AbstractObjective. To explore the utility of the polymerase chain reaction (PCR) in the diagnosis, management, and investigation of arthritis due toNeisseria gonorrhoeae.Methods. The PCR was used to detect DNA fromN gonorrhoeaein model systems and in extracts of synovial fluid (SF) from patients with systemic gonococcal infections and objective evidence of arthritis.Results. OneN gonorrhoeaeorganism or its equivalent was detectable in human SF from inflamed joints. Five of 8 patients with systemicN gonorrhoeaeinfection and arthritis hadN gonorrhoeaeDNA demonstrated by PCR in at least 1 pretreatment SF specimen that wasN gonorrhoeaeculture positive. Thirty‐seven of 38 control specimens were negative, the exception probably being due to cross‐contamination from a positive specimen. All specimens that were positive forN gonorrhoeaeby other methods were also positive by PCR. Two others were positive by PCR but negative by other methods. Four pretreatment specimens were negative by all methods, including PCR. This suggests that, for these patients, negative cultures reflected true absence ofN gonorrhoeae, and not the presence of unculturable organisms. This group also had a significantly shorter duration of disease than did the patients withN gonorrhoeaeDNA found in their SF. All patients had a prompt response to antibiotic treatment. Two of 3 patients whose specimens were previously positive showed marked decreases in SFN gonorrhoeaeDNA after treatment.Conclusion. The PCR using these or similar oligonucleotide primers can be a useful adjunct in the diagnosis of gonococcal arthritis and can be of value in assessing its response to therapy. In someN gonorrhoeae–associated arthritides, there appears to be a lack of both viable and nonviableN gonorrhoeaeorganisms in the SF. These observations may have implications regarding the pathogenesis of this form of arth
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