Disseminated Gonococcal Infection

Disseminated gonococcal infection is caused by hematogenous infection of N. gonorrhoeae from the primary site of infection. It occurs in both men and women, but is seen more frequently in women, because women with gonorrhea are often asymptomatic, which allows the dissemination of infection before the patient experiences symptoms. Pregnancy, menses, and terminal component complement deficiencies also increase the risk for disseminated gonococcal infection as a result of endometrial exposure of submucosal vessels to the infecting organisms. Disseminated gonococcal infection (Kerle KK et al 1992) is a rare complication, were a systemic spread of the bacteria in the bloodstream may cause, tenosynovitis, and dermatitis but can also present as perihepatitis.
The knees, wrists, ankles, and finger joints are most commonly affected. Tenosynovitis most commonly affects the flexor tendon sheaths of the wrist or the Achilles tendon ("lovers' heels") [Angulo JM et al 1999] However the symptoms of DGI vary from patient to patient. By the time the symptoms of DGI appear, many patients no longer have any localized symptoms of mucosal infection. The classic presentation of DGI is an arthritis dermatitis syndrome. Skin rash is also presenting in patients, but a careful examination will reveal a rash in most patients with DGI. Rash is usually found below the neck and may also involve the palms and soles. The dermatitis consists of lesions varying from maculopapular to pustular, often with a hemorrhagic component. Lesions are peripherally located, and may be painful before they are visible. Fever is common but rarely exceeds 39°C. Rare complications of DGI include gonococcal meningitis, pericarditis, and endocarditis. Headache, neck pain and stiffness, fever, and decreased sensorium may indicate gonococcal meningitis. This disease may be clinically indistinguishable from meningococcal meningitis on presentation, although the course of gonococcal meningitis is usually less