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Clinical Summary

Disseminated gonococcus (gonococcemia) is a systemic infection that presents in 1% to 3% of untreated mucosal (urethral, endocervical, pharyngeal, and rectal) gonorrhea infections. The hematogenous dissemination of Neisseria gonorrhoeae results in fever, arthralgias, and scattered pustules. The initial lesion is an erythematous macule that evolves into a papule and hemorrhagic pustule. Petechial or purpuric macules can occur. These lesions are few, asymmetric, painful, and predominantly located on the distal extremities. The spectrum varies from skin lesions alone to associated tenosynovitis, septic arthritis, endocarditis, and meningitis.

Management and Disposition

Initiation of IV ceftriaxone and a single dose of azithromycin can be started in the emergency department (ED) with subsequent admission. Confirmatory testing with nucleic acid amplification techniques can be obtained to quickly confirm infection, but blood cultures should be obtained (prior to antibiotic initiation) to elucidate potential antibiotic-resistant strains. Dermatology consultation may help confirm the diagnosis.


  1. Pregnant or menstruating females have a higher risk of disseminated gonococcemia.

  2. Disseminated gonococcemia is the most common cause of septic arthritis in young, sexually active adults.

  3. Obtain blood cultures prior to giving antibiotics as antimicrobial resistance is increasing.

FIGURE 13.29

Disseminated Gonococcus. Erythematous macules of disseminated gonococcus—these will evolve into hemorrhagic pustules. (Photo contributor: David Effron, MD.)

FIGURE 13.30

Disseminated Gonococcus. Vesiculopustule (A) and hemorrhagic pustule with surrounding erythema (B). (Photo contributors: A: Stephan E. Russ, MD, B: David Effron, MD.)

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