How useful are cultures and Gram stains in diagnosing gonococcal septic arthritis

How useful are cultures and Gram stains in diagnosing gonococcal septic arthritis?

Unlike nongonococcal arthritis, the Gram stains of synovial fluid are positive in <25% in gonococcal arthritis. Cultures improve the diagnostic yield. Because urethritis is often asymptomatic, all patients should have a urine specimen as well as urethral/rectal/pharyngeal swabs sent for Gram stain, culture, and NAAT testing. Urethral smears and cultures are more useful in men (>90% sensitivity) than in women.

Culture positivity in dGI
SiteIsolation Rate
Genitourinary80%
Synovial fluid50%
Rectum20%
Pharynx10%
Blood<30%
SkinRare
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