Which tests are performed in the workup of gonococcal arthritis?

Updated: Jan 12, 2019
  • Author: Victoria Fernandes Sullivan, MD; Chief Editor: Herbert S Diamond, MD  more...
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A complete blood count (CBC) should be obtained; most patients with gonococcal arthritis have mild leukocytosis. The erythrocyte sedimentation rate (ESR) is elevated in most cases.

Cultures of likely sites of gonococcal infection are the most important tests to perform for the diagnosis of disseminated gonococcal infection (DGI) and consequent gonococcal arthritis. Synovial fluid cultures are positive for N gonorrhoeae in no more than 50% of cases [1] and alone are insufficient to establish the diagnosis. Cultures of blood, cervix, rectum, urethra, and pharynx should be obtained. [12] Positive culture results help confirm the diagnosis and provide antibiotic sensitivities for the particular infecting strain of the organism.

Patients should also be tested for other sexually transmitted infections, including HIV, hepatitis B, chlamydia, and syphilis.

Point-of-care ultrasound in the emergency department can aid in diagnosis by identifying tenosynovitis and excluding arthritis or simple soft-tissue swelling. [13] Plain radiography findings of the affected joint are usually normal. However, they may be indicated to exclude articular damage and to rule out other processes, such as fracture. 

Biopsy of skin lesions shows dermal vasculitis with perivascular neutrophils. Neutrophilic infiltration of the epidermis may also be seen in pustular lesions.

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