Gonococcal bacteria, that cause sexually transmited disease, Gonorrhoea cna also result in infection of the joint. Gonococcal arthritis account for 70 percent of episodes of infectious arthritis in persons under 40 years of age.
The infection typically results from bacteremia arising from gonoccoccal infection which may be asymptomatic and unnoticed.
Females are two to three times more likely than men to develop disseminated gonococcal infection and arthritis. The risk is greatest during the menstrual period. Persons with complement deficiencies, which are needed for defense against gonococci are prone to recurrent episodes of gonococcemia.
Clinical Picture
Disseminated Infection
The most common manifestation of disseminated gonococcal infection is a syndrome of fever, chills, rash, and articular sumptoms.
Small numbers of papules that progress to hemorrhagic pustules develop on the trunk and the extensor surfaces of the distal extremities. Migraory arthritis and tenosynovitis of the knees, hands, wrists, feet, and ankles are prominent.
The cutaneous lesions and articular finding are believed to be the consequence of an immune reaction to circulating gonococci and immune complex deposition in tissues.
Gonococal Arthritis
A single joint, such as the hip, knee, ankle, or wrist, is usually involved in true gonococcal arthritis which is less common than disseminated
Labortary Investigations
In disseminated gonococcal infection the synovial fluid cultures are consistently negative. Blood cultures are positive in fewer than 45 percent of patients.
In true gonococcal septic arthritis Synovial fluid that contains more than 50,000 leukocytes/µL and cultures of synovial fluid are positive in fewer than 40 percent of cases. Blood cultures are almost always negative.
Specimens for culture should be obtained from potentially infected mucosal sites i.e. urethra and cervix. Cultures and gram-stained smears of skin lesions ossasionallly are positive.
The specimen is taken onThayer-Maretin agar directly or in special transport media at the bedside and transferred promptly to the microbiology laboratory in an atmosphere of 5% CO2, as generated in a candle jar.
PCR-based assays are extremely sensitive in detecting gonococcal DNA in synovial fluid.
A dramatic alleviation of symptoms within 12 to 24 h after the initiation of appropriate antibiotic therapy supports a clinical diagnosis of the disseminated gonococcal infection syndrome if cultures are negative.
Treatment
Mainstay of treatment is antibiotic therapy. Following antibiotics may be used
- Intravenous Antibiotics- Initiate Ceftriaxone (1 g intravenously or intra-muscularly every 24 h) to cover possible penicillin-resistant organisms. These may be required to be given for 3-4 days.
- Oral Therapy- Once local and systemic signs are clearly resolving, the 7 day course of therapy can be completed with any of these oral agent.
- Cefixime (400 mg twice daily)
- Ciprofloxacin (500 mg twice daily)
- Amoxicillin (500 mg three times daily).
Suppurative arthritis usually responds to needle aspiration of involved joints and 7 to 10 days of antibiotic treatment. Arthroscopic lavage or arthrotomy is rarely required.
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