Disseminated gonococcal infection
- Don L Goldenberg, MD
Don L Goldenberg, MD
- Section Editor — Pain Disorders in Rheumatology
- Professor of Medicine
- Tufts University School of Medicine
- 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 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 "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. However, 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 a common cause of acute polyarthralgias, polyarthritis, or oligoarthritis in young, healthy patients. 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 . DGI has a number of unique and characteristic clinical features that allow it to be distinguished from other types of infectious arthritis. (See 'Clinical manifestations' below and 'Differential diagnosis' below.)
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
- The tenosynovitis, dermatitis, polyarthralgia syndrome
- Purulent arthritis without skin lesions
- Physical examination
- Laboratory studies
- DIFFERENTIAL DIAGNOSIS
- Bacterial arthritis
- Hepatitis B
- Connective tissue diseases
- Acute rheumatic fever
- Infective endocarditis
- Other infectious diseases
- EVALUATION AND MANAGEMENT
- Preferred antimicrobial regimen
- Duration of treatment and the need for joint drainage
- "Step-down" therapy from parenteral to oral treatment
- Concurrent treatment for Chlamydial infection
- Treatment and assessment of sexual partners
- Recurrent episodes of DGI
- SUMMARY AND RECOMMENDATIONS