Increase in gonococcal arthritis in Madrid, Spain, 2022-2023.

This article focuses on the recent increase in gonococcal arthritis (GA), a manifestation of disseminated gonococcal infection (DGI) caused by Neisseria gonorrhoeae (NG), observed in a tertiary-care hospital in Madrid, Spain, between October 2022 and October 2023. Five cases, primarily in males with recent unprotected sexual activity, were diagnosed using culture and nucleic acid amplification tests (NAAT) on synovial fluid, with treatment involving intravenous ceftriaxone followed by oral cefixime. The study highlights the utility of molecular techniques for detecting NG in culture-negative cases and identifying mutations associated with fluoroquinolone resistance, which informs antibiotic therapy decisions. The authors recommend routine NG screening in synovial and genital samples using NAAT to improve diagnosis and antimicrobial resistance testing to guide effective treatment in areas with high resistance rates.