Disseminated gonococcal infection (DGI) can present as either purulent monoarthritis or as a triad of:
Although the infection originates in genitourinary, pharyngeal, or rectal mucosa, the primary infection is usually silent and is followed by acute fevers, chills, and malaise (as in this patient). Risk factors include recent menses, pregnancy or postpartum state, complement deficiency, and systemic lupus erythematosus (SLE).
Patients with possible DGI should be evaluated with blood cultures, nucleic acid amplification testing of urine and suspected primary infection sites (eg, vagina, pharynx), and synovial fluid analysis. Initial treatment includes intravenous ceftriaxone every 24 hours plus a single dose of azithromycin (to cover possible antibiotic-resistant gonococcal strains and possible coinfection with Chlamydia trachomatis).
A 25-year-old woman comes to the office due to joint pain. The patient was feeling well until 4 days ago when she acutely developed a fever and generalized malaise. At that time, she also noticed pain in her right wrist, right ankle, and the small joints of the right hand. Since the onset of her illness, the fever has resolved, but the joint pain is getting worse. The patient has had no chest pain, cough, abdominal pain, dysuria, hematuria, or rash. Her last menstrual period was a week ago, and she uses a copper intrauterine device for contraception. Medical history is otherwise unremarkable. Her mother has rheumatoid arthritis and her paternal uncle has Crohn disease. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 C (99 F), blood pressure is 112/71 mm Hg, and pulse is 94/min. Examination shows prominent tenderness to palpation at the right wrist and along the right extensor hallucis longus tendon with passive extension. A 5-mm, hemorrhagic pustule is noted on the sole of her right foot. Which of the following is the best diagnostic test for this patient's condition?
Those with uncomplicated urogenital infections should be treated with dual therapy as follows:
These medications are typically administered simultaneously in the clinic to ensure treatment adherence.
"The most appropriate treatment for this patient is a single dose of intramuscular ceftriaxone (250 mg) plus oral doxycycline (100 mg twice daily) for 14 days."