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Possible DGI

Dear Doc,

87 days ago I received unprotected oral sex ( I am a male) from an escort.  Worried about possible STDs, I saw a doctor at an urgent walk in clinic 2 days later.  I was given a shot of 250 mg of Cerfexatrone? and 1gram of azthromycn.  I was not tested at the time, Doc said I was likely not infected and If I was the treatment would cure it If I was.  3-4 weeks after the incident I was treated for tendonitis in my foot.I was told by the doc it had nothing to do with sexual encounter and to forget about it so I did.  Last night my left knee out of no where became very swollen, as the night progressed the it became became very stiff and something I could no longer ignore.  It is still very swollen, It is not red nor hot to the touch and only slightly painful at the moment.  I am worried that this maybe gonococcal arthritis and that my epsiode of tendonitis was actually bacterial phase of dgi.

1) Is it possible that gonorrhea could of disseminated in the 2 days before the treatment I received?
2) From what I have read, It seems second phase of DGI (mono-arthritis )occurs just days after the first phase and not weeks.  If I did have DGI is it possible that the two phases be so spread apart?
3) I have also read it is possible to have mono-arthritis as the only sign of DGI. Assuming my tendonitis was not DGI, Could this current swollen knee problem by gonococcal arthritis or is 87 days to late for onset?

Thank you in advance for your answer
9 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Last answer. You do not have DGI. Seeking therapy is a waste of time.  

The thread is now over.  EWH
Helpful - 0
Avatar universal
Thanks for the response.  I know it seems that this all adds up to not having DGI and that I am needlessly concentrating on it but there are a lot of coincidences between my knee and tendonitis in my foot. I guess I will have to give it up or seek therapy....This is very difficult and unfortunately the best evaluation I have had is from you and not my that doctors I have seen in person.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
You really do not need to continue to focus on DGI- it is not a realistic possiblity.  In an effort to help you move forward from here, this will be my last reply on the subject.

1.  Yes, your test woul dhave been postive it you had gonorrhea.

2.  Yes, if you had DGI, the knee swelling would have been apprarent when you were examined.

EWH
Helpful - 0
Avatar universal
Sorry for the change is screen name- I could not sign in with the other one for some reason....

Hi Doc,
I just wanted to follow up, I went to an orthopedic and explained my situation.  He more or less echoed what the doctor said at urgent care but with a little more caution.  He did an ultra sound to check my knee from the previous damage that had been there and said he didn't not see anything remarkable. In examining my knee he also said there was almost no effusion and because of this could not take any fluid from the knee.  He did say that if it does swell up he wants to see me right away.  I still have a bit of pain...

Beyond this, when reviewing my lab reports I did see that not only was I treated for G and C I was actually tested for Gonorrhea and Chlamydia via urine with a negative result, but it was not two days after my sexual encounter it was the day after (I realized I had made that mistake when originally writing to you but I did not bother to correct it, as I did not think it would make much difference in your evaluation).  my follow up questions are


1) If gonorrhea did disseminate in the course of one day, would my urine test of been positive? Are tests from place of entry positive with DGI?

2) If my knee pain was connected to DGI would the swelling of lasted for a significant amount of time?  From what both doctors I saw had said, it seems the swelling was not significant enough at the time of examination for them to worried even though I sought treatment in about a 24 hours time span.

Thanks for your response....
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
I don't want to get between you an your doctors- to do so would be inappropriate however this certainly does sound reasonable.  If your swelling continues or worsens, you may wish to see your own doctor or orthopedist.  EWH
Helpful - 0
Avatar universal
Thanks Doc,

I was nervous last night so I went to the urgent care. I was of course nervous about GI but I also wanted to follow through to make sure it was not anything serious, as you stated that I should check out any acute arthritis.  I did volunteer the information.  The doctor was compassionate, he sat down and explained how rare the disease is especially in my situation.  He explained to me what a septic joint looks like and that just by looking and feeling my knee he could tell that it was not DGI or septic.  At this point it was only minimally swollen on the top of the knee, not red, not tender but still a little stiff.  He said there was not enough indication to take synovial fluid from the knee and not to worry so much

1)Does this sound like a good evaluation? he seemed knowledgeable but it was such a brief evaluation.  

I just want to make sure enough precaution was made.

Thanks
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
1.  Yes, when people get DGI the knee is typically warm and tender.
2.  No, I do not think your sexual history is relevant to your swollen knee.  When you are seen the doctor may take a sexually history an if they do, that is a good thing, they are being thorough, but you do not need to volunteer it

Take care.  EWH
Helpful - 0
Avatar universal
Thanks for the response....

A couple of years back, I had a torn meniscus in this knee, maybe I tore it again, that seems like a more likely possibility.

Just a couple of follow ups in effort to put my mind at ease

1) If this was GI would'nt my knee be red and warm to the touch and painful?
2) In seeking care do you think it is necessary to provide my doctor with the details of this sexual encounter?
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to our Forum.  I'll be happy to provide some perspective on your concerns but the long and the short of things is that if you have acute arthritis, it needs to be evaluated by a health care provider and sooner is better than later.  Depending on the examination and complete history, testing for any number of things may be needed to sort this out.

Statistically however DGI is now a rare disease and for a person to develop DGI or other form of sexually caused reactive arthritis following the treatment you have received is very, very rare.  As you note, you did not have any signs of symptoms of and STD and the treatment you received has an excellent (>98%) cure rate for gonorrhea if you had it.  I suspect that your joint swelling is due to something other than GI.  In answer to your specific questions:

1) Is it possible that gonorrhea could of disseminated in the 2 days before the treatment I received?
Precisely when the organism disseminates to cause DGI is not known however most of the studies correlate the infection with the presence of longer duration, asymptomatic disease.  Two days would be extraordinarily short.

2) From what I have read, It seems second phase of DGI (mono-arthritis )occurs just days after the first phase and not weeks.  If I did have DGI is it possible that the two phases be so spread apart?
Correct. The time course of GI is far more contracted than yours has been.  Another argument for why this is not DGI.

3) I have also read it is possible to have mono-arthritis as the only sign of DGI. Assuming my tendonitis was not DGI, Could this current swollen knee problem by gonococcal arthritis or is 87 days to late for onset?
Please see comment above.  The probability that is is DGI is very close to zero.

Please get checked out.  You do need to know what this is due to.  DGI however is not a meaningful concern. EWH
Helpful - 0

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