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Disseminated gonococcal infection

INTRODUCTION

Disseminated gonococcal infection (DGI) results from bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae, which can lead to a variety of clinical symptoms and signs, such as tenosynovitis, dermatitis, and multiple skin lesions.

This topic will discuss the epidemiology, clinical manifestations, diagnosis and treatment of DGI. The clinical manifestations, diagnosis and treatment of uncomplicated gonococcal infection (eg, cervicitis and urethritis) are discussed elsewhere. (See "Treatment of uncomplicated gonococcal infections" and "Diagnosis of gonococcal infections" and "Epidemiology, pathogenesis, and clinical manifestations of Neisseria gonorrhoeae infection".)

EPIDEMIOLOGY

Disseminated gonococcal infection (DGI) occurs in 0.5 to 3 percent of patients infected with Neisseria gonorrhoeae. Most are younger than 40 years of age, although DGI can occur in virtually any age group.

DGI is a common cause of acute polyarthralgias, polyarthritis, or oligoarthritis in young, healthy patients. Males or females may be affected. As an example, one study of 151 consecutive patients with acute nontraumatic arthritis or arthralgia seen at the University of Washington hospitals found that N. gonorrhoeae was the most common cause of illness [1]. DGI has a number of unique and characteristic clinical features that allow it to be distinguished from other types of infectious arthritis.

PATHOPHYSIOLOGY AND PREDISPOSING FACTORS

The probability that a localized gonococcal infection will spread to joints and other tissues depends upon specific host, microbial, and possibly immune factors.

                         

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Literature review current through: Mar 2014. | This topic last updated: Nov 16, 2012.
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References
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  1. Rompalo AM, Hook EW 3rd, Roberts PL, et al. The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. Arch Intern Med 1987; 147:281.
  2. O'Brien JP, Goldenberg DL, Rice PA. Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore) 1983; 62:395.
  3. Phupong V, Sittisomwong T, Wisawasukmongchol W. Disseminated gonococcal infection during pregnancy. Arch Gynecol Obstet 2005; 273:185.
  4. Petersen BH, Lee TJ, Snyderman R, Brooks GF. Neisseria meningitidis and Neisseria gonorrhoeae bacteremia associated with C6, C7, or C8 deficiency. Ann Intern Med 1979; 90:917.
  5. Wise CM, Morris CR, Wasilauskas BL, Salzer WL. Gonococcal arthritis in an era of increasing penicillin resistance. Presentations and outcomes in 41 recent cases (1985-1991). Arch Intern Med 1994; 154:2690.
  6. Britigan BE, Cohen MS, Sparling PF. Gonococcal infection: a model of molecular pathogenesis. N Engl J Med 1985; 312:1683.
  7. Rinaldi RZ, Harrison WO, Fan PT. Penicillin-resistant gonococcal arthritis. A report of four cases. Ann Intern Med 1982; 97:43.
  8. Schoolnik GK, Buchanan TM, Holmes KK. Gonococci causing disseminated gonococcal infection are resistant to the bactericidal action of normal human sera. J Clin Invest 1976; 58:1163.
  9. Lewis LA, Choudhury B, Balthazar JT, et al. Phosphoethanolamine substitution of lipid A and resistance of Neisseria gonorrhoeae to cationic antimicrobial peptides and complement-mediated killing by normal human serum. Infect Immun 2009; 77:1112.
  10. Liebling MR, Arkfeld DG, Michelini GA, et al. Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction. Arthritis Rheum 1994; 37:702.
  11. Muralidhar B, Rumore PM, Steinman CR. Use of the polymerase chain reaction to study arthritis due to Neisseria gonorrhoeae. Arthritis Rheum 1994; 37:710.
  12. Read P, Abbott R, Pantelidis P, et al. Disseminated gonococcal infection in a homosexual man diagnosed by nucleic acid amplification testing from a skin lesion swab. Sex Transm Infect 2008; 84:348.
  13. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am 2005; 19:853.
  14. Goldenberg DL. Gonococcal arthritis and other Neisserial infections. In: Arthritis and Allied Conditions, 12th Edition, McCarthy DJ, Koopman WS (Eds), Lea and Febiger, Philadelphia 1993. p.2025.
  15. Andersson S, Krook A. Primary meningococcal arthritis. Scand J Infect Dis 1987; 19:51.
  16. http://www.cdc.gov/std/treatment/2010/default.htm (Accessed on January 03, 2011).
  17. Centers for Disease Control and Prevention (CDC). Cephalosporin susceptibility among Neisseria gonorrhoeae isolates--United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2011; 60:873.
  18. Muratani T, Akasaka S, Kobayashi T, et al. Outbreak of cefozopran (penicillin, oral cephems, and aztreonam)-resistant Neisseria gonorrhoeae in Japan. Antimicrob Agents Chemother 2001; 45:3603.
  19. Barry PM, Klausner JD. The use of cephalosporins for gonorrhea: the impending problem of resistance. Expert Opin Pharmacother 2009; 10:555.
  20. Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep 2012; 61:590.