Answer 3 Gonorrhea. This patient has disseminated gonorrhea manifesting as gonococcal arthritis. The arthritis of disseminated gonorrhea is asymmetric and migratory. Any joint can be involved, but the knees, wrists, ankles, and finger joints are the most common. Associated fever and chills are likely. The skin lesions (pustules) are the result of disseminated gonococcal infection. Reactive arthritis caused by C. trachomatis infection (formally Reiter syndrome) is a possibility, but arthritis is usually accompanied by nongonococcal urethritis and conjunctivitis. Reactive arthritis would not present with scattered pustules as is present in this patient. Herpes, chancroid, and syphilis would not manifest with joint pains and purulent cervical discharge. Click here to return to the questions
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