What Is Gonococcal Arthritis?

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Gonococcal arthritis is a rare complication of gonorrhea, a sexually transmitted infection (STI). Gonococcal arthritis causes painful inflammation and swelling of the joints and tissues. It is considered a type of septic arthritis, which means an infection causes symptoms within a joint.

Learn more about gonococcal arthritis, its symptoms and causes, how it is diagnosed, and treatment options.

Arthritis

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Gonococcal Arthritis Symptoms

Gonococcal arthritis can occur in any of your joints, including the ankles, knees, elbows, wrists, or the bones of the head or trunk. This type of arthritis might affect a single joint or many joints.

Symptoms of gonococcal arthritis may include:

  • Inflamed, swollen joints
  • Tender, painful joints, especially with movement
  • Restricted range of motion of joints
  • Fever and/or chills
  • Skin lesions or pustules (blisters) on the palms: These can be quite painful.
  • Tenosynovitis: inflammation of the synovium (the fluid-filled sheath) that surrounds a tendon

About 15% of people will report joint pain as a primary symptom of gonococcal arthritis, and skin lesions are present in about 75% of cases. Severe complications might include perihepatitis (inflammation of the tissues surrounding the liver), meningitis, or endocarditis.

Symptoms in Newborns

Gonococcal arthritis might also affect newborns because it can be passed from mother to baby during childbirth.

Symptoms that babies might experience include:

  • Problems with feeding
  • Irritability
  • Fever
  • Spontaneous limb movement
  • Gonococcal conjunctivitis: Symptoms include eye pain, redness, and a purulent (pus) discharge.

Complications

In addition to gonococcal arthritis, untreated gonorrhea can lead to other serious health complications, including a condition called pelvic inflammatory disease, infertility, and pregnancy complications. Babies who contract gonorrhea from their mothers have a higher risk of infection, sores on their skin, and blindness. 

If you or a partner have symptoms of an STI, it is important to seek out medical attention. The sooner the infection is treated, the sooner it is cleared, and the risk of complications, like gonococcal arthritis, is reduced.

Symptoms of an STI might include:

  • Unusual discharge from the vagina or penis
  • Painful urination
  • A rash around the genitals
  • Vaginal bleeding not related to a monthly period
  • Itchy genitals or anus
  • Blisters and/or sores around the genitals or anus

Causes

The bacterium Neisseria gonorrhoeae causes gonorrhea. These bacteria are transmitted through unprotected oral, anal, or vaginal sexual contact. Sex without a condom can increase your risk of gonorrhea. Babies can contract gonorrhea during childbirth through their infected mother.

Gonococcal arthritis affects 0.4% to 3% of people with gonorrhea. According to a 2012 report in the journal American Family Physician, it is the most common cause of infectious arthritis in “sexually active, previously healthy” people.

It occurs when bacteria spread beyond the initial infection through the bloodstream to other areas of the body. The bacteria can focus on a joint and start to grow, and the infection might occur in more than one joint.

Historically speaking, this type of arthritis affects mostly women. This is not because of the risk of gonorrhea. People with an upper reproductive tract that includes organs such as the uterus, fallopian tubes, and ovaries have a path that bacteria can use to travel farther into the body, increasing the chance of infection at other sites.

Diagnosis

To diagnose gonococcal arthritis, your doctor will review your symptoms and determine what testing might help them reach a diagnosis.

A complete blood count (CBC) might be obtained to look for mild leukocytosis, an elevated white blood cell count that can be a sign of infection. An erythrocyte sedimentation rate (ESR) may be done, as an increase in this measure is a sign of inflammation.

Synovial joint fluid might be pulled from the joint and examined, but this alone often isn’t enough to establish a diagnosis. Your doctor will use a needle to extract the synovial fluid from the inflamed joint. That sample is then sent to a lab to look for signs of the gonorrhea bacteria.

If your doctor suspects a gonorrhea infection, they may request additional testing. This might include:

  • Swabs from the back of the throat, rectum, and cervix/urethra for culture and microscopic evaluation
  • A urine or blood test

Treatment

Treatment of gonococcal arthritis starts with treating the cause of the arthritis—the gonorrhea infection. That usually involves antibiotics. Treating gonococcal arthritis typically includes a procedure called joint aspiration.

Antibiotics for the Infection

The Centers for Disease Control and Prevention (CDC) recommends a single dose of 500 milligrams (mg) of intramuscular ceftriaxone (injected into a large muscle). Ceftriaxone can also be given intravenously (through a vein). This antibiotic can stop the infection, but it will not repair any damage caused by the disease.

If you are still experiencing symptoms after a few days, it is a good idea to let your doctor know. A test-of-cure follow-up test will need to be done seven to 14 days after treatment.

Because reinfection is common, people who test positive for gonorrhea should be retested three months after the initial treatment for the infection, even if their sex partners have been treated.

Joint Aspiration for the Arthritis

Research shows that draining the excess synovial fluid can help relieve pain and swelling in cases where there is significant inflammation and fluid in the joint or joints affected by gonococcal arthritis.

A joint aspiration procedure involves using a sterile needle and syringe to drain the fluid from the affected joint. This procedure is usually done at your doctor’s office. Joint aspiration is sometimes called arthrocentesis.

Prognosis

Most people start to feel better within a day or two after they start antibiotics for the gonorrheal infection. And most will make a full recovery.

A timely diagnosis and appropriate treatment for gonorrhea are necessary to reduce the potential for severe and chronic joint pain. Untreated gonorrhea can also lead to pelvic inflammatory disease, infertility, pregnancy complications, or an infection that can spread to other parts of the body.

A Word From Verywell

The best way to prevent gonococcal arthritis is to avoid contracting gonorrhea. STIs are best prevented by abstinence from sexual intercourse. Being in a monogamous sexual relationship can reduce your risk of STIs.

Sexually active people can reduce their risk of gonorrhea by using condoms and getting screened for STIs regularly. Screenings are especially important if you have new or multiple partners. It is also a good idea to encourage partners to get tested as well. 

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