Epidemiology of gonococcal arthritis in Brittany - France (EpGAr study)

Gonococcal infections are sexually-transmitted infections (STIs), which in 0.5-3 % of cases, can progress to disseminated infections (DGI). This study aimed to characterize the epidemiology of septic arthritis and tenosynovitis caused by Neisseria gonorrhoeae, the two most common clinical manifestations of DGI (30-90 %).

A retrospective observational study was conducted in two French referral hospitals from June 2014 to June 2024. Adult patients treated for septic arthritis due to N. gonorrhoeae with a positive culture of joint fluid were included.

We identified ten cases (eight males and two females) with a mean age of 44 years. The infected joints were the wrist, knee, thumb, elbow, ankle, and hip. On average, it took 13 days from the onset of symptoms to the administration of appropriate antibiotic treatment. Among the ten cases, seven strains were available. Of these, five were resistant to fluoroquinolones and six to tetracyclines. All strains were susceptible to third-generation cephalosporins. All patients received ceftriaxone as first-line therapy and achieved complete recovery in 70 % (7/10) of cases at the one-year follow-up. Whole genome sequencing identified virulence-associated alleles, such as porB1a, but no clustering of hypervirulent clones was observed.

Our findings highlight the variety of joints affected by septic arthritis caused by N. gonorrhoeae, as well as high level of resistance to both fluoroquinolones and tetracyclines. These results emphasize the importance of vigilance when diagnosing and managing gonococcal infections, particularly in high-risk populations, and highlight the need for further research into alternative treatments to address emerging resistance.