25th February 2025

Gonococcal arthritis

Overview of gonococcal arthritis

This is caused by Neisseria gonorrhoea, a sexually transmitted infection, and is the commonest cause of septic arthritis in fit young adults. There is likely a reactive element as well.

Signs and symptoms of gonococcal arthritis

It can present as an acute monoarthritis but is often a migratory asymmetric polyarthritis. It is associated with tenosynovitis, and lower limb pustular dermatitis; this is known as arthritis-dermatitis syndrome. Patients can be unwell if disseminated. 

Investigations in gonococcal arthritis

Synovial fluid analysis is often sterile and cultures negative. NAAT (nucleic acid amplification test) can be positive.

Management of gonococcal arthritis

Treatment is according to the local antibiotic regimen, with awareness of resistance. Discussion with sexual partners is important.