Gonococcal - Purulent arthritis

Canadian Guidelines on Sexually Transmitted Infections - Gonococcal Infections

 

- Test, and treat regardless of clinical signs/symptoms, all recent (60 days) sexual contacts.

- Recurrent gonococcal septic arthritis warrants investigation for complement deficiency.

- Diagnostic tests:

  • test for HIV, syphilis, chlamydia, and hepatitis B (if no history of vaccine)
  • cultures of blood and synovial fluid for Neisseria gonorrhoeae
  • NAAT and culture from skin lesions for Neisseria gonorrhoeae
  • NAAT and culture from urine or vaginal/endocervical specimen for Neisseria gonorrhoeae
  • Anal and/or pharyngeal swabs for NAAT and culture for Neisseria gonorrhoeae in persons performing oral sex and /or having receptive anal intercourse.
 
Usual Pathogens

Neisseria gonorrhoeae

 

Empiric Therapy Dose Duration
Joint drainage    
+    
Ceftriaxone 2g IV daily 7-14 days
+    
Azithromycin 1g PO 1 dose
Alternative    
Joint drainage    
+    
Ceftriaxone 2g IV daily 7-14 days
+    
Doxycycline 100mg PO bid 7 days