What is Gonococcal Arthritis?
Gonococcal arthritis is a type of arthritis caused by the spread of the Neisseria gonorrhoeae bacteria through the bloodstream. This bacteria is mainly spread through sexual contact. Gonococcal arthritis is a physical symptom of a widespread infection caused by this bacteria. It primarily takes two forms: localized septic arthritis, which is a severe infection in one or more joints, and arthritis-dermatitis syndrome, a condition characterized by joint pain and skin rash.
What Causes Gonococcal Arthritis?
Neisseria gonorrhoeae, a type of bacteria, is what causes gonococcal arthritis, a type of joint disease. It is usually caught through sexual activity, and it’s a common cause of joint disease in sexually active teenagers. However, it can also be passed from mother to baby during childbirth, leading to gonococcal infection in newborns.
Risk Factors and Frequency for Gonococcal Arthritis
Gonorrhea, caused by N. gonorrhoeae, can lead to a more serious condition called disseminated gonococcal infection (DGI) in about 0.5% to 3% of patients. Statistics from the 1980s suggest that up to 14% of patients with arthritis had this type of infection. Gonococcal arthritis, a symptom of DGI, typically affects younger, healthy individuals, though it can occur in any age group.
- Between 0.5% and 3% of patients with gonorrhea develop disseminated gonococcal infection (DGI).
- According to 1980s data, N. gonorrhoeae was linked to up to 14% of arthritis patients.
- Gonococcal arthritis, a form of DGI, is more common in young, healthy individuals.
- However, gonococcal arthritis can occur in any age group.
Signs and Symptoms of Gonococcal Arthritis
Disseminated gonococcal infection (DGI) is a condition most commonly known for two main forms: the arthritis-dermatitis syndrome and localized purulent arthritis, which appears without skin issues. It’s important to note that some patients may show symptoms that fall between these two types. The condition spreads from an infection, usually starting in the genital/urinary tract, rectum, or throat, caused by N. gonorrhoeae bacteria. However, people with visible symptoms of DGI often don’t show symptoms of this initial localized infection.
The arthritis-dermatitis syndrome is a type of DGI that typically includes three main symptoms. These are tenosynovitis (inflammation of the sheath around a tendon), dermatitis (skin inflammation), and polyarthralgia (multiple joint pains). Often, this syndrome comes with additional general symptoms like fever, chills, and a feeling of discomfort or malaise. Tenosynovitis is a unique sign of this type of arthritis and doesn’t usually appear in other forms. It’s identified by tenderness along the tendon sheath and pain when the tendon is stretched out. This usually affects multiple tendons and often involves fingers, wrists, toes, and ankles. Polyarthralgia typically affects various joints and isn’t symmetric, while skin issues appear in up to 75% of cases, typically excluding the face. The most common skin issues are pustules or blisters, although there are many different types.
Localized septic arthritis is the second major form of DGI, usually showing up as a condition that affects one, or relatively few, joints simultaneously with pain and swelling. Most people with this form don’t show general symptoms like fever or chills. The most commonly affected joints include the knees, ankles, wrists, and elbows.
- Arthritis-dermatitis syndrome symptoms include:
- Tenosynovitis
- Dermatitis
- Polyarthralgia (multiple joint pains)
- Associated symptoms often include fever, chills, and malaise
- Skin issues such as pustules or blisters are common
- Localized septic arthritis symptoms include pain and swelling of one or several joints
- Commonly affected joints include knees, ankles, wrists, and elbows
Testing for Gonococcal Arthritis
If you’re experiencing joint pain or swelling, especially if you’re under 40 and sexually active, or if you’re a man who has sex with other men, your doctor might suspect you have an infection in your joint, such as septic arthritis. To figure out if that’s what’s going on, your doctor will review your sexual and menstrual history if you’re a woman who hasn’t gone through menopause yet, and do a physical exam, looking closely at your skin and joints. Certain skin conditions and joint pains suggest this kind of infection.
To officially confirm whether you have an infection called disseminated gonococcal infection (DGI) or gonococcal arthritis, which is caused by a bacteria known as Neisseria gonorrhoeae, doctors typically need to find this bacteria in a sample taken from your bloodstream, joint fluid, or skin lesions. Unfortunately, these tests often don’t find the bacteria. In such situations, the doctor can still diagnose you with the condition based on your symptoms, or if they find the bacteria in samples taken from areas like your throat, anus, or urethra. They might also test you for other sexually transmitted diseases like HIV, syphilis, and chlamydia, as these often occur alongside a gonococcal infection.
Your doctor may take two blood samples to help them differentiate between gonococcal arthritis and septic arthritis caused by other pathogens. However, these cultures are only positive in less than one-third of all cases. In cases where your blood tests or joint fluid analysis come back negative, the doctor might suggest testing samples from your urethra or vagina, or urine samples if nucleic acid amplification testing (NAAT) is available, to still identify the bacteria. Culturing a sample taken from your genital area could be a good alternative.
If your joints are swollen and have a build-up of fluid, your doctor will likely draw some of this fluid out for testing. Usually, a high white blood cell count, a lower glucose concentration, and elevated lactate dehydrogenase (LDH) levels in this fluid suggest an infection, but these numbers are not definitive proof. The bacteria in question is only found in about half the joint fluid samples from patients with localized purulent arthritis, which means it can’t always be relied upon for diagnosis. Testing this fluid with NAAT, if available, is a better bet, as it can identify the bacteria in more than 75% of cases.
Sampling your skin lesions is typically not part of the process, as it is challenging to obtain a good sample, and the tests, including NAAT, often come back negative.
Treatment Options for Gonococcal Arthritis
If doctors suspect you have a spread-out infection of gonorrhea or gonococcal arthritis, they often recommend initial treatment in a hospital setting. Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. Gonococcal arthritis is a complication of gonorrhea where the bacteria infect the joints.
The first choice of antibiotics is typically ceftriaxone. Delivered directly into your vein or muscle, this treatment aims to control the infection quickly. To also target potential co-infection with another sexually transmitted bacterium called Chlamydia trachomatis, they might add doxycycline, another antibiotic.
There are also alternatives if you can’t take ceftriaxone for some reason. These include other cephalosporins like cefotaxime and ceftizoxime. Azithromycin is another alternative.
However, some forms of oral cephalosporins such as cefixime may not work as well due to widespread bacterial resistance. If possible, doctors try to test the bacteria to see which antibiotics will work. Antibiotic treatment typically continues for a week after symptoms start to improve. Those with more severe forms of the infection may need treatment for a longer period.
If a bacterial test can’t be done, parenteral cephalosporin (an antibiotic-related ceftriaxone) would be used. This is administered directly into your muscle or vein, not taken by mouth.
If you’ve had gonorrhea or gonococcal arthritis, it’s vital to inform and get treatment for any recent sexual partners. If you get repeated infections, doctors may test you for an immune system issue called complement deficiency.
If you have a history of allergies to antibiotics like ceftriaxone, don’t worry—most people can tolerate it. If you’re allergic to beta-lactams (a group of antibiotics including penicillin), doctors may do skin or challenge tests to see if you react to ceftriaxone. If you’re allergic, doctors can help your body get used to the medication through a process called desensitization.
If you present symptoms of localized purulent arthritis (a type of gonococcal arthritis where pus forms in the joint), you might need to have the joint drained. This can be done with a minimally invasive surgery or numerous aspirations where a needle is used to remove fluid until your symptoms improve. Open surgery might be necessary if aspirations aren’t good enough.
What else can Gonococcal Arthritis be?
When it comes to identifying gonococcal arthritis, it’s important to remember that it can often mimic other medical conditions. Here are some conditions which might look similar:
- Septic arthritis: This is another form of severe joint inflammation due to different bacteria. Doctors can tell it apart from gonococcal arthritis by examining joint fluid samples in a lab.
- Poststreptococcal arthritis: Referred to acute rheumatic arthiritis, it can cause rashes and inflammation in multiple joints. However, the rash usually does not last long and is generally not filled with fluid or pus.
- Crystal arthropathy: It can also show up as inflammation in one or a few joints and can be distinguished by analyzing joint fluid samples.
- Other inflammatory arthritis: Conditions like rheumatoid arthritis, reactive arthritis, and psoriatic arthritis might be confused with gonococcal arthritis. Yet, these conditions are usually associated with other clinical signs or x-ray findings that are not seen in disseminated gonococcal infection.
In addition, some infections like Lyme disease, infective endocarditis, and certain viruses could also involve the joints in some way, further complicating diagnosis.
What to expect with Gonococcal Arthritis
The outlook is very positive for disseminated gonococcal arthritis, a widespread form of gonorrhea infection that affects the joints, if it is treated with suitable therapy. However, it is essential to promptly and effectively treat this condition, as failing to do so can sometimes result in rare complications. These complications may include meningitis (an infection of the membranes surrounding your brain and spinal cord), perihepatitis (inflammation around the liver), osteomyelitis (a bone infection), and endocarditis (an inflammation of the heart’s inner lining).
Possible Complications When Diagnosed with Gonococcal Arthritis
- Meningitis (brain and spinal cord infection)
- Joint damage
- Perihepatitis (infection around the liver)
- Endocarditis (infection in heart lining and valves)
- Osteomyelitis (bone infection)
Recovery from Gonococcal Arthritis
Once the treatment is finished, it’s essential to check up on the patient’s health again. It’s also necessary for the patient to undergo tests for other infections that can be passed through sexual contact within a period of 3 to 6 months. Most significantly, it’s equally vital to treat the patient’s partners.
