Tuttle CS, Van Dantzig T, Brady S, Ward J, Maguire G, 2015. The epidemiology of gonococcal arthritis in an Indigenous Australian population. Sex Transm Infect 91: 497–501.
Noble RC, Reyes RR, Parekh MC, Haley JV, 1984. Incidence of disseminated gonococcal infection correlated with the presence of AHU auxotype of Neisseria gonorrhoea in a community. Sex Transm Dis 11: 68–71.
Belkacem A, Caumes E, Ouanich J, Jarlier V, Dellion S, Cazenave B, Goursaud R, Lacassin F, Breuil J, Patey O; Working Group FRA-DGI, 2013. Changing patterns of disseminated gonococcal infection in France: cross-sectional data 2009–2011. Sex Transm Infect 89: 613–615.
Klausner JD, 2018. Disseminated Gonococcal Infection. Available at: https://www.uptodate.com/contents/disseminated-gonococcal-infection. Accessed January 6, 2018.
Antibiotic Expert Groups, 2014. Therapeutic Guidelines: Antibiotic, Version 15. Melbourne, Australia: Therapeutic Guidelines Limited.
Centre for Disease Control, 2015. Sexually Transmitted Diseases Treatment Guidelines. Gonococcal Infections. Available at: https://www.cdc.gov/std/tg2015/gonorrhea.htm. Accessed January 6, 2018.
Phupong V, Sittisomwong T, Wisawasukmongchol W, 2005. Disseminated gonococcal infection during pregnancy. Arch Gynecol Obstet 273: 185–186.
Khoo CL, Davies AJ, Dobson CM, Cheesbrough J, Edwards J, Sweeney J, 2009. Disseminated gonococcal infection in pregnancy. J Obstet Gynaecol 29: 550–551.
Davido B, Dinh A, Lagrange A, Mellon G, de Truchis P, Perronne C, Cremieux AC, 2014. Chronic gonococcal arthritis with C5 deficiency presenting with brief flare-ups: care study and literature review. Clin Rheumatol 33: 1351–1353.
Mitchell SR, Nguyen PQ, Katz P, 1990. Increased risk of neisserial infections in systemic lupus erythematosus. Semin Arthritis Rheum 20: 174–184.
Zeth K, Kozjak-Pavlovic V, Faulstich M, Fraunholz M, Hurwitz R, Kepp O, Rudel T, 2013. Structure and function of the PorB porin from disseminating Neisseria gonorrhoeae. Biochem J 449: 631–642.
Roth A, Mattheis C, Muenzner P, Unemo M, Hauck CR, 2013. Innate recognition by neutrophil granulocytes differs between Neisseria gonorrhoeae strains causing local or disseminating infections. Infect Immun 81: 2358–2370.
Banerjee A, Wang R, Supernavage SL, Ghosh SK, Parker J, Ganesh NF, Wang PG, Gulati S, Rice PA, 2002. Implications of phase variation of a gene (pgtA) encoding a pilin galactosyl transferase in gonococcal pathogenesis. J Exp Med 196: 147–162.
Tapsall JW, Phillips EA, Shultz TR, Way B, Withnall K, 1992. Strains characteristics and antibiotic susceptibility of isolates of Neisseria gonorrhoeae causing disseminated gonococcal infection in Australia. Members of the Australian Gonococcal Surveillance Programme. Int J STD AIDS 3: 273–277.
Lo TS, Buettner AM, Ingebretson MC, 2002. Concurrent acute gouty and gonococcal arthritis. Lancet Infect Dis 2: 313.
Kolodny AL, Greenstein GH, 1963. Concomitant appearance of gonorrheal arthritis and gout in monarticular arthritis. Md State Med J 12: 598–600.
Linner JH, 1943. Suppurative myositis and purulent arthritis complicating acute gonorrhoea. JAMA 123: 12.
Swarts RL, Martinez LA, Robson HG, 1981. Gonococcal pyomyositis. JAMA 246: 246.
Romiopoulos I et al. 2016. A rare case of disseminated pyogenic gonococcal infection in an immunocompetent woman. Case Rep Infect Dis 2016: 9629761.
Jitmuang A, Boonyasiri A, Keurueangkul N, Leelaporn A, Leelarasamee A, 2012. Gonococcal subcutaneous abscess and pyomyositis: a case report. Case Rep Infect Dis 2012: 790478.
Haugh PJ, Levy CS, Hoff-Sullivan E, Malawer M, Kollender Y, Hoff V, 1996. Pyomyositis as the sole manifestation of disseminated gonococcal infection: case report and review. Clin Infect Dis 22: 861–863.
Gurbani SG, Cho CT, Lee KR, Powell L, 1995. Gonococcal abscess of the obturator internal muscle: use of new diagnostic tools may eliminate the need for surgical intervention. Clin Infect Dis 20: 1384–1386.
Cronstein BN, Van de Stouwe M, Druska L, Levin RI, Weissmann G, 1994. Nonsteroidal anti-inflammatory agents inhibit stimulated neutrophil adhesion to endothelium: adenosine dependent and independent mechanisms. Inflammation 18: 323–335.
Sukeishi A, Isami K, Hiyama H, Imai S, Nagayasu K, Shirakawa H, Nakagawa T, Kaneko S, 2017. Colchicine alleviates acute postoperative pain but delays wound repair in mice: roles of neutrophils and macrophages. Mol Pain 13: 1744806917743680.
Morgan DS, Fisher D, Merianos A, Currie BJ, 1996. An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117: 423–428.
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Two male travelers with histories of gout and hazardous alcohol consumption, presented with a triad of severe culture-positive disseminated gonococcal infection, crystal-positive polyarticular gout, and gonococcal soft tissue collections, following unprotected sexual contact in The Philippines. Both men initially attributed symptoms to gout, since their usual joints were affected, but clinical deterioration occurred with self-administration of anti-inflammatory agents alone. The clinical courses were severe and protracted, requiring aggressive management of infection with prolonged intravenous antimicrobials and repeated surgery, and prolonged anti-inflammatory agents for gout. Joint symptom onset in each case occurred within a week of sexual exposure in conjunction with hazardous alcohol ingestion. We speculate that acute dissemination of infection to previously damaged joints triggered polyarticular gout, with progressive infection, exacerbated by unopposed anti-inflammatory agents and delayed antibiotics. Disseminated gonococcal infection can occur with polyarticular gout and delays in recognition and treatment, including while traveling, can lead to severe disease from both.
Authors’ addresses: Emma L. Smith and Kay E. Hodgetts, Division of Medicine, Royal Darwin Hospital, Darwin, Australia, E-mails: firstname.lastname@example.org and email@example.com. Anna P. Ralph and Nicholas M. Anstey, Menzies School of Health Research, Darwin, Australia, E-mails: firstname.lastname@example.org and email@example.com.