A Pain in the Hip: Sexually Transmitted Septic Arthritis Diagnosed With Bedside Ultrasound in the Emergency Department

Q: What is disseminated gonococcal infection (DGI) and why can it be missed?

DGI is a rare complication of a sexually transmitted infection. Some clinicians may misunderstand its onset and misclassify it as a later manifestation similar to other STIs.

Q: What was the key timeline leading to the correct diagnosis in this case?

The patient had negative STI results 16 days before presentation, then returned with right hip pain after a near-term emergency visit for urinary symptoms. The short interval required maintaining a broad differential diagnosis.

Q: Why is prompt recognition of septic arthritis of the hip important?

Septic arthritis is a medical emergency that can cause rapid joint destruction and significant morbidity if not diagnosed and treated in a timely manner.

Sep 30, 2026

Uploaded by awa

Disseminated gonococcal infection (DGI) is an uncommon complication of a sexually transmitted infection and may be misinterpreted as a later manifestation of a gonococcal illness. This case report describes a patient with negative STI testing 16 days before presentation who returned to the emergency department with right hip pain one day after evaluation for a urinary tract infection. Despite the brief interval, a broad differential enabled the correct diagnosis. The report explains the onset of gonococcal septic arthritis, appropriate workup steps, treatment differences versus other causes, and likely prognosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Introduction

Case Presentation

How to Cite This Article

Received 08/21/2025 Review began 10/09/2025 Review ended 12/01/2025 Published 12/07/2025 © Copyright 2025 Storch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98653 Open Access Case Report Published via University of Florida College of Medicine – Jacksonville A Pain in the Hip: Sexually Transmitted Septic Arthritis Diagnosed With Bedside Ultrasound in the Emergency Department Ian D. Storch 1, Justin Nippert 1 1. Emergency Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, USA Corresponding author: Ian D. Storch, [ian.d.storch@gmail.com](ian.d.storch@gmail.com) Abstract Disseminated gonococcal infection (DGI) is a recognized but uncommon complication of a sexually transmitted infection (STI) . Some physicians and advanced practice providers may have a misunderstanding of the onset of DGI and think of it as a later manifestation of a gonococcal infection similar to syphilis, another common sexually transmitted infection. This is a case report of a patient tested for STIs 16 days prior to his presentation with negative results. However, he presented to the emergency department again with right hip pain one day after being seen for a urinary tract infection. Despite the short amount of time between negative test results and repeat emergency department visits, keeping a broad differential diagnosis allowed for the correct diagnosis to be made. This case report provides a better understanding of the onset of gonococcal septic arthritis, discusses the proper workup, differences in treatment compared to some other causes of septic arthritis, and the likely prognosis of gonococcal septic arthritis. Categories: Emergency Medicine, Orthopedics Keywords: disseminated gonococcal arthritis, disseminated gonococcal infection, hip effusion, septic arthritis, septic arthritis of hip Introduction Septic arthritis of the hip, or any joint, is a medical emergency requiring prompt recognition and treatment. It can lead to rapid joint destruction and significant morbidity if not diagnosed and treated in a timely manner. While many bacteria can cause septic arthritis, Neisseria gonorrhoeae is a common bacterial cause of septic arthritis in sexually active patients. This case report discusses a patient with gonococcal septic arthritis of the hip, highlighting the clinical presentation, diagnostic challenges, and management strategies. There are at least 600,000 cases of gonorrhea each year in the United States [1] . Depending on how robust the local healthcare infrastructure is and the access to healthcare in a region, the training level of the medical care provider who is initially evaluating these patients can vary widely. These patients can present to public health department clinics, primary care clinics, OB/GYN clinics, and emergency departments, among other health care facilities. The sheer number of cases of gonorrhea each year, and the clinics in which they present, underscores the importance of maintaining clinical vigilance for complications. Neisseria gonorrhoeae is a gram-negative diplococcus primarily known for causing localized genitourinary infections. Normally, patients will present with symptoms within 2-5 days at the primary mucosal site of infection [2] . However, in a subset of cases, it can disseminate hematogenously, leading to disseminated gonococcal infection (DGI) . Dissemination is rare, estimated to be < 1% of cases of gonorrhea [3] . However, some older literature suggested a 1-3% of cases of gonorrhea would present with dissemination [2] . It is unclear if this decrease is due to more accurate and timely testing for the disease, more public awareness, or easier access to treatment. When it does spread, it can happen as quickly

FAQs

What is disseminated gonococcal infection (DGI) and why can it be missed?

DGI is a rare complication of a sexually transmitted infection. Some clinicians may misunderstand its onset and misclassify it as a later manifestation similar to other STIs.

What was the key timeline leading to the correct diagnosis in this case?

The patient had negative STI results 16 days before presentation, then returned with right hip pain after a near-term emergency visit for urinary symptoms. The short interval required maintaining a broad differential diagnosis.

Why is prompt recognition of septic arthritis of the hip important?

Septic arthritis is a medical emergency that can cause rapid joint destruction and significant morbidity if not diagnosed and treated in a timely manner.

Sep 30, 2026

Uploaded by awa