Last month, Carole presented a patient of a young man presenting with rapidly progressive polyarthralgia and sore throat who was found to have disseminated gonorrhea. Urine GCCT NAAT was negative, but pharyngeal NAAT was positive for gonorrhea.
The most common manifestations of N. gonorrhoeae are cervicitis and PID in females and urtherthris and epididymitis in males. Extragenital manifestations include proctitis, pharyngitis and conjunctivitis. Disseminated gonococcal infections occurs in only 0.5-3% of cases, and classily presents with septic arthritis – polyarthralgia and involvement of distal joints should increase your suspicion for gonorrhea.
Carole emphasized with this case that swabbing the mucosal site of symptoms has an increased sensitivity compared to culture. For those with septic arthritis, cultures for N. gonorrhoeae may only be positive in approximately 50% of cases and gram stain is even less sensitive at 10% (see image for your classic gram negative diplococci). Blood cultures have <10% sensitivity even in disseminated cases.
References:
The Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female
Julianne E. Burns, Erin H. Graf
Journal of Clinical Microbiology Mar 2018, 56 (4) e00932-17; DOI: 10.1128/JCM.00932-17