Treatment of Gonococcal Arthritis

Initial Management

The Centers for Disease Control and Prevention recommends initial therapy with ceftriaxone 1g IV or IM daily, followed by oral therapy to complete 7 days of treatment once clinical improvement begins 1, 2, 3
Hospitalization is recommended for initial therapy, especially for patients who may not comply with treatment, have uncertain diagnosis, or present with purulent synovial effusions or other complications 1, 3, 4
First-line treatment is ceftriaxone 1g IV or IM every 24 hours 1, 2, 3, 4

After clinical improvement, switch to one of the following oral regimens to complete a full 7 days of antimicrobial therapy: cefixime 400mg orally twice daily 1, 3, 4 or ciprofloxacin 500mg orally twice daily (contraindicated in pregnancy, children ≤17 years, and areas with quinolone resistance) 1, 3, 4

For patients who cannot tolerate cephalosporins or quinolones, spectinomycin 2g IM every 12 hours is recommended 1, 2, 3
Pregnant women should not be treated with quinolones or tetracyclines, and should use recommended cephalosporins (ceftriaxone) instead 1, 2, 3, 4
Children who weigh >45kg can be treated with adult regimens 2, 3, 4

Patients with gonococcal arthritis should be treated presumptively for concurrent Chlamydia trachomatis infection 1, 3, 4
Recommended regimens for chlamydial coverage include azithromycin 1g orally in a single dose or doxycycline 100mg orally twice daily for 7 days 5
All recent sex partners should be evaluated and treated 1, 3, 4

Patients should be examined for clinical evidence of endocarditis and meningitis 1, 3, 4
For gonococcal meningitis or endocarditis, more prolonged therapy is required (10-14 days for meningitis, at least 4 weeks for endocarditis) 1