing to identify Neisseria gonorrhoeae. The most definitive procedure involves arthrocentesis, where synovial fluid is drawn from the affected joint for analysis. This fluid is analyzed for an elevated white blood cell count, typically over 50,000 cells/mm³, indicating a joint infection.
A significant challenge is that synovial fluid cultures are often negative, isolating the organism in only about 50% of purulent arthritis cases. Therefore, Nucleic Acid Amplification Tests (NAATs) are used, as they detect bacterial genetic material in joint fluid with greater sensitivity than traditional culture. Testing non-joint mucosal sites—such as the urethra, cervix, pharynx, and rectum—using NAATs is also necessary, as a positive result confirms the source of the systemic infection.
Treatment Protocols and Prognosis
Treatment for confirmed or highly suspected gonococcal arthritis requires immediate antibiotic therapy, often necessitating initial hospitalization. The standard first-line treatment involves administering intravenous (IV) antibiotics, typically ceftriaxone, at a dose of 1 gram every 24 hours. This parenteral therapy is continued for 24 to 48 hours after the patient demonstrates clear clinical improvement, such as a reduction in fever and joint pain.
Following initial improvement, the treatment transitions to an oral antibiotic regimen, such as cefixime, lasting 7 to 14 days in total. Unlike other forms of bacterial septic arthritis, GA often responds well to antibiotics and needle aspiration, rarely requiring surgical drainage. The prognosis is excellent if treatment is initiated promptly, though delayed care can lead to permanent joint damage.