How did the STD get there, Doc??
Disseminated gonococcal infection is a systemic illness that begins with a mild or absent prodromal phase which progresses to polyarthralgias, tenosynovitis, and skin lesions (pustular or petechial rash). In some cases, this can ultimately manifest as a purulent arthritis and even pericarditis, endocarditis, or meningitis!
- Synovial fluid culture and gram stain are only positive less than 40% of the time
- Be sure to inform your lab that you want to evaluate for gonorrhea as this requires special testing
- Blood cultures frequently negative too
- Make sure to collect specimens from mucosal sites (i.e. cervical, rectal, urethral or pharyngeal) as these are more often positive
- Clinical correlation!
For “dermatitis-arthritis syndrome”:
- IV ceftriaxone every 24 hours +/- azithromycin for suspected chlamydia infection
- Can change to oral antibiotics if improvement of effusion and rash after IV treatment (i.e oral cefixime for at least 7 days)
- Typically see rapid improvement after initiation of IV antibiotics
For purulent arthritis:
- Likely will need longer course of IV antibiotics and repeat joint aspirations for re-accumulation. Rarely requires surgical drainage.
- Advise the patient to inform all partners of need for treatment and screen for other STIs
· SSexually transmitted diseases treatment guidelines, 2015. Workowski KA, Bolan GA, Centers for Disease Control and Prevention
Current Diagnosis & Treatment Emergency Medicine, 7e. Chapter 42. Infectious Disease Emergencies. Jon Jaffe, MD; Taylor Ratcliff, MD
· Current Diagnosis & Treatment of Sexually Transmitted Diseases. Chapter 16. Gonorrhea. Heidi Swygard, MD, MPH; Arlene C. Sena, MD, MPH; Peter Leone, MD; Myron S. Cohen, MD