This infection occurs in people who have been infected with gonorrhea. It affects women four times more often than men, and is most common among sexually active adolescent girls. There is also increased risk during menstruation and pregnancy. Two forms of arthritis exist -- one with skin rashes and multiple joint involvement, and a second, less common, form in which disseminated gonococcemia leads to infection of a single joint (monoarticular) and joint fluid cultures are positive. Single joint arthritis follows generalized spread (dissemination) of the gonococcal infection. Dissemination is associated with symptoms of fever, chills, multiple joint aches (arthralgia), and rashes (1-mm to 2-cm red macules). This episode may end as a single joint becomes infected. The most commonly involved joints are the large joints such as the knee, wrist, and ankle.
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