Objectives
Background: Neisseria gonorrhea is a sexually transmitted infection that has increased in prevalence by 10.5% nationally since 2010 in the US. The incidence of gonorrhea in teenagers in Peoria County is 3.5% compared to 0.5% nationally. In pregnancy, it can be characterized by purulent vaginal discharge, although many times it is incidentally identified on initial prenatal labs. Approximately 0.5 to 3% of cases cause gonococcal bacteremia with extragenital manifestations, primarily arthritis. Of note in pregnancy, arthritis or dermatitis may be the only symptom and a high index of suspicion should be had in order to screen for this common sexually transmitted disease.
Methods
Case: A 19 y/o Gravida 2 Para 1001 at 11 weeks gestation was admitted for headache, fever, chills, myalgias, and arthralgias and was suspected to have pyelonephritis, for which cephalexin was given. A few days later, endocervical cultures were positive for Neisseria Gonorrhea and Chlamydia Trachomatis. Blood cultures were also positive for Neisseria Gonorrhea. Clinically her symptoms were improving, although a lesion was noted on her right lower extremity. Infectious disease was consulted at this time for disseminated gonococcal infection in a pregnant patient. She was immediately started on azithromycin and ceftriaxone with a PICC line. Throughout her hospitalization, her arthralgias and myalgias continued to improve. The patient was discharged home 3 days after hospitalization with improving symptoms and continuation of ceftriaxone for a total of 14 days via PICC line.
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