Gonococcal Arthritis

I. Gonococcal Arthritis

It is caused by Neisseria gonorrhea, a bacteria which also causes Gonorrhea (a sexually transmitted disease). It usually occurs in otherwise healthy individuals in contrast to other forms of infective arthritis. The primary site of infection are the genitalia, rectum, conjunctiva and throat.

Risk factors

  • It is more common in women especially during menstruation and pregnancy.
  • Homosexual men are also at higher risk.
  • Pelvic examination with instruments and surgical procedures may provoke the dormant infection.

Signs and symptoms

This form of arthritis can involve many (polyarticular) or one (monoarticular) of the joints, usually on one side of the body (asymmetrical). The commonest joint involved is the knee. The onset is sudden with pain and swelling of the joint. The joint involvement is migratory (moving from one joint to another) in nature and there may be fever, malaise, urinary and genital symptoms. Besides this, skin eruptions may be seen.

Investigations

  • The following investigations may be advised to support the diagnosis:
  • Blood tests may show an increased white blood cell count and ESR.
  • Blood culture may show presence of the bacteria in the blood.
  • Synovial fluid examination shows increased white cell count and may show the presence of the bacteria specially in the monoarticular (single joint involvement) form.
  • Other tests may include cultures from skin, uro-genital tract and throat lesions.
  • X-ray is non-specific, and in later stages may show decreased joint space.

Management

  • Rest to the affected joint
  • Drugs: It responds well to ceftriaxone, cefotaxime or cefixime antibiotics. Antibiotic therapy should be continued for 7-10 days. Besides, pain killers are also used.
  • Joint rehabilitation: Exercises to maintain mobility and strength are essential after the acute phase is over.