Disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA): II. Clinical manifestations, diagnosis, complications, treatment, and prevention

This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.