Gonococcal Arthritis Differential Diagnoses
- Author: Rachel Robbins, MD; Chief Editor: Herbert S Diamond, MD more...
In the pediatric population, the diagnosis of gonococcal arthritis must be considered if the patient is sexually active or abused. In the geriatric population, gonococcal arthritis is uncommon but should be considered if suggested by the patient’s sexual history.
In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:
- Nongonococcal septic arthritis
- Bacterial endocarditis
- Parvovirus infection
- Gout (may mimic septic arthritis and rarely occurs with gonococcal arthritis)
Infectious causes of fever and purpuric skin lesions include the following:
- Rickettsial infections
- Rocky Mountain spotted fever
- Staphylococcal bacteremia
- Enterovirus infection
- Coxsackievirus infection
- Echovirus infection
Noninfectious causes of fever and purpuric skin lesions include the following:
- Systemic lupus erythematosus with small-vessel vasculitis
- Rheumatoid arthritis with small-vessel vasculitis
- Polyarteritis nodosa
- Hypersensitivity vasculitis
- Henoch-Schönlein purpura
Dalla Vestra M, Rettore C, Sartore P, Velo E, Sasset L, Chiesa G, et al. Acute septic arthritis: remember gonorrhea. Rheumatol Int. 2008 Nov. 29(1):81-5. [Medline].
Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003 Apr. 17(2):201-8. [Medline].
Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. 2005 Dec. 19(4):853-61. [Medline].
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta, GA: U.S.Department of Health and Human Services; November 2015. [Full Text].
Roth A, Mattheis C, Muenzner P, Unemo M, Hauck CR. Innate recognition by neutrophil granulocytes differs between Neisseria gonorrhoeae strains causing local or disseminating infections. Infect Immun. 2013 Jul. 81(7):2358-70. [Medline].
World Health Organization Fact Sheet Number 110. Available at http://www.who.int/mediacentre/factsheets/fs110/en/index.html. December 2015; Accessed: July 26, 2016.
Belkacem A, Caumes E, Ouanich J, Jarlier V, Dellion S, Cazenave B, et al. Changing patterns of disseminated gonococcal infection in France: cross-sectional data 2009-2011. Sex Transm Infect. 2013 Dec. 89 (8):613-5. [Medline].
Tuttle CS, Van Dantzig T, Brady S, Ward J, Maguire G. The epidemiology of gonococcal arthritis in an Indigenous Australian population. Sex Transm Infect. 2015 Mar 19. [Medline].
Marker-Hermann E. Septic arthritis, osteomyelitis, gonococcal and syphilitic arthritis. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology. 4th ed. Philadelphia, PA: Mosby Elsevier; 2008. 1013-28.
Low SY, Ong CW, Hsueh PR, Tambyah PA, Yeo TT. Neisseria gonorrhoeae paravertebral abscess. J Neurosurg Spine. 2012 Jul. 17(1):93-7. [Medline].
Davis BT, Pasternack MS. Case records of the Massachusetts General Hospital. Case 19-2007 - a 19-year-old college student with fever and joint pain. N Engl J Med. 2007 Jun 21. 356(25):2631-7. [Medline].
Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T, et al. Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction. Arthritis Rheum. 1994 May. 37(5):702-9. [Medline].
Read P, Abbott R, Pantelidis P, Peters BS, White JA. Disseminated gonococcal infection in a homosexual man diagnosed by nucleic acid amplification testing from a skin lesion swab. Sex Transm Infect. 2008 Oct. 84(5):348-9. [Medline].
Kimmitt PT, Kirby A, Perera N, Nicholson KG, Schober PC, Rajakumar K, et al. Identification of Neisseria gonorrhoeae as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time PCR. J Travel Med. 2008 Sep-Oct. 15(5):369-71. [Medline].
[Guideline] Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline]. [Full Text].
Centers for Disease Control and Prevention. Notice to readers: discontinuation of spectinomycin. MMWR. 2006. 55:370.
Centers for Disease Control and Prevention. Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines 2006: Fluoroquinolones no longer recommended for treatment of gonococcal infections. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm. Accessed: April 13, 2014.
Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections. MMWR Morb Mortal Wkly Rep. 2012 Aug 10. 61:590-4. [Medline].
Kirkcaldy RD, Harvey A, Papp JR, Del Rio C, Soge OO, Holmes KK, et al. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance - The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014. MMWR Surveill Summ. 2016 Jul 15. 65 (7):1-19. [Medline]. [Full Text].