Spectrum of gonococcal arthritis: evidence for sequential stages and clinical subgroups

In a series of 84 patients with gonococcal (GC) arthritis, 41 were documented as follows: 17 had positive blood culture or typical skin rash (Hematogenous Group); four had positive joint culture plus hematogenous manifestations (Transition Group); and 20 had positive joint culture without positive blood culture or skin rash (Joint Localization Group). The hematogenous group, especially patients with proved gonococcemia, presented significantly earlier after onset of symptoms than patients with joint localization alone, suggesting sequential stages of disease. Patients with verified bacteremia were significantly more toxic than those with rash or culture-proved joint infection alone. Nine of the joint localization patients had a monoarthritis with minimal systemic manifestations. The remaining 11 had a polyarthritis and were significantly more toxic. A concept of sequential stages and clinical subgroups of GC arthritis is proposed which may improve patient classification and differential diagnosis.