Gonococcal arthritis is a type of joint infection caused by the bacteria *Neisseria gonorrhoeae*, which is the same organism responsible for the sexually transmitted infection gonorrhea. This condition occurs when the bacteria spread from the initial site of infection, usually the genital tract, into the bloodstream and then reach the joints, leading to inflammation and damage.
The development of gonococcal arthritis begins with an infection by *Neisseria gonorrhoeae*, a gram-negative bacterium that primarily infects mucous membranes such as those in the urethra, cervix, rectum, throat, or eyes. In many cases, especially in women, the initial gonorrhea infection may be asymptomatic or cause only mild symptoms, which allows the bacteria to persist and multiply unnoticed. In men, symptoms like painful urination and purulent discharge are more common, making early detection somewhat easier.
If the infection is not treated promptly, the bacteria can enter the bloodstream, a condition known as disseminated gonococcal infection (DGI). Once in the bloodstream, the bacteria can travel to various parts of the body, including the joints. Gonococcal arthritis typically affects multiple joints, often the knees, wrists, ankles, and elbows, and is characterized by joint pain, swelling, redness, and warmth. Patients may also experience fever and general malaise.
The joint infection caused by *Neisseria gonorrhoeae* is a form of septic arthritis, which means the joint space becomes infected and inflamed due to the presence of bacteria. The bacteria induce an immune response that leads to inflammation of the synovial membrane (the lining of the joint), causing swelling and pain. The infection can cause the accumulation of pus within the joint, leading to further damage if not treated.
Gonococcal arthritis often presents in two clinical forms. The first is a more systemic form called arthritis-dermatitis syndrome, which includes symptoms such as fever, skin lesions, and tenosynovitis (inflammation of the tendon sheaths), along with joint pain. The second form is a localized septic arthritis, where one or more joints become acutely inflamed and infected.
The risk factors for developing gonococcal arthritis include having untreated or inadequately treated gonorrhea, being sexually active with multiple partners, and having a compromised immune system. Women are more likely to develop disseminated infection than men, possibly due to the higher likelihood of asymptomatic genital infections.
Diagnosis of gonococcal arthritis involves clinical examination, joint fluid analysis, and microbiological cultures to identify *Neisseria gonorrhoeae*. Joint fluid typically shows signs of infection such as increased white blood cells and bacteria. Blood cultures may also be positive in some cases.
Treatment requires prompt administration of appropriate antibiotics to eradicate the bacteria. Because *Neisseria gonorrhoeae* has developed resistance to many antibiotics over time, treatment usually involves specific antibiotics recommended based on current resistance patterns. In addition to antibiotics, affected joints may need to be drained to remove infected fluid and reduce pressure and pain.
If untreated, gonococcal arthritis can lead to severe joint damage, chronic pain, and disability. Early recognition and treatment are crucial to prevent these complications. Preventing gonococcal arthritis largely depends on preventing and effectively treating gonorrhea infections through safe sexual practices, regular screening, and timely antibiotic therapy.
In summary, gonococcal arthritis is a serious joint infection caused by the spread of *Neisseria gonorrhoeae* from a primary mucosal infection into the bloodstream and joints. It develops through a process of bacterial dissemination, immune response, and joint inflammation, requiring prompt diagnosis and treatment to avoid lasting joint damage.