Gonorrhea is a purulent infection caused by Neisseria gonorrhea. It is transmitted via sexual contact or through transmission at delivery. DGI or dinseminated gonococcal infection results from a bacteremic spread of Neisseria gonorrhea, which causes a host of clinical features, such as dermatitis, tenosynovitis, and multiple skin lesions.
Disseminated gonococcal infection develops in 0.5 to 3 % of patients who have been infected with N.
Symptoms Of Disseminated Gonococcal Infection
The typical presentation of disseminated gonococcal infection is an arthritis-dermatitis syndrome. Pain and discomfort in the joints or tendons is the commonest presenting feature during the preliminary stage of the infection.
In the 2nd phase of DGI, there is septic arthritis. The knee is the most common site of purulent gonococcal arthritis. The afflicted joint is painful and sore. There may be pus formation, joint stiffness and reduced range of movement of the joint.
Men and women are known to be equally afflicted. In a clinical trial of 151 consecutive patients with acute non traumatic arthritis or arthralgia seen at the University of Washington hospitals found that N.
DGI has a various characteristic manifestations which help to distinguish it from other categories of infectious arthritis. Some people develop dermatitis and multiple lesions on the skin. These are painful and pus filled and need prompt attention.
Treatment Of Disseminated Gonococcal Infection
Your doctor will ask you to carry out a few investigations. Culture is the most common diagnostic test for gonorrhea. Cultures are especially suitable when the clinical diagnosis is obscure, when the treatment regimen has failed, when contact tracing is difficult, and in case legal queries originate.
Thereafter, a DNA probe and a polymerase chain reaction assay and ligand chain reaction is done. The DNA probe is an antigen detection test which tries to identify gonorrhea DNA in specimens.
In those who may have disseminated gonorrheal infection, all the mucosal sites need to be cultured – i.e. cervix, pharynx, urethra, rectum; as well as the blood and synovial fluid. Three sets of blood cultures need to be done.
For uncomplicated urogenital, anorectal, and pharyngeal gonococcal infection, a drug regimen comprising of ceftriaxone along with doxycycline or azithromycin is recommended. Experts advise ceftriaxone, cefotaxime, ceftizoxime for all cases of disseminated gonorrheal infection.
- For males, the management is outpatient for genital infection; on the other hand, admission is required for DGI.
- In females, the risk of complications is higher. Due to non-compliance, re-infection, and poor follow-up, doctors advise admitting a female patient, more so, when pelvic inflammatory disease is suspected.
- In those cases wherein future fertility is at risk, most doctors are rather aggressive.
- When there is corneal involvement, the patient is admitted for treatment with intravenous anti-biotic. These patients are discharged once the corneal infection starts improving.
- A septic joint needs to be aspirated in order to make the initial diagnosis and to get rid of all inflammatory exudate. An open drainage of the joint is seldom done, excepting in cases of infection of the hip in children.
- Also, health care provider will recommend elimination of the intrauterine device in women having PID.