4. 1998;102(4 pt 1):939–944. In United States gonococcal arthritis is recorded to be affecting individuals between the age group of 15 to 29 years. 19. Ceftriaxone as a parenteral therapy, either given intravenously or intramuscularly, is the preferred initial antibiotic of choice. 2007;44(suppl 3):S84–S101. O'Brien CJ, Emerg Infect Dis. MEJEBI T. MAYOR, MD, JD, Providence Hospital, Washington, District of Columbia, MICHELLE A. ROETT, MD, MPH, Georgetown University/Providence Hospital Family Medicine Residency Program, Colmar Manor, Maryland, KELECHI A. UDUHIRI, MD, MPH, MS, Franklin Square Hospital Family Medicine Residency Program, Baltimore, Maryland. Gonococcal infections in the adult. Klausner JD. Pain in the wrists and hands resulting from tendon inflammation. Gonococcal conjunctivitis has an average incubation period of six days. Gonococcal arthritis is a complication of gonorrhea, a sexually transmitted infection that results in inflammation and pain in the tissues and joints. Golden MR, Newman LM, Blake DR, For males, treatment is always outpatient for genital infection; however, admission may be necessary for complications such as disseminated gonococcal infection (DGI… This content is owned by the AAFP. afpserv@aafp.org for copyright questions and/or permission requests. Peterman TA, Duggan A, Gonorrhea. Østergaard L, et al. The CDC recommends that men who have sex with men be screened at least annually for gonorrhea at urethral, rectal, and pharyngeal sites for a history of insertive anal, receptive anal, and receptive oral intercourse, respectively.1,2 Screening for urethral infections should be performed with urine nucleic acid amplification testing, whereas rectal or pharyngeal screening should be performed with nucleic acid amplification swab. Mortensen J, 25. Related letter: Testing Options for the Detection of Gonorrhea and Chlamydia. Although study results have been mixed, some studies have found that glucosamine works no better than placebo. 9. Search terms used were Neisseria gonorrhoeae, gonorrhea, and sexually transmitted infections. Gonococcal arthritis was a leading type of septic arthritis among young adults3., 4. and accounted for up to two-thirds of septic arthritis and tenosynovitis seen in North America in the 1970s. Intensive counseling also increases adherence to treatment in women and contraceptive use in adolescent males, and decreases nonsexual risky behavior and pregnancy in sexually active adolescent females.32 Culturally appropriate intensive behavioral interventions may be more effective than standard prevention counseling for reducing the rate of reinfection with gonorrhea (number needed to treat = 12).33. Workowski KA, Gonococcal arthritis is one of the several types of infection caused by Neisseria gonorrhoeae, a Gram-negative diplococcus.It is one of the most prevalent sexually transmitted diseases (STDs) worldwide, and the leading cause of septic arthritis.Asymmetric polyarthralgia preceded or accompanied by fever and subsequent swelling of one or two joints is the typical clinical presentation. Mortensen J, Patients in whom gonococcal arthritis is suspected should be admitted to the hospital to. To see the full article, log in or purchase access. Most people need to take antibiotics for about a week, but some forms of NGU require a two-week course of antibiotics. Ness RB. Fluoroquinolones are no longer recommended for the treatment of gonorrhea because of antimicrobial resistance. Barry PM, U.S. Preventive Services Task Force. 28. Workowski KA. Minnis AM, Acupuncture. This type usually results in single joint infection. Lyss SB, Recommended Regimen Ceftriaxone 1–2 g IV every 12–24 hours The second type is rare in nature. 86/No. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. 27. Mortensen J, ; 2008;121(7):572–576. 10(November 15, 2012) 17. Metrorrhagia also may be a sign of an acute gonococcal infection.4, Untreated gonorrhea causes 10 to 20 percent of PID cases, and 15 percent of women with PID develop infertility from tubal scarring.7 One-half of patients who have had three or more episodes of PID develop infertility.7 The CDC recommends that symptomatic women be examined for PID by palpating for cervical or adnexal tenderness, and tested for gonorrhea, chlamydia, bacterial vaginosis, and trichomoniasis with endocervical swabs for light microscopy and nucleic acid amplification testing. Sex Transm Dis. Kalyon TA. CDC = Centers for Disease Control and Prevention; USPSTF = U.S. Preventive Services Task Force, A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Women more often are asymptomatic, but may present with complications such as PID.1,4, More than 95 percent of women with gonorrhea have no symptoms.4 Gonorrhea may infect the endocervix, Bartholin glands, Skene ducts, vagina, rectum, or pharynx.4 The most common manifestation is cervicitis, which usually occurs five to 10 days after exposure.6 Ten to 20 percent of women with cervical gonorrhea also have a pharyngeal infection.4 If symptoms occur, they are usually mild, and may mimic acute cystitis or vaginitis. U. S. Preventive Services Task Force. Am J Public Health. Long, warm showers or baths especially in the morning help ease stiffness in your joints. Berman S, 2010;116(2 pt 1):419–428. J Pediatr Adolesc Gynecol. disseminated gonococcemia. The CDC recommends consultation with an infectious disease specialist for patients with a history of severe allergic reactions to cephalosporins. Gonococcal infection should prompt physicians to test for other sexually transmitted infections, including human immunodeficiency virus. Cultures from skin lesions in disseminated gonococcal infections are usually negative, but joint aspirate may have greater yield. Mortensen J, Ann Intern Med. Definition: Gonococcal arthritis is inflammation of a joint due to a gonorrhea infection. Other antibiotics are erythromycin and ofloxacin. 2010;59(RR-12):1–110.... 2. Ann Fam Med. Sexually transmitted diseases treatment guidelines, 2010 [published correction appears in MMWR Recomm Rep. 2011;60(1):18]. However, some medications cause side effects, and a natural approach to pain relief is becoming more popular. Up to 30 percent of cases of ophthalmia neonatorum are caused by C. trachomatis, although gonorrhea still accounts for two or three cases in every 10,000 live births. 2005;352(7):676–685. 4th ed. Whittington WL, Pelvic inflammatory disease. 2005;142(11):914–925. Meltzer MI. Patients with gonococcal arthritis usually require initial hospitalization for intravenous (IV) antibiotic therapy; upon improvement, they can be switched to oral antibiotics. Pain from your muscles, bones, tendons, and bursae usually increases when you move. Cohen MS, Fung M, Handsfield HH, Gunn RA, Sexually transmitted diseases treatment guidelines, 2010 [published correction appears in. Aydogan H, Doxycycline 3. Causes. Confirm the diagnosis. Shang A, Gonococcal infections include urogenital, anorectal, pharyngeal, and conjunctival infections. Dr. Mayor is an assistant professor in the Department of Obstetrics and Gynecology at Howard University in Washington, DC, and acts as site director for the residents rotating at Providence Hospital.... MICHELLE A. ROETT, MD, MPH, FAAFP, is an associate professor in the Department of Family Medicine at Georgetown University Medical Center, Washington, DC. According to the Centers for Disease Control and Prevention (CDC), approximately 700,000 new cases of Neisseria gonorrhoeae infection occur annually in the United States, making it the second most frequently reported bacterial sexually transmitted infection (STI) after Chlamydia trachomatis.1 Reported rates of chlamydia and gonorrhea are highest among females 15 to 19 years of age.1 Incarcerated women younger than 35 years also exhibit high rates of infection.2, Enlarge Cook RL, 24. et al. The current treatment recommended by the CDC is a dual antibiotic therapy. Am J Med. Hospitalization is indicated in patients with suppurative arthritis or when the diagnosis is in doubt. Gonorrhea. Ghanem KG. The CDC recommends that all men who have sex with men and practice insertive anal intercourse be screened at least annually for urethral gonococcal infection with a urine nucleic acid amplification test. The U.S. Preventive Services Task Force (USPSTF) recommends that all newborns receive ocular topical medication for prophylaxis against gonococcal ophthalmia neonatorum.15, Uncomplicated urethral, cervical, or rectal gonococcal infection, Ceftriaxone (Rocephin), 250 mg IM in a single dose, Azithromycin (Zithromax), 1 g orally in a single dose, or doxycycline, 100 mg orally twice per day for 7 days*, If ceftriaxone is not available, use cefixime (Suprax), 400 mg orally in a single dose, Azithromycin, 1 g orally in a single dose, or doxycycline, 100 mg orally twice per day for 7 days*, For patients with severe cephalosporin allergy, use azithromycin, 2 g orally in a single dose, Disseminated gonococcal infection (hospitalization recommended), Ceftriaxone, 1 g IM or IV every 24 hours until 24 to 48 hours after improvement begins, Cefotaxime (Claforan), 1 g IV every 8 hours until 24 to 48 hours after improvement begins, Ceftizoxime (Cefizox), 1 g IV every 8 hours until 24 to 48 hours after improvement begins 24 to 48 hours after improvement begins, switch to cefixime, 400 mg orally twice per day, for at least one week of total antimicrobial treatment, Ceftriaxone, 1 to 2 g IV every 12 hours for 10 to 14 days for meningitis and at least 4 weeks for endocarditis, For patients with penicillin allergy, use azithromycin, 2 g orally in a single dose, Urethral, cervical, rectal, or pharyngeal gonococcal infection, Children weighing > 45 kg (100 lb): same as adult recommendations, Children weighing ≤ 45 kg: ceftriaxone, 125 mg IM in a single dose, Children weighing > 45 kg: ceftriaxone, 50 mg per kg IV or IM per day for 7 days, Children weighing ≤ 45 kg: ceftriaxone, 50 mg per kg IV or IM per day (not to exceed 1 g per day) for 7 days, Infants born to mother with untreated gonorrhea with no signs of infection, Ceftriaxone, 25 to 50 mg per kg IV or IM in a single dose, not to exceed 125 mg, Neonatal disseminated gonococcal infection or scalp abscess, Ceftriaxone, 25 to 50 mg per kg IV or IM per day for 7 days, Cefotaxime, 25 mg per kg IV or IM every 12 hours for 7 days, Ceftriaxone, 25 to 50 mg per kg IV or IM per day for 10 to 14 days, Cefotaxime, 25 mg per kg IV or IM every 12 hours for 10 to 14 days. Berman S; Giannini CM, In: Holmes KK, Sparling PF, Stamm WE, et al., eds. Fluoroquinolones are not recommended in the United States for treatment of gonorrhea or associated conditions because of the emergence of quinolone-resistant N. gonorrhoeae.1,18 [corrected] Ceftriaxone, 250 mg in a single intramuscular injection, plus either azithromycin (Zithromax), 1 g orally, or doxycycline, 100 mg orally twice daily for seven days, is ef… Beyond osteoarthritis: recognizing and treating infectious and other inflammatory arthropathies in your practice. Screening for gonorrhea: recommendation statement. Kamb ML, [corrected] First-line treatment for uncomplicated urogenital, anorectal, or pharyngeal gonococcal infections is a single intramuscular injection of ceftriaxone, 250 mg, accompanied by either azithromycin, 1 g orally, or doxycycline, 100 mg orally twice daily for seven days, to prevent bacterial resistance and address the likelihood of coinfection with Chlamydia trachomatis. Rheumatol Int. / afp Antibiotic drugs are … Gilchick RA. Johnson RE, Gonococcal Arthritis Ankle. Lancet. A woman who is pregnant, or believes she might be, should consult with a doctor, before and after treatment. Pediatrics. Piper JM, et al. Padian NS. Ghanem KG. http://www.cdc.gov/std/ept. ; Gunn RA, The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. Antibiotic drugs are commonly used to treat gonorrhea, and retesting is necessary to see if the infection has cleared up. Gonococcal infection is also more common among African Americans, however it is less prevalent in Native American, Hispanic, and Asian population. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Prim Care. Pelvic inflammatory disease. If left untreated, gonorrhea may cause pelvic inflammatory disease in women, or it may disseminate, causing synovial and skin manifestations. Behavioral counseling to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force. It … U. S. Preventive Services Task Force. Glucosamine. This is inflammation of a joint due to a bacterial or fungal infection. Newman LM, Culture should be performed in the infant and mother, including testing for chlamydia. Blake DR, Accessed March 11, 2011. Royce RA, Philadelphia, Pa.: Saunders/Elsevier; 2010. Simple hot and cold treatments can make a world of difference when it comes to arthritis pain. Initial treatment with ceftriaxone or another advanced-generation cephalosporin is warranted until signs and symptoms have improved; continuation of treatment for a total period of therapy of 1 week can be accomplished with a fluoroquinolone. Culture of non-genital sites increases the detection of gonorrhea in women. In: Holmes KK, Sparling PF, Stamm WE, et al., eds. Copyright © 2020 American Academy of Family Physicians. Conn's Current Therapy 2011. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. ... Arthritis treatments depending on herbs and essential oils include, Lavender and rosemary essential oil – They have a strong anti-inflammatory and analgesic properties and they provide comfort if massaged on the painful areas. Cohen MS, Klausner JD. Gonococcal arthritis is a joint infection. 32. Padian NS. This dosage is more effective for common pharyngeal infections than the previously recommended dose of 125 mg. Azithromycin may be used as an alternative treatment option for patients with previous allergic reactions to penicillin, but because of the likelihood of antimicrobial resistance, its use should be limited. Azithromycin 2. MMWR Morb Mortal Wkly Rep. et al. Depending on the type of antibiotic your doctor prescribes, you may only have to take a single dose, or you may have to take a longer course. Data Sources: A PubMed search was conducted for gonorrhea-related topics, including clinical reviews, randomized controlled trials, and meta-analyses. Obstet Gynecol. 2012 Nov 15;86(10):931-938. Gonococcal arthritis is caused by infection with the gram-negative diplococcus N gonorrhoeae, a highly infectious organism capable of colonizing diverse mucosal surfaces. Haile Z, Minnis AM, Clin Infect Dis. Ann Intern Med. 2009;36(8):478–489. Am Fam Physician. Marsolo K, Khatua S. Gonococcal arthritis is an infection of a joint. O'Brien CJ, Stephens SC, Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997–2003. Piper JM, Kent CK, Hook EW III, Handsfield HH. Whittington WL, Roy K, Braithwaite RS, Bauer V. Wang SA, 2005;81 (3):193–200. 2009;49(12):1793–1797. The risk of … Sex Transm Dis. Gonococcal arthritis is an infection of a joint. 21. Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997–2003. The USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk of STIs.31 High-intensity behavioral counseling refers to multiple sessions in a primary care or STI clinic setting. / Journals Gonococcal arthritis is also known as disseminated gonococcal infection. Whitlock E, Effectiveness of female controlled barrier methods in preventing sexually transmitted infections and HIV: current evidence and future research directions. Shang A, N Engl J Med. A visit after about a week of treatment is also very important in a complicated case of infection to check and confirm that the infection was cured. Gonococcal arthritis (disseminated gonococcal infection). 2012;61(31):590–594. Ness RB, Fung M, et al. Centers for Disease Control and Prevention. Pelvic Inflammatory Disease Evaluation and Clinical Health Study Investigators. 10-05146-2. Centers for Disease Control and Prevention. 2006;193(3):336–345. Diagnosis and Management of Gonococcal Infections. Ocular prophylaxis for gonococcal ophthalmia neonatorum: reaffirmation recommendation statement. Lee MA, Sexually Transmitted Disease Surveillance 2010. Ness RB. 2010;37(4):713–727. Barry PM, Patient information: See related handout on gonorrhea, written by the authors of this article. Urine nucleic acid amplification tests have a sensitivity and specificity comparable to those of cervical and urethral samples. Marsolo K, Gonococcal arthritis is a type of septic arthritis. Beyond osteoarthritis: recognizing and treating infectious and other inflammatory arthropathies in your practice. The workup should include evaluation for other causes of arthritis, and oral, genital, blood, and fluid aspirate cultures.12,13  Table 4 lists the diagnostic features of gonococcal infections.1,2,4, Mucopurulent or purulent endocervical exudate, Sustained endocervical bleeding easily induced by swab, Endocervical Gram stain showing increased PMNL count or leukorrhea with more than 10 WBCs per high-power field (low positive predictive value) and gram-negative intracellular diplococci (50 percent of women), Positive culture or nucleic acid amplification test, Gonococcal conjunctivitis (ophthalmia neonatorum), Conjunctival erythema with mucopurulent eye discharge, Gram stain smear of conjunctival exudates showing elevated PMNL count or gram-negative intracellular diplococci, Cervical motion, uterine, or adnexal tenderness, Abnormal cervical or vaginal mucopurulent discharge, Laboratory confirmation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis, WBCs present on saline microscopy (wet-mount preparation) of vaginal secretions, Endometrial biopsy with histopathologic evidence of endometritis, Transvaginal sonography or magnetic resonance imaging showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic infection, Laparoscopic abnormalities consistent with pelvic inflammatory disease, Mucopurulent or purulent discharge on examination, Urethral smear with Gram stain showing more than five PMNLs per oil immersion field and WBCs containing gram-negative intracellular diplococci, First void urine with positive leukocyte esterase on urine dip and microscopic examination with more than 10 WBCs per high-power field. 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