Gonococcal Arthritis

Gonococcal arthritis is a rare complication of the sexually transmitted infection (STI) gonorrhea. It generally causes painful inflammation of the joints and tissues. Gonorrhea is a very common STI, especially among teens and young adults. The Centers for Disease Control and Prevention (CDC) reports that there are 820,000 new infections in the United States each year.

Gonorrhea is usually spread through sexual contact, but babies can also contract it from their mothers during childbirth. Common symptoms include painful urination, pain during intercourse, pelvic pain, and discharge from the vagina or penis. Gonorrhea infections can also produce no symptoms whatsoever.

While this type of infection clears up quickly with antibiotics, many people do not seek treatment for STIs. This may be due to embarrassment or because they aren’t experiencing symptoms and don’t know they are infected.

Gonococcal arthritis is one of many complications that occur as a result of untreated gonorrhea. Symptoms include swollen, painful joints and skin lesions. If left untreated, this condition can lead to chronic joint pain.

In many cases, gonorrhea causes no symptoms, so you may not be aware that you have it. Gonococcal arthritis can occur in the ankles, knees, elbows, wrists, and, rarely, in axial skeletal joints (bones of the head and trunk). It can affect many joints or a single joint.

Symptoms may include:

  • red and swollen joints
  • joints that are tender or painful, especially when you move
  • restricted joint range-of-motion
  • fever
  • chills
  • skin lesions

In infants, symptoms may include:

  • difficulty feeding
  • irritability
  • crying
  • fever
  • spontaneous movement of a limb

Gonorrhea is caused by a bacterium called Neisseria gonorrhoeae. Men and women contract gonorrhea through oral, anal, or vaginal intercourse. Babies can also get gonorrhea during childbirth if their mothers are infected.

Women and teenage girls are at an increased risk for contracting gonorrhea. Other risk factors include new sexual partners or multiple partners, and not practicing safe sex (i.e., not using condoms).

In addition to joint swelling and pain, an untreated gonorrhea infection can lead to other more serious health complications, including:

  • pelvic inflammatory disease (a serious infection of the uterus lining, ovaries, and fallopian tubes that can lead to scarring)
  • infertility in men and women
  • complications during pregnancy
  • increased risk of HIV/AIDS

Babies who contract gonorrhea from an infected mother are also at a higher risk for infections, skin sores, and blindness.

If you or your partner has symptoms of an STI, seek medical attention as soon as possible.

To diagnose gonococcal arthritis, your doctor will review your symptoms and conduct one or more tests to look for a gonorrhea infection. This can be detected using a variety of tests, including:

  • throat culture (a sample of tissue is swabbed from the throat and tested for bacteria)
  • cervical gram stain (as part of a pelvic exam, your doctor will take a sample of tissue from the cervix, which will be tested for the presence of bacteria)
  • urine or blood test

If you test positive for gonorrhea and are experiencing symptoms associated with gonococcal arthritis, your doctor may want to test joint fluid to confirm diagnosis. Your doctor will extract a sample of fluid from the area around an inflamed joint with a needle. The fluid will then be sent to a laboratory to test it for the presence of bacteria.

The underlying gonorrhea infection must be treated in order to relieve your symptoms. The primary form of treatment is antibiotic drugs. Because some strains of gonorrhea have become drug-resistant, your doctor may prescribe several types of antibiotics.

According to treatment guidelines set by the Centers for Disease Control and Prevention (CDC), gonorrhea infections should be treated with a 250 mg dose of the antibiotic ceftriaxone (given as an injection) in addition to an oral antibiotic. This may include 1 mg azithromycin, given in a single dose, or 100 mg of doxycycline, taken twice daily for seven to 10 days. These guidelines from the CDC change over time and your doctor will be referencing the most up-to-date versions — so treatments may vary.

You must be retested after one week of treatment to see if your infection has cleared up.

You should inform all your sexual partners about your diagnosis so that they can be tested and treated. You should refrain from sexual relations until you and all your partners have been treated to prevent the spread of infection.

Most people feel relief after a day or two of treatment and make a full recovery. However, without treatment, this condition can lead to chronic joint pain.

Abstaining from sex is the only sure way to prevent STIs. People who are sexually active can lower their risk by using condoms and getting tested on a regular basis. Having new or multiple sexual partners can also put you at increased risk. Taking steps to practice safe sex and stay informed about your sexual health can help you get a quick diagnosis or prevent infection in the first place.

The CDC recommends that the following groups get tested for gonorrhea every year:

  • sexually active men who have sex with men
  • sexually active women under the age of 25
  • sexually active women who have new or multiple partners

You should notify all your sexual partners if you’ve been diagnosed with gonorrhea. They will need to be tested and possibly treated as well. Don’t have sex until you have completed treatment and your doctor confirms that the infection has been cured.