Clinical and biological features of gonococcal arthritis: a 20-year retrospective study

Gonococcal arthritis is a rare but severe complication of Neisseria gonorrhoeae infection, often underdiagnosed due to variable presentation and difficulties of conventional tests to detect N. gonorrhoeae. We aimed to describe its clinical features, diagnostic yield of polymerase chain reaction (PCR) versus culture and patient outcomes.

We retrospectively analyzed all cases of gonococcal arthritis admitted to the University Hospital of Liège from January 2005 to June 2025 (n = 7). Patients were included if they presented with arthritis, defined either by clinical joint swelling or effusion on ultrasonography, and microbiological evidence of N. gonorrhoeae infection, defined as a positive PCR or culture in synovial fluid or in the blood. Clinical, microbiological and treatment data were reviewed.

Seven patients (57% male, mean age: 42 years) were included with confirmed gonococcal arthritis. Three joints were affected on average, most often knee, ankle, or fingers. Urogenital symptoms were reported in 43% and urogenital PCR was positive in 66%. Synovial fluid PCR was positive in all cases when performed, with shorter time to positivity than culture (1.7 vs 2.8 days), whereas blood cultures had a low rate of positivity (29%). At the end of hospitalization, no patient had achieved full recovery. At the last follow-up visit, only one patient achieved complete recovery.

We highlight the clinical interest of systematic synovial fluid PCR: blood and synovial fluid cultures lack diagnostic yield compared to synovial fluid PCR, while synovial fluid culture also shows delayed positivity compared with the latter. We also observe that genitourinary PCR and clinical symptoms display lack positivity. Finally, despite appropriate therapy, residual joint impairment is frequent, highlighting the need for early recognition and optimized management.