ICD-9-CM 098.50 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 098.50 should only be used for claims with a date of service on or before September 30, 2015. Trends in susceptibility of Neisseria gonorrhoeae to ceftriaxone from 1985 through 1991. These Common Symptoms May Include: The development of a fever. 61:590-4. Published 2014 Mar 31. doi:10.11604/pamj.2014.17.242.4181 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145263. The leukocyte count in synovial fluid is inflammatory, usually in the range of 10 000 to 100 000 cells/mm³ 13). Skin lesions occur in up to 75% of cases and are frequently seen in the trunk and extremities and usually spares the face. Gonococcal bacteremia is more likely to be associated with polyarthralgias and skin lesions. Sex Transm Infect. Gonococcal arthritis affects women more often than men. Gonococcal arthritis affects women more often than men. Specific strains of Neisseria gonorrhoeae have virulence factors that have been associated with dissemination. Disseminated gonococcal infection causes. Neisseria gonorrhoeae is usually transmitted sexually and is an important cause of bacterial arthritis in sexually active adolescents. In 1984 we started an outpatient clinic for patients with early arthritis of less than one year ... gonococcal arthritis Symptoms of foot and ankle arthritis often involve the following: Tenderness or pain. It occurs in people who have gonorrhea, which is caused by the bacteria Neisseria gonorrhoeae. MMWR Surveill Summ. A thorough history and physical examination including an emphasis on sexual history are needed in patients with suspected gonococcal arthritis. Christopher A. Ohl, Derek Forster, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), 2015. Dalla Vestra M, Rettore C, Sartore P, Velo E, Sasset L, Chiesa G, et al. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ Case 19-2007 - a 19-year-old college student with fever and joint pain. 1991 Aug; 50(8):572-3. When obtained from the primary site of infection, 90% of results are positive in cervical samples, 50-75% in male urethral samples, 20% in pharyngeal samples, and 15% in rectal samples. Host-related risk factors for disseminated infection include the following 21): Organism-related risk factors for disseminated gonococcal infection include the following 22): The clinical presentation of disseminated gonococcal infection is typically divided into a bacteremic form (arthritis-dermatitis syndrome) and a septic arthritis form. Gonococcal arthritis. Approximately 60% developed fever in one study in women with disseminated gonococcal infection. It occurs in people who have gonorrhea, which is caused by the bacteria Neisseria gonorrhoeae. Suppurative gonococcal arthritis is frequently monoarticular. Oral cephalosporins are therefore not recommended as initial therapy. Pain in the lower abdominal area – this symptoms [3] can be especially severe in some cases. Ann Rheum Dis. Gonorrhea may have no symptoms at all at first, which means that many people don’t even know they have it. Acute septic arthritis: remember gonorrhea. Identification of Neisseria gonorrhoeae as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time PCR. Gonococcal arthritis is more commonly seen in young healthy individuals although it may occur in any age group 3). Balsa A, Martin-Mola E. Infectious arthritis I: bacterial arthritis. Gonococcal arthritis results from blood dissemination of Neisseria gonorrhoeae from primary sexually acquired mucosal infection. The rarity of gonococcal arthritis in association with HIV infection. [Full Text]. Gonococcal arthritis is caused by infection with the Gram-negative diplococcus Neisseria gonorrhoeae. Guillot X, Delattre E, Prati C, Wendling D. Joint Bone Spine. This is inflammation of a joint due to a bacterial or fungal infection. Gonococcal arthritis is a complication of gonorrhea, a sexually transmitted infection that results in inflammation and pain in the tissues and joints. The tenosynovitis of disseminated gonococcal infection is asymmetric and may affect both large and small joints and most commonly occurs over the dorsum of the wrist and hand, as well as over the metacarpophalangeal joints, ankles, and knees. Changing patterns of disseminated gonococcal infection in France: cross-sectional data 2009-2011. Nucleic acid amplification tests (NAATs) may be used as an adjunct to cultures and can be performed on samples from the cervix, urethra, rectum, urine, pharynx, synovial fluid, Third-generation cephalosporins are the first choice treatment 15), such as ceftriaxone, (1 g IM/IV), ceftizoxime (1g IM/IV every 8 hours) and cefotaxime (1g IV every 8 hours). Best Pract Res Clin Rheumatol. N Engl J Med. Gonococcal arthritis may be classified into bacteraemic form (arthritis-dermatitis syndrome) and suppurative form, but many patients have features of both 5). 81(7):2358-70. Reactive arthritis can sometimes also involve inflammation of the urethra (non-gonococcal urethritis), which is the tube that carries urine out of the body. 2016 Jul 15. 334286-overview Although not always possible, the microbiologic diagnosis should be attempted, and antimicrobial susceptibility testing should be performed to guide antibiotic therapy. Yield is highest if the culture is obtained from the primary infection site. A high clinical suspicion is necessary for patients who present with joint pain or swelling that is concerning for septic arthritis especially in those who are sexually active and younger than 40 years old and in certain at-risk populations such as in men who have sex with men (MSM) 30). Two sets of blood cultures should be obtained, and a positive result helps distinguish gonococcal arthritis from other pathogens that cause septic arthritis. Gonococcal arthritis is an infection of a joint. 2006 May; 26(4):373-4. El Mezouar I, Tahiri L, Lazrak F, Berrada K, Harzy T. Gonococcal polyarthritis with sternoclavicular joint involvement in pregnant woman: a case report. A prospective study in the Netherlands of patients diagnosed with septic arthritis found that 84 percent of adults had an underlying medical condition and 59 percent had a previous joint disorder.13 In a review of musculoskeletal infections in patients with human immunodeficiency virus infection, about 0.5 per… Gonococcal arthritis affects women more often than men. Patients with recurrent disseminated gonococcal infection or gonococcal arthritis will require further evaluation for complement deficiency. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). Dermatol Online J. 2014;17:242. This patient presented with cutaneous foot lesions that were diagnosed as a disseminated gonococcal infection. [Medline]. INTRODUCTION Disseminated gonococcal infection (DGI) results from bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae, which can lead to a variety of clinical symptoms and signs, such as arthritis or arthralgias, tenosynovitis, and multiple skin lesions. Notice to readers: discontinuation of spectinomycin. Rheumatol Int. 2006. True arthritis occurs in less than 50% of cases 4). Beatrous SV, Grisoli SB, Riahi RR, Matherne RJ, Matherne RJ. The most commonly involved joint are the knees, wrists, ankles and fingers. Sexually Transmitted Infections (STIs). Although each form presents with its own symptom complex, the overlap can be considerable. 1013-28. [Medline]. [Medline]. Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines 2006: Fluoroquinolones no longer recommended for treatment of gonococcal infections. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Gonococcal Arthritis. Case report and review of literature]. However, they may be indicated to exclude articular damage and to rule out other processes, such as fracture. In the geriatric population, gonococcal… Best Pract Res Clin Rheumatol. Mucosal surface cultures should be placed on prewarmed selective plates (ie, Thayer-Martin or modified New York media) and blood agar for identification of other possible organisms. 2017 Jan 15. Findings are positive in more than 80% of cases. [Medline]. Most commonly distributed on the trunk, extremities (sometimes involving the palms and soles) Typically < 10 lesions that have a transient course (subside in 3–4 days) Additional manifestations: fever and chills (especially in the acute phase) Purulent gonococcal arthritis. [Medline]. Symptoms of Gonococcal urethritis … Gonococcal arthritis is a complication of gonorrhea. Gonococcal arthritis is an infection of a joint. Lyme disease Tuttle CS, Van Dantzig T, Brady S, Ward J, Maguire G. The epidemiology of gonococcal arthritis in an Indigenous Australian population. It is most common among sexually active teen girls. 55:370. Available at http://www.who.int/mediacentre/factsheets/fs110/en/index.html. 1013-28. Gonococcal arthritis is a complication of gonorrhea. Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center, Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology, Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting, Timothy M Straight, MD Instructor, Department of Medicine, Uniformed Services University School of Medicine, Timothy M Straight, MD is a member of the following medical societies: American College of Physicians, Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference. [Updated 2018 Nov 25]. [12] Positive culture results help confirm the diagnosis and provide antibiotic sensitivities for the particular infecting strain of the organism. 2012 Jul. 2003 Apr;17(2):201-8. https://doi.org/10.1016/S1521-6942(02)00125-0. Gonococcal arthritis is one of many complications that occur as a result of untreated gonorrhea. Beatrous SV, Grisoli SB, Riahi RR, Matherne RJ, Matherne RJ. Symptoms resolve spontaneously in 30-40% of cases or evolve into a septic arthritis in 1 or several joints. Gonococcal arthritis. 2018 Jan;39(1):54-56. Laboratory tests typically performed on synovial fluid include cell count, crystal analysis, Gram stain, and culture. 236299-overview Typically, a synovial fluid analysis will show white blood cell (WBC) count of 50,000 cells/mm3 or more; although, a cell count below 10,000 cells/mm³ is not uncommon. As a rule, complications of gonococcal arthritis are rare. 1983 Nov; 62(6):395-406. Davis BT, Pasternack MS. Case records of the Massachusetts General Hospital. The erythrocyte sedimentation rate (ESR) is elevated in most cases. Sex Transm Infect. Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Centers for Disease Control and Prevention (CDC). [14, 15, 16] However, an important limitation of polymerase chain reaction (PCR) and other NAATs is they do not provide antibiotic sensitivities to guide choice of antibiotic for treatment. Patients should be tested for other sexually transmitted infections, including Chlamydia trachomatis, HIV, syphilis, Mycoplasma genitalium, and herpes simplex virus. Infect Immun. Saline lavage can also be used. Gonococcal urethritis: Introduction. The wrist, elbows, ankles, and knees are most commonly affected. Septic arthritis caused by N gonorrhoeae is monoarticular or pauciarticular, and is more commonly associated with positive synovial fluid cultures and negative blood cultures. Gonococcal Arthritis. Carlin E, Urban C, Sidle J, Cirilli A, Larson J, Richman M, Dexeus D. Gonococcal Tenosynovitis Diagnosed with the Aid of Emergency Department Bedside Ultrasound. [Medline]. Approximately 60% of patients present with symptoms consistent with the bacteremic form, and the remaining 40% present with symptoms of more localized infection. Disseminated gonococcal infection (DGI) frequently results in petechial or pustular acral skin lesions, asymmetric polyarthralgia, tenosynovitis, or oligoarticular septic arthritis (581). Share cases and questions with Physicians on Medscape consult. Atlanta: U.S. Department of Health and Human Services; 2017. 2013 Jul. When a synovial effusion is present, it should be aspirated. Gonococcal arthritis results from blood dissemination of Neisseria gonorrhoeae from primary sexually acquired mucosal infection. Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections. J Neurosurg Spine. Gonococcal Arthritis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470439. Obtaining skin lesion specimens is usually not done because of the difficulty of sampling and its very poor yield. For a rectal culture, the swab is inserted approximately 2.5 cm into the canal (ie, to the crypts of Morgagni, a frequent focus of infection). Rheumatol Int. Low SY, Ong CW, Hsueh PR, Tambyah PA, Yeo TT. Centers for Disease Control and Prevention. NAAT (nucleic acid amplification testing) of synovial fluid is more sensitive (greater than 75%) than culture and should be performed if available. [Medline]. Tenosynovitis is a unique finding in gonococcal arthritis and is usually not seen in other forms of septic arthritis. The lesion on this patient's heel was due to the systemic dissemination of the N gonorrhoeae bacteria. García-Arias M, Balsa A, Mola EM. Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta KappaDisclosure: Nothing to disclose. Centers for Disease Control and Prevention. Diseases & Conditions, encoded search term (Gonococcal Arthritis) and Gonococcal Arthritis, Notable Knuckles, Part 2: Evaluating More Conditions of the Hand, Notable Knuckles: Evaluating Arthritic Conditions of the Hand, Evaluation and Management of Septic Arthritis and Its Mimics in the Emergency Department, Proposed RA Guidelines: Maximize Methotrexate Before Switching, Turmeric Capsules Reduce Knee Osteoarthritis Pain, Small-Fiber Polyneuropathy May Underlie Dysautonomia in ME/CFS, Denosumab Favored Over Alendronate for BMD Protection in Glucocorticoid-Induced Osteoporosis, Treatment Sequence With Romosozumab Influences Osteoporosis Outcomes. The diagnosis of gonococcal arthritis or DGI is also secure if a mucosal gonococcal infection is documented in … Footnote: Disseminated gonococcal infection with arthritis. Diseases & Conditions, 2002 In bacteraemic form also called arthritis-dermatitis syndrome, clinical features include migratory polyarthralgia (knees, elbows and ankles), moderate fever, chills, vesicular or pustular lesions, tenosynovitis (50 to 60% of cases of gonococcal arthritis) particularly extensor tendon of the hands, wrists, fingers, toes and ankles 6). Chir Main. O’Brien JP, Goldenberg DL, Rice PA. Medicine (Baltimore). Gonococcal arthritis. Belkacem A, Caumes E, Ouanich J, Jarlier V, Dellion S, Cazenave B, et al. 23 (1):[Medline]. April 13, 2007; Accessed: July 31, 2018. In patients who present with localized purulent arthritis, Neisseria gonorrhoeae will be isolated in only about 50% (range of 25% to 75%) of synovial fluid specimens. Repeat arthrocentesis should be performed when inflammatory synovial effusions recur in order to remove inflammatory mediators, debris, and purulence. 333612-overview Gonococcal urethritis: An infection of the urethra causing inflammation by a gonococcal organism. Gonococcal arthritis is a rare disorder. 356(25):2631-7. 2015 Mar 19. Widespread resistance to oral cephalosporins such as cefixime has been documented. Li R, Gossman WG. Synovial fluid cultures are positive for N gonorrhoeae in no more than 50% of cases World Health Organization. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. When they do occur, they may include any of the following: A high clinical suspicion is necessary for patients who present with joint pain or swelling that is concerning for septic arthritis especially in those who are sexually active and younger than 40 years old and in certain at-risk populations such as in men who have sex with men (MSM) 30). The risk of dissemination after mucosal gonococcal infection depends on both the ability of the patient’s immune system to control the infection and the virulence of the organism 20). A complete blood count (CBC) should be obtained; most patients with gonococcal arthritis have mild leukocytosis. However, it may also be acquired perinatally during childbirth and may cause gonococcal infection in newborns 18). [Full Text]. Septic arthritis. 1991 Dec; 18(12):1932-3. Gonococcal arthritis – Gonococcal arthritis typically presents acutely in sexually active individuals with fever, chills, skin … Bacterial arthritis: Epidemiology, pathogenesis, and microbiology in infants and children …is an important cause of bacterial arthritis … Dermatol Online J. Footnote: Disseminated gonococcal infection with skin Lesions. A dose of 100 mg of doxycycline twice a day for 7 days is an alternative to azithromycin 32). The culture of skin lesions is often negative. Cultures (of synovial fluid, blood, cervix, urethra, rectum, and throat) are performed for diagnosing gonococcal infection and subsequent gonococcal arthritis. Bottled blood culture media containing sodium polyethylene sulfate inhibits growth. Gonococcal arthritis is the most common form of arthritis in sexually active young adults. Biopsy of skin lesions shows dermal vasculitis with perivascular neutrophils. It is one of the most prevalent sexually transmitted diseases (STDs) worldwide, and the leading cause of septic arthritis. J Travel Med. Gonococcus strain characteristics (Protein 1A serotype, Lack of protein II), Protein Por B1A on the outer membrane – This inhibits host factor H and C4-binding protein, making host complement cascade less effective, Strains with nutritional requirements for arginine, hypoxanthine, and uracil (ie, AHU strains) – These are often associated with protein IA, Colony opacity (Opa) protein-independent invasion – Opa proteins are adhesins crucial to the process of N gonorrhoeae attachment to host cells, particularly avoidance of carcinoembryonic antigen-related cell adhesion molecule-3 (CEACAM3). Surgical drainage may be needed in joints refractory to drainage via arthrocentesis; however, it is rarely necessary in patients with gonococcal arthritis. [15] These tests can help to confirm a diagnosis of DGI when cultures are negative. enable_page_level_ads: true Tenosynovitis and polyarthralgia may be related to autoimmune abnormalities induced by Neisseria gonorrhoeae. Definition: Gonococcal arthritis is inflammation of a joint due to a gonorrhea infection. NAAT of skin specimens may be slightly more sensitive, but this is not widely available. [Medline]. [Full Text]. 6th ed. Pan Afr Med J. Symptoms of urethritis can include: pain or a burning sensation when you pee Dalla Vestra M, Rettore C, Sartore P, Velo E, Sasset L, Chiesa G, et al. Patients should be educated about the mode of transmission of gonorrhea, tested for HIV and syphilis initially and after 4-6 weeks. Please confirm that you would like to log out of Medscape. Diseases & Conditions, 2002 1. Gonococcal arthritis. [Medline]. If the woman is allergic to β lactam drugs, spectinomycin, 2 g IM every 12 hours may be used. Often recommended since these frequently co-exist with gonococcal arthritis in association with HIV infection Nicholson! To guide antibiotic therapy of the N gonorrhoeae bacteria lower extremities antibiotic dose are recommended each form presents its! 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