Disseminated gonorrhea in Adult
Disseminated gonococcal infection occurs more commonly in women, due to their higher incidence of occult infection. Recent menstruation and pregnancy are risk factors for gonococcemia. Other risk factors include the presence of HIV, lupus, or complement deficiencies; multiple sexual partners; low socioeconomic status; drug use; men who have sex with men (MSM); and a prior history of STIs. Gonococcemia is most prevalent in the adolescent and young adult populations.
The onset of gonococcemia is often abrupt with fever (usually 101°-104°F [38.3°-40°C]), skin lesions, and arthralgias and/or tenosynovitis. Successive crops of pustules on a purpuric base, papules, petechiae, or areas of necrosis may appear during febrile episodes. Arthralgias are asymmetric and migratory, involving at first the extensor tendons of wrists, fingers, knees, and ankles. Later, septic arthritis leads to pain and swelling in one or occasionally more joints.
Septic arthritis may result in progressive joint destruction and osteomyelitis. Other complications include myocarditis, toxic hepatitis, and, less commonly, endocarditis and meningitis. The mortality of endocarditis remains as high as 19% due to congestive heart failure, nephritis, large vegetations, and aortic involvement. Major embolic phenomena may occur.
Abdominal spread of gonococci may cause gonococcal perihepatitis (Fitz-Hugh-Curtis syndrome) with abdominal pain, tenderness, and, occasionally, a hepatic friction rub. Pharyngitis, acute salpingitis, sterility, pelvic peritonitis, and pelvic abscesses may complicate gonorrhea in women. Men uncommonly develop epididymitis, inguinal lymphadenitis, penile edema, periurethral abscesses, and gonococcal prostatitis. Men who have sex with men (MSM) may develop proctitis, rectal discharge, and pharyngitis.
A54.86 – Gonococcal sepsis
5085001 – Gonococcemia
Differential Diagnosis & Pitfalls
- Other forms of vasculitis and septic vasculitis have to be considered (lupus erythematosus, Sweet syndrome).
- Subacute bacterial endocarditis
- Acute meningococcemia
- Chronic meningococcemia
- Ecthyma gangrenosum
- Vibrio vulnificus infection
- Rocky Mountain spotted fever
- Cholesterol emboli
- Reactive arthritis (Reiter syndrome)
- Disseminated herpes zoster
- Secondary syphilis
- Disseminated intravascular coagulopathy