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Gonococcal arthritis: case series of 58 hospital cases

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Abstract

Objectives

Extra-genital manifestations of gonococcal infection are rare (0.5–3%). Among them, gonococcal arthritis (GA) is the most frequent, accounting for 30–90% of disseminated infections. Our study aimed to describe all hospital cases of GA in Reunion Island, a French overseas territory.

Methods

We conducted a retrospective, multicentric, observational study of all cases of certain, probable or possible GA from 2008 to 2020.

Results

We identified 58 cases of GA, mostly certain cases (n = 48). Sex ratio was balanced, but men were older than women (51 vs 27 years, p < 0.001). A total of 41% had travelled abroad during the previous 3 months, mostly in Madagascar or South-East Asia. The most frequently infected joint was the knee, followed by ankle, wrist and fingers or carpal joints. Only 16% of cases had genital symptoms, but 50% had another extra-genital manifestation, mainly skin lesions (40%). Positivity rate of joint puncture was 91%, with a purulent liquid. Only 58% had a positive culture, and 33% had only a positive PCR. There was no 3GC-resistant strain. In comparison with gonococcal infection without arthritis, patients were older and had fewer genital but more extra-genital symptoms. On discharge 60% had persistent articular symptoms. GA represented 18% of all hospitalised septic arthritis cases with microbial identification in 2019.

Conclusions

GA is rare but it is important to make an early diagnosis and treat promptly, as joint destruction may be important, leading to persistent symptoms after discharge. PCR use in joint puncture is useful in cases with negative culture.

Key Points

• Gonococcal arthritis is rare but is the most frequent form of extra-genital gonococcal infection. It accounts for more than 30% of hospitalised community-acquired proven septic arthritis in Reunion Island.

• It affects mostly the knee joint, is most of the time oligo- or poly-articular and is associated with tenosynovitis and extra-genital symptoms in half of the cases. Concomitant genital symptoms are often missing.

• Profitability of joint puncture is high. As culture is not very sensitive, the use of PCR helps the diagnosis and should systematically be performed if available.

• There seems to be a high proportion of joint persistent symptoms at and after discharge.

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Abbreviations

1GC:

1st generation cephalosporin

3GC:

3rd generation cephalosporin

CRP:

C-reactive protein

DGI:

Disseminated gonococcal infection

GA:

Gonococcal arthritis

HIV:

Human immunodeficiency virus

IQR:

Interquartile range

IV:

Intravenous

NG:

Neisseria gonorrhoeae

NSAIDs:

Non-steroidal anti-inflammatory drugs

PCR:

Polymerase chain reaction

PrEP:

Pre-exposure prophylaxis

SD:

Standard deviation

STI:

Sexually transmitted infections

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Acknowledgements

Special thanks to Michel Bohrer for his help to identify the patients with gonococcal arthritis in hospital databases.

Author information

Authors and Affiliations

  1. Internal Medicine Department, CHU Nord, La Réunion, France

    Aurore Moussiegt, Xavier Guillot & Loïc Raffray

  2. Internal Medicine and Infectious Disease Department, CH Ouest, La Réunion, France

    Claire François

  3. Bacteriology Department, CHU Nord, La Réunion, France

    Olivier Belmonte & Nicolas Traversier

  4. Bacteriology Department, CHU Sud, La Réunion, France

    Julien Jaubert & Sandrine Picot

  5. Internal Medicine Department, GH Est, La Réunion, France

    Françoise Josse

  6. Department of Infectious Disease, Internal Medicine and Dermatology, CHU Sud, La Réunion, France

    Patrice Poubeau & Antoine Bertolotti

  7. Infectious Disease Department, CHU Nord, La Réunion, France

    Marie-Pierre Moiton

  8. Inserm CIC 1410, Saint-Pierre, Réunion Island, France

    Antoine Bertolotti

  9. Université de La Réunion, UMR PIMIT, CHU de La RéunionUnité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, INSERM U1187, IRD 249 Sainte-Clotilde, CNRS 9192, La Réunion, France

    Loïc Raffray

  10. Service de Médecine Interne, CHU Félix Guyon, Allée des Topazes, 97400, Saint Denis, France

    Loïc Raffray

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  1. Aurore Moussiegt
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  2. Claire François
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Correspondence to Loïc Raffray.

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Moussiegt, A., François, C., Belmonte, O. et al. Gonococcal arthritis: case series of 58 hospital cases. Clin Rheumatol 41, 2855–2862 (2022). https://doi.org/10.1007/s10067-022-06208-w

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  • DOI: https://doi.org/10.1007/s10067-022-06208-w

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