Gonococcal Arthritis

What is Gonococcal Arthritis?

Gonococcal arthritis occurs in 0.08-0.6% of cases of complicated gonorrhea. More often women are ill, including girls suffering from gonococcal vulvovaginitis. Men get sick extremely rarely due to the rapid recovery of urethritis. The exceptions are homosexuals suffering from gonococcal proctitis.

Causes of Gonococcal Arthritis

The causative agent of the disease is gonococcus, which penetrates the joint cavity by hematogenous route, metastasis from the primary urogenital focus. This possibility is created by disseminated (generalized) gonorrhea, which occurs in approximately 1% of men and 4% of women. The high frequency and severity of the disease in women is often explained by the asymptomatic course of the primary infection, its late recognition and too late treatment. Predisposing factors in women are also pregnancy and menstruation, during which favorable conditions for reproduction of gonococcus are created in the genitals. The possibility of the development of reactive arthritis in patients with gonorrhea is being questioned by many authors, since it turned out that in the past, arthritis of such a genesis took the venereal form of Reiter’s disease.

Symptoms of Gonococcal Arthritis

True gonococcal arthritis is characterized by the same symptoms as any other septic articular process: high fever, chills, lesion of one or more joints, leukocytosis. The usual localization of the process is the knee, ankle, and wrist joints, in which there are pronounced signs of local inflammation and the atrophy of the periarticular muscle groups is rapidly developing. It is extremely rare to develop gonococcal mono or oligoarthritis without the general symptoms of sepsis. Gonococcal skin lesions in the form of nodular papules on a red base, sometimes vesicles and pustules filled with purulent or hemorrhagic contents with a dark necrotic center, usually localized on the back, distal limbs, around the joints, are simultaneously found in 25-50% of patients.

In the initial, acute period of the disease, bacteremia is observed, which can be proved by the release of gonococcus from the blood, and in 50% of patients it is possible to identify the microorganism from synovial fluid. In the synovial membrane examined at the height of the disease, the pattern of acute inflammation is determined with abundant infiltration of tissue with neutrophilic leukocytes up to the formation of microabscesses.

Diagnosis of Gonococcal Arthritis

Radiographic signs. Pronounced epiphyseal osteoporosis from the very early stages of the disease. Destruction of cartilage and erosion of the articular ends of the bones develop only with late and inadequate treatment.

Diagnosis. The diagnosis of gonococcal arthritis is considered absolutely proven when a microbe is isolated from the blood or found in smears and cultures of synovial fluid. The gonococcal etiology of the articular process can be considered as probable if the microorganism is found only in the anogenital foci, but adequate penicillin therapy brings a quick and complete effect.

The reaction of Bordeaux – Zhangu has only an auxiliary diagnostic value, since in acute gonorrhea it becomes positive only at the 2nd to 4th week of the disease. However, in chronic complicated gonorrhea (epididymitis, salpingoophoritis, prostatitis, etc.) is positive in 40-90% of cases. The results of the reaction can be taken into account in unclear forms of articular pathology, especially in women with chronic inflammatory foci of the urinary tract.

Differential diagnosis. Acute gonococcal arthritis, especially in the absence of convincing evidence of its connection with gonorrhea, should be differentiated from other infectious arthritis. It should be borne in mind that gonococcal arthritis occurs, as a rule, in practically healthy people, while other infectious arthritis is more common in debilitated patients, against the background of severe common diseases. Reiter’s disease, unlike gonococcal arthritis, is predominantly diagnosed in men who are carriers of HLA B27; its development is in chronological connection with non-gonococcal (most often chlamydial) urethritis or prostatitis, and the clinical symptoms, in addition to arthritis, include such symptoms as conjunctivitis, balanitis, damage to the mucous membranes of the oral cavity, keratodermia of the soles and palms.

Treatment of Gonococcal Arthritis

In the acute period – rest, creating a comfortable position for the affected limb with the help of pillows, rollers, tires, dry heat on the joint. Penicillin is necessarily prescribed at 6000000-10000000 IU / day 4 times. If the diagnosis is established in a timely manner and treatment is started early, after 1-3 days, a strikingly rapid reverse development of all clinical manifestations of the disease can occur, which is recommended to be taken into account as an additional diagnostic sign of gonococcal arthritis.

Penicillin treatment is continued for 7-14 days, sometimes replacing it with ampicillin, at a dose of 2 g / day, as the condition improves. You can also use erythromycin 1.5-2 g / day for 1-2 weeks. In true gonococcal arthritis, short-term antibiotic therapy is quite effective. In addition to penicillin, prescribed NSAIDs (indocide, reopirin, butadione, voltaren, etc.). It is extremely rare for severe pain in the acute period to use the more powerful analgesics (promedol, etc.). When abating inflammation prescribed massage, gymnastics, physiotherapy (Solux, diathermy, paraffin baths).

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