This infection occurs in people who have been infected with gonorrhea. It affects women more frequently than men (4:1) and its highest incidence is among sexually active adolescent girls. There is also increased risk during menstruation and pregnancy.

Two forms of arthritis exist -- one with skin rashes and multiple joint involvement, and a second, less common, form in which disseminated gonococcemia leads to infection of a single joint (monoarticular) and joint fluid cultures are positive.

Single joint arthritis follows generalized spread (dissemination) of the gonococcal infection. Dissemination is associated with symptoms of fever, chills, multiple joint aches (arthralgia), and rashes (1-mm to 2-cm red macules). This episode may end as a single joint becomes infected. The most commonly involved joints are the large joints such as the knee, wrist, and ankle.

• migrating joint pain for 1 to 4 days (polyarthralgia)
• pain in the hands/wrists due to tendon inflammation (tenosynovitis)
• single joint pain
• fever
• skin rash or lesion

• positive cervical Gram stain (positive for gonococci)
• urethral culture for gonorrhea in men
• cervical culture for gonorrhea in women
• rectal culture for gonorrhea in men and women
• throat culture for gonorrhea
• joint fluid Gram stain
• synovial fluid culture for gonorrhea (culture of joint aspirate)
• blood cultures should be checked in all cases of possible gonococcal arthritis

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first aspect is to cure the infected person. The second is to locate and test all sexual contacts and to treat them to prevent further spread of the disease. That is why mandatory reporting has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the incidence is once again rising.

Beginning about the time of the Vietnam war, the United States saw the appearance of strains of gonorrhea that are resistant to penicillin and tetracycline. These resistant strains have been increasing over the last few years. Because of this, a new standardized treatment regimen has now been recommended by the Centers for Disease Control (CDC).

Instead of the standard penicillin treatment, gonorrhea is now treated by a large number of new and very potent antibiotics. You should check with your health care provider at the time of treatment to ascertain the best and most up-to-date treatment at the time.

A follow-up visit 7 days after treatment to recheck cultures and confirm the cure of infection is important.

Symptoms usually improve within 24 to 48 hours after initiation of treatment. Complete recovery is anticipated with treatment.

Untreated, there may be:

• persistent discomfort in the joint(s)
• infertility
• other gonorrhea complications, such as disseminated gonorrhea (spread throughout the body)

Call your health care provider if you experience symptoms suggestive of gonococcal arthritis.

Prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner are considered the ideal means of prevention. The use of condoms provides the best protection against gonorrhea and other sexually transmitted diseases. Treatment of all sexual partners of a known infected person is essential to prevent further spread or reinfection.