Clinical features:
(1) The patient is usually young and sexually active.
(2) Women may be affected more often than men.
(3) The source infection is often untreated, usually because it is asymptomatic.
(4) The patient presents with arthralgias that may involve one, several or multiple joints and may be migratory.
(5) Joint involvement is primarily in the limbs, often sparing the axial skeleton.
(6) Joint involvement is often asymmetrical which may be helpful in distinguishing the arthritis from that seen with autoimmune diseases.
(7) Joint involvement is often accompanied by tenosynovitis and skin lesions (arthritis-dermatitis syndrome).
(8) Septic arthritis may develop if the patient is left untreated, with development of a purulent effusion.
(9) Osteomyelitis may be a late complication.
The diagnosis may be straightforward if diplococci are seen in a Gram stain of a joint aspirate or if Neisseria gonorrhoeae is isolated in culture. However, both are often negative, especially in the early stages.
In a sexually active patient multiple body sites should be cultured, including blood. Molecular techniques are usually more sensitive than culture. If all sites are negative, then consider evaluating any recent sexual partners.
The outcome is usually good if treated promptly and with appropriate antibiotics. Antibiotic resistance is becoming more common, so susceptibility testing of culture isolates should be considered.
