Disseminated Gonococcal Infection

The recent marked increase in incidence of gonorrhea prompted this analysis of the systemic manifestations of gonococcal infection. Of 42 patients with disseminated infection, 79% were women. Most had asymptomatic anogenital infections, and dissemination arose during pregnancy or menstruation in 71%. Arthritis occurred in 38 patients, in whom a characteristic clinical picture was seen. An initial "bacteremic stage," with polyarthralgias, skin lesions, and positive blood cultures, was followed by a "septic joint stage," with positive synovial fluid cultures or joint destruction. Blood cultures were positive in 9 of 13 patients seen within 2 days of the onset of symptoms, and cell-wall-deficient gonococci were isolated from a "sterile" septic joint. These findings discount any role of cross-reactive antigens and antibodies in the pathogenesis of "sterile" gonococcal arthritis. Liver function abnormalities were detected in 14 patients, and myocarditis or pericarditis occurred in 10 patients. Meningitis occurred in two patients, and endocarditis led to death in one patient and to valve replacement in another.