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Sept 21, 1984

Treatment of Gonococcal Osteomyelitis

Author Affiliations

The University of North Carolina at Chapel Hill

JAMA. 1984;252(11):1411. doi:10.1001/jama.1984.03350110017019

To the Editor.—  We refer to the article by Drs Tindall and Regan-Smith1 on gonococcal osteomyelitis. We have recently reported an additional case2 and reviewed three other cases not described in their article. Although gonococci that produce disseminated infections are usually exquisitely sensitive to penicillin, two of these additional cases of gonococcal osteomyelitis were caused by β-lactamase-producing strains.3,4 This observation calls attention to two points: (1) The setting of acute, asymmetric pauciarticular arthritis in a sexually active patient is complex. While the response of patients with gonococcal arthritis to penicillin is usually dramatic, failure to respond may not absolutely exclude the diagnosis. (2) Empiric therapy with cefoxitin or cefotaxime5 may be indicated for patients with presumed gonococcal arthritis or osteomyelitis who do not respond rapidly to penicillin and who may have had sexual exposure in areas where β-lactamase-producing gonococci have been isolated.

Tindall EA, Regan-Smith MG:  Gonococcal osteomyelitis complicating septic arthritis .  JAMA 1983; 250:2671-2673.Crossref
Black JR, Cohen MS:  Gonococcal osteomyelitis: A case report and review of the literature .  Sex Transm Dis 1984;11:96-99.Crossref
Rinaldi RZ, Harrison WO, Fan PT:  Penicillinresistant gonococcal arthritis: A report of four cases .  Ann Intern Med 1982;97:43-45.Crossref
Leftik MI, Miller JW, Brown JD:  Penicillin-resistant gonococcal polyarthritis .  JAMA 1978;239:134.Crossref
 Centers for Disease Control: Treatment of sexually transmitted diseases .  Rev Infect Dis 1982;4:S729-S746.Crossref