Arthrocentesis of the involved joint should be performed along with fluid analysis including cell count, crystal analysis, and culture.īesides synovial fluid analysis and culture on Thayer-Martin media, a patient with symptoms suggestive of DGI should have skin, oropharyngeal, urethral (males), cervical (females) and rectal cultures performed on Thayer-Martin media. Synovial fluid should be submitted on Thayer-Martin media. Blood should be cultured in enriched broth medium. If a NAAT is not available then culture is the preferred alternative.īlood culture tends to be positive in the bacteremic form while synovial culture is positive frequently in the septic arthritis form. A NAAT can be used to test specimens collected from the endocervix (women), vagina (women), urethra (men), and urine (men and women). If available and validated for the specific specimen being tested, a nucleic acid amplification test (NAAT) is the preferred diagnostic test for gonococcal (as well as chlamydial) infection. What diagnostic tests should be performed? The most common joints involved are the wrists, fingers, ankles, and toes. Musculoskeletal exam may show tenosynovitis that can be identified based on swelling of the tendon sheath with pain on movement. They may last up to 4 days and will resolve with or without treatment. Other skin findings may include urticarial lesions, erythema nodosum, and erythema multiforme. Most patients have between 2 and 10 lesions. The number of lesions may range from few to up to 50. Typical lesions seen in DGI are painless tiny papules, pustules, or vesicles with erythematous base. Physical examination should be thorough and may often help to confirm the diagnosis. Skin lesions may be present such as tiny papules, pustules, or vesicles with erythematous base, erythema nodosum, or erythema multiforme. Congenital or acquired complement deficiency as well as systemic lupus erythematosus, which is associated with complement deficiency, may increase the risk of developing DGI. There is usually a recent history of sexual activity especially in women during time of menses, pregnancy, or immediate postpartum period. The typical patient with DGI is young (less than 40 years old), with asymmetrical migratory polyarthralgias, tenosynovitis, and dermatitis. Time from infection to clinical manifestations may range from 1 day to 3 months. Many patients will have overlapping features of both syndromes. Diagnostic Confirmation: Are you sure your patient has disseminated gonorrhea?ĭGI presents as two syndromes: 1) a bacteremic form that includes a triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis and 2) a septic arthritis form characterized as a purulent arthritis without associated skin lesions.
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