Septic arthritis caused by N gonorrhoeae is monoarticular or pauciarticular, and is more commonly associated with positive synovial fluid cultures and negative blood cultures. Gonococcal bacteremia is more likely to be associated with polyarthralgias and skin lesions. The diagnosis of gonococcal arthritis or DGI is also secure if a mucosal gonococcal infection is documented in the presence of a typical clinical syndrome that responds promptly to appropriate antimicrobial therapy. Hospitalization is indicated in patients with suppurative arthritis or when the diagnosis is in doubt. Initial treatment with ceftriaxone or another advanced-generation cephalosporin is warranted until signs and symptoms have improved; continuation of treatment for a total period of therapy of 1 week can be accomplished with a fluoroquinolone.

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