Gonococcal arthritis--a common rarity.

Swediaur (1819) commented on the lack of previous mention of swelling of the knees as a consequence of 'blennorrhagia' and reported that he had personally attended several patients in whom the arthropathy started from the 8th to the 16th day of the illness; it was not until the turn of the century that gonococcal arthritis was eventually defined as a clinical entity in association with gonococcal septicaemia. Lindemann (1892) cultured the characteristic diplococci from a joint which became involved after ophthalmia neonatorum. Bacteriological proof of gonococcal septicaemia during life was reported from the Johns Hopkins Hospital by Thayer and Blumer (1896) and the occurrence of this septicaemia in association with arthritis and various types of skin lesions was reviewed by Buschke (1899). In the pre-antibiotic era, gonococcal arthritis was described as a disease occurring more commonly in men than women (Wehrbein, 1929; Luys, 1922; Lees, 1932); it was regarded by some as the commonest cause of pyogenic arthritis requiring hospital admission (Cole, 1908). It was reported in infants and children in two large series by Holt (1905) and Cooperman (1927), and the well-known association with pregnancy was documented by Royston (1923). The advent of therapy with sulphonamides (Colston, 1937; Parrish, Console, and Battaglia, 1940) and antibiotics (Hagemann, Hendin, Lurie, and Stein, 1952), and the wider recognition of Reiter's syndrome (Reiter, 1916) as a clinical entity resulted in a reappraisal of gonococcal arthritis. It was suggested that the term 'gonococcal arthritis' should be reserved for cases in which Neisseria gonorrhoeae was actually isolated from the joint fluid (New Engl.Jt. Med., 1968; Partain, Cathcart, and Cohen, 1968)-the term 'presumptive gonococcal arthritis' being applied to cases with the typical clinical course and antibiotic response in which the gonococcus was cultured from some other site. Kirsner and Hess (1969) and other workers pointed out that with greater diagnostic accuracy linked to the awareness of Reiter's syndrome there has been a reduction in the frequency with which gonococcal arthritis is diagnosed in males, but how much of this is due to early cure of symptomatic urethral gonorrhoea in the heterosexual male is unknown. Pariser, Farmer, and Marino (1964),