Disseminated gonococcal infection in women

OBJECTIVE: To review the clinical presentation, complications, and response to treatment of pregnant and nonpregnant women admitted for management of disseminated gonococcal infection over a 34-year period. METHODS: This was a review of all women diagnosed with disseminated gonococcal infection who were admitted to Parkland Memorial Hospital from 1975 through 2008. Medical records were reviewed and data extracted that included demographic information, clinical and laboratory findings, and response to antimicrobial treatment. In addition to determining perinatal outcomes, the clinical findings of women in the pregnant cohort were compared with those of nonpregnant women. RESULTS: Of 112 women hospitalized for treatment during the study period, 80 (71%) were nonpregnant and 32 (29%) were pregnant. In both groups, the frequency of disseminated infections declined substantively over the last 34 years. Presenting symptoms were similar for pregnant and nonpregnant women, and with one exception, all had arthritis that involved a mean of two joints, most commonly the knee and wrist. Two notable differences between the cohorts were that pregnant women sought care a mean of 2 days after symptoms began compared with that of 5 days for nonpregnant women (P=.003). Related to this, only 50% of pregnant women had a joint effusion compared with 70% of nonpregnant women (P=.05). CONCLUSION: The frequency of disseminated gonococcal infection decreased remarkably over the 34-year study period, paralleling the decreasing prevalence of mucosal Neisseria gonorrhoeae infections reported nationwide. In women with disseminated infections, prompt recognition and antimicrobial treatment will usually result in a favorable outcome.