A 30-year-old homosexual man living with HIV and receiving virologically suppressive antiretroviral treatment presented to the emergency department with a 3-day history of pain in his left wrist accompanied by fever and chills. On examination, the left wrist showed redness, swelling, tenderness and decreased range of movement. The patient had no history of trauma, insect bites or scratches. Four weeks earlier, he had engaged in unprotected oral sex with a casual partner. Nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoea (Ng) were performed from oropharyngeal, anal and urine samples. Arthrotomy and washout of the left radiocarpal joint were done. Ng was detected in both the oropharyngeal swab and the synovial fluid. Ceftriaxone 1 g daily was administered intravenously and a second washout of the joint was performed,
Gonococcal arthritis results from blood dissemination of Ng from primary sexually…