Symptoms of disseminated gonococcal infection
• Skin rash (two-third patients): typically 2 to 10 small painless macules, papules, or pustules on the distal extremities; patients are often unaware of these lesions and they may be easily overlooked on physical exam.
• Tenosynovitis (two-third patients): usually monoarticular but can be polyarticular and migratory. The knee is most commonly involved, followed by the wrist, ankle, and elbow. Unlike other causes of septic arthritis, the small joints of hand are frequently involved. <50% patients develop purulent arthritis.
• It is important to note that only 25% patients with DGI have genitourinary symptoms (i.e., pelvic inflammatory disease [PID]) consistent with a localized gonorrhea infection. Therefore, lack of symptoms of PID either in the past or present does not rule out DGI.