Disseminated gonococcal infection
- Don L Goldenberg, MD
Don L Goldenberg, MD
- Section Editor — Pain Disorders in Rheumatology
- Emeritus Professor of Medicine, Tufts University School of Medicine
- Affiliate Assistant, Rheumatology Division, Oregon Health Science University
- Affiliate Instructor, School of Nursing Oregon Health Sciences University
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
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 arthritis or arthralgias, tenosynovitis, 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 "Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents" and "Epidemiology and pathogenesis of Neisseria gonorrhoeae infection".)
Disseminated gonococcal infection (DGI) occurs in 0.5 to 3 percent of patients infected with N. gonorrhoeae. Most are younger than 40 years of age, although DGI can occur in any age group. DGI historically occurred more frequently in women than men. Although a more recent study from France suggested that in some western countries DGI may now be more common in men than women , it is not clear if this change is generalizable beyond this study.
DGI is considered a common cause of acute polyarthralgias, polyarthritis, or oligoarthritis in young, healthy patients. In one study of patients with acute nontraumatic arthritis or arthralgia, N. gonorrhoeae was identified in 19 percent in a cohort from the 1970s and 14 percent in a cohort from the 1980s . However, more recent data are lacking.
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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- PATHOPHYSIOLOGY AND PREDISPOSING FACTORS
- Host factors
- Microbial factors
- Immune factors
- CLINICAL MANIFESTATIONS
- Spectrum of findings
- Tenosynovitis, dermatitis, polyarthralgia (also called arthritis-dermatitis syndrome)
- Purulent arthritis without skin lesions
- Clinical suspicion
- History and physical examination
- Laboratory and microbiologic testing
- Screening for other sexually transmitted infections
- DIFFERENTIAL DIAGNOSIS
- Initial antimicrobial therapy
- Definitive therapy and duration
- - Tenosynovitis, dermatitis, polyarthralgia
- - Purulent arthritis
- Patients with beta-lactam allergy
- OTHER MANAGEMENT ISSUES
- Treatment of Chlamydia coinfection
- Partner management
- RECURRENT INFECTION
- SUMMARY AND RECOMMENDATIONS