Disseminated gonococcal infection: the problems of diagnosis and management

Blood borne gonococcal infection is now much commoner in women, with pregnancy and menstruation favoring such dissemination. The clinical spectrum of gonococcemia can be bizarre, leading to failure to consider it in the differential diagnosis of the acutely ill febrile patient. The commonest presentation is the 'arthritis dermatitis' syndrome, with the potential risk of endocarditis, hepatitis, meningitis, and destructive arthritis occurring in those inadequately treated. Such patients require urgent hospitalization and appropriate chemotherapy for a minimum of 10 days, the drug of choice being penicillin G. Definitive bacteriological diagnosis is not always achieved, the presumptive diagnosis resting on the clinical course and response to antibiotics.