Most patients who develop a disseminated gonococcal infection are young, sexually active females.
The patient may or may not have evidence of an untreated sexually transmitted disease.
Most common manifestations:
(1) mono, oligo or polyarthritis, often sparing the axial skeleton and showing an asymmetrical distribution
(2) dermatitis (macules, papules, pustules, vesicles, bullae, erythema nodosum, etc)
(3) tenosynovitis
Less common manifestations:
(1) endocarditis, especially of the aortic valve
(2) osteomyelitis
(3) meningitis
(4) intermittent bacteremia
(5) septic shock with multi-organ failure
Identification of Neisseria gonorrhoeae is key to the diagnosis. This may involve culture of multiple mucosal sites (genital, anorectal, pharynx), joint fluid and blood. Molecular techniques are more sensitive than culture. If cultures of the patient are negative, then detection of the organisms in the sexual partner may be helpful.
