Disseminated Gonococcal Infection

What is disseminated gonococcal infection?

Summary

Disseminated gonococcal infection is a condition in which a common sexually transmitted pathogen, Neisseria gonorrhoeae, spreads through the bloodstream and causes a variety of systemic symptoms, including the potential complication of meningitis. Neisseria gonorrhoeae is the organism that causes gonorrhea, a sexually transmitted infection that causes pain with urination and purulent discharge from the urethra in men and from the vagina in women. In some people with untreated Neisseria gonorrhoeae infections (about 1-3% of people), the organism may spread through their bloodstream and cause disseminated gonococcal infection, which can include meningitis.

Symptoms include joint and tendon pain, small fluid-filled bumps on the skin, fever, and chills.

Treatment will involve antibiotics and possible drainage of joint fluid. Your doctor may also recommend that you contact recent sexual partners so they can be tested and treated if need be.

Recommended care

You should visit your primary care physician to confirm the diagnosis and discuss treatment options for managing symptoms.

Disseminated gonococcal infection symptoms

The symptoms of disseminated gonococcal infection and potential meningitis usually occur two to three weeks after the genitourinary infection, although in most cases the initial genitourinary infection does not cause any symptoms.

Main symptoms

People who develop disseminated gonococcal infection usually experience one of two types of symptoms, which can also include symptoms of meningitis. In the first type of presentation, called “arthritis-dermatitis syndrome,” people develop a combination of skin symptoms and pain in multiple joints and tendons. In the second type of presentation, called “purulent arthritis,” people usually only develop pain in one or a few joints with substantial swelling. More information on these symptoms is listed below, including potential symptoms of meningitis:

• Joint pain: Joint pain can be seen in both types of disseminated gonococcal infection and may also be associated with symptoms of meningitis. In arthritis-dermatitis syndrome, the joint pain usually affects multiple joints throughout the body, and may “move” from one joint to the next. In purulent arthritis, usually, only one or a few joints are affected, and the affected joints may be red and swollen. Purulent arthritis usually affects the wrists, ankles, or knees, and usually does not affect joints in the center of the body.
• Tendon pain: People with the arthritis-dermatitis syndrome can develop pain in the tendons, which are tough, fibrous bands in our body that connect muscles to bones. The tendons that are affected are usually in the arms. You may experience pain in the front of your forearms when you bend your fingers.
• Small fluid-filled bumps on the skin: Many people with the arthritis-dermatitis syndrome form of disseminated gonococcal infection will develop skin findings, and these skin findings may also be associated with symptoms of meningitis. The most common skin finding is small fluid- or pus-filled bumps, usually located on the hands or feet. These bumps usually last three to four days and then disappear without treatment. In rare cases, people may develop red spots, raised red bumps, large fluid-filled bumps, or other skin findings.
• Fever and chills: Some people with disseminated gonococcal infection and potential meningitis may develop a fever and chills near the beginning of the infection. This is more common in the arthritis-dermatitis syndrome form of disseminated gonococcal infection.

Disseminated gonococcal infection causes

There are a number of factors that may increase the risk of developing a disseminated gonococcal infection, detailed below. It should also be noted that disseminated gonococcal infection occurs more frequently in people younger than 40 years of age and in women.

Untreated genitourinary Neisseria gonorrhoeae infection

The primary cause of disseminated gonococcal infection is untreated genitourinary Neisseria gonorrhoeae infection. This can occur because most cases of genitourinary Neisseria gonorrhoeae infection do not cause any symptoms, especially in women (more than 95 percent of the time). Therefore, people may have Neisseria gonorrhoeae infection without realizing it and do not seek treatment.

Recent menstruation

Recent menstruation in a woman who has a Neisseria gonorrhoeae infection may increase the risk of developing a disseminated gonococcal infection. The exact reason for this is unclear, but it may be due to changes in the woman’s body and in the Neisseria gonorrhoeae bacteria during menstruation that make the bacteria more likely to spread.

Pregnancy or recent childbirth

Having a Neisseria gonorrhoeae infection while pregnant or if you have recently given birth also increases the risk of developing disseminated gonococcal infection. This may be due to changes to the immune system during pregnancy that makes it more likely for Neisseria gonorrhoeae to spread.

Deficiency in a specific part of the immune system

Some people have a deficiency in a specific part of the immune system called the complement system. The complement system is a part of the immune system that attacks certain bacteria such as Neisseria gonorrhoeae. Therefore, having a deficiency in the complement system increases the risk of developing a disseminated gonococcal infection.

Being infected with a more aggressive strain of Neisseria gonorrhoeae

Some strains of Neisseria gonorrhoeae have specific factors that help them avoid the body’s immune system and spread throughout the body. Being infected with one of these more aggressive strains of Neisseria gonorrhoeae can increase the risk of developing a disseminated gonococcal infection.

Treatment options and prevention

Antibiotics

All people who develop disseminated gonococcal infection need to be treated with a course of antibiotic medications. The specific medications used may vary based on the doctor’s preferences and the specific strain of organism causing the infection, but most cases will be treated with ceftriaxone (Rocephin), which is given intravenously or injected into the muscle, and azithromycin (Zithromax), which is taken as a pill. Antibiotics are usually continued for one to two weeks until symptoms improve.

Drainage of joint fluid

People with disseminated gonococcal infection who have joint swelling may benefit from having the fluid drained from the joint [3]. Drainage of the fluid should relieve some symptoms and may help in the diagnosis of the infection. The fluid is usually first drained by using a needle. If the fluid cannot be fully drained with a needle, a surgical procedure may be used to drain the fluid.

Test and treatment sexual partners

In most cases of disseminated gonococcal infection, your doctor may recommend that you try to contact any sexual partners you have had in the last 60 days to offer them a diagnosis and potential treatment options for Neisseria gonorrhoeae infection. Since most cases of Neisseria gonorrhoeae infection do not cause any symptoms, this can help catch Neisseria gonorrhoeae infections early and prevent it from spreading.

When to seek further consultation

If you develop any symptoms of disseminated gonococcal infection such as fever, joint pain, tendon pain, or a rash, you should go see your doctor. Your doctor can order laboratory tests to determine if you have disseminated gonococcal infection and then offer the appropriate treatment.

If you develop symptoms of a Neisseria gonorrhoeae genitourinary infection such as pain with urination and/or a purulent discharge coming from the urethra or vagina, you should go see your doctor. Your doctor can order lab tests to determine if you have a genitourinary Neisseria gonorrhoeae infection, and then prescribe the appropriate treatment to reduce your chances of developing disseminated gonococcal infection.