Gonococcal arthritis is the most common cause of septic arthritis in adolescents and young adults.3 Joint infection will typically have a prodromal phase where migratory arthritis and tenosynovitis predominate before pain and swelling settle on one or more septic joints. Vesiculopustular lesions, especially on the fingers, may be found.
Synovial fluid cultures are often negative in gonococcal arthritis, with only 25 to 50 percent of cases yielding positive identification of the organism. Cultures of the posterior pharynx, urethra, cervix, and rectum, prior to antibiotic treatment, may increase the culture yield. 3
Treatment for gonococcal arthritis follows the same principles as treatment for nongonococcal septic arthritis. Neisseria gonorrhoeae, in the setting of arthritis, remains sensitive to penicillin, and extended antibiotic coverage is typically not required following identification of the organism.
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