Disseminated gonococcal infection during two decades in the university hospital, Thailand.

Abstract

Background: Disseminated gonococcal infection (DGI) caused by Neisseria gonorrhoeae commonly presents with the classic triad of polyarthritis, tenosynovitis, and dermatitis. There is no clinical and microbiological data of DGI in Thailand.

Objective: To study the clinical features, outcomes of treatments, and antimicrobial susceptibility data of DGI patients.

Methods: All medical records of DGI patients at King Chulalongkorn Memorial Hospital (KCMH) from January 2002 through September 2019 were reviewed and analyzed. The patients were defined as definite DGI (the clinical features and the evidence of gonococcal infection) and probable DGI (clinical features with response to treatment with third-generation cephalosporins and with no evidence of gonococcal infection).

Results: There were 41 patients (27 definite and 14 probable DGI), with a male-to-female ratio of 1:1.4 and median age of 30 years. The middle-age and elderly group accounted for 20% of the patients. The clinical features were fever (90.27%), arthritis (92.7%), tenosynovitis (63.4%), and genitourinary symptoms (29.3%). The most common pattern of joint involvement was oligoarthritis (52.6%). The majority of the patients had good clinical outcomes, while complications occurred in 4.8% of the patients including osteomyelitis and pyomyositis. All 19 antimicrobial-susceptibility results were susceptible to ceftriaxone.

Conclusions: During the past 2 decades in KCMH, the age of the DGI patients tends to be older, and there is no gender difference as in the historical studies. The clinical features are still similar to the previous studies. The majority of the patients had good clinical outcomes. There is no case of ceftriaxone-resistant N. gonorrhoeae.