STD joint pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Information, in part. from the American College of Rheumatology

There are a number of sexually transmitted diseases associated with arthritis.

The first is disseminated gonococcal infection.

It is an infection that can occur when gonorrhea in the urethra, throat, cervix or rectum is not treated. It is sometimes called the 'arthritis dermatitis syndrome' because the bacteria spreads to other parts of the body causing joint pain and/or skin lesions.

It occurs in people who have been infected with gonorrhea. It affects women four times more often than men. There is also an increased risk of transmission during pregnancy and menstruation.


• Often the initial symptoms are flu-like (fever, fatigue, aching)
• Fever
• Chills, malaise
• Migrating joint pain for 1 to 4 days
• Joint pain, either single or multiple joints (knee pain, wrist pain , ankle pain)
• Joint swelling (knees, wrists, ankles)
• Skin rash: the classical rash associated with gonococcemia begins as flat pink to red spots (macules) which evolve into raised pus-filled bumps (pustules)
• Painful tendons of wrist or heels
• A combination of skin rash and aching swollen tendons -- sometimes known as tenosynovitis-dermatitis syndrome

Signs and tests

• Blood culture
• Skin lesion culture
• Culture of synovial fluid from joints
• Urethral discharge culture
• Culture from endocervix
• Throat culture
• Anal culture

The diagnosis is made by extracting fluid from the affected joint and testing it for the gonorrhea bacteria. The doctor also looks for the typical signs and symptoms of this infection.

Antibiotic treatment administered early is the treatment of choice.

Treat STDs as soon as possible and assure that all sexual partners are tested and treated.

The next STD is Hepatitis B. This is characterized by mild fever, headache, muscle aches, and joint pain. Other symptoms include tiredness, loss of appetite, nausea and vomiting. A patient may also have dark-colored urine and pale bowel movements. Stomach pain. Skin and whites of eyes turning yellow (jaundice). About 30% of people have no symptoms. Treatment inlcudes taking a medicine to help the liver fight damage from the virus. There are medications available to treat long-lasting (chronic) HBV-infection. These work for some people, but there is no cure for hepatitis B when you first get it.

Syphilis is caused by a spirochetal bacteria and usually starts with a red painless sore on the vagina, penis, tongue or throat. After a few months, it can cause fever, sore throat, headache or joint pain. It can also cause a scaly rash on the hands or feet. The disease is treated with antibiotics. If left untreated, it can cause serious health problems.

Musculoskeletal Disorders Are Often Associated With HIV Infection
TB & Outbreaks Week
People with HIV often experience a wide array of musculoskeletal symptoms secondary to HIV infection. Some studies have shown that approximately 70 percent of HIV patients had bone, joint, or muscle involvement. These musculoskeletal diseases can be a direct effect of the virus or a part of the opportunistic infections that occur in HIV patients because of the weakened immune system.

Ayaz A. Baviji, M.D., and colleagues reviewed the research studying muscle, bone and joint disorders in HIV patients, summarizing their findings in the report "Musculoskeletal Manifestations of Human Immunodeficiency Virus Infection" published in the Journal of the American Academy of Orthopaedic Surgeons (2002;10(5)). Although musculoskeletal involvement may occur at any phase of HIV infection, it more commonly develops in later stages. Nevertheless, 50-70 percent of HIV patients complain of muscle and joint pain at early stages of HIV infection. Therefore, HIV infection should be considered if there is a sudden onset of muscle and joint pain in individuals who have been exposed to HIV.

Muscle disease processes experienced by HIV patients can be inflammatory, infectious, or related to tumor growth. An inflammation of a voluntary muscle (myositis), for example, may be the first symptom of HIV. Other muscle diseases may result from drug-induced effects of HIV drugs, primarily azidothymidine (AZT), or direct invasion of muscle tissue by HIV.

Beginning as a lung infection, TB may spread to the skeletal structure; one study showed that the disease involved the spine in 66 percent of the cases studied, the hip in 18 percent, the knee in 10 percent, other joints in 5 percent, and other bones in 1 percent.

HIV-associated arthritis, swollen or painful joints, and Reiter's syndrome are more likely to afflict HIV-positive than HIV-negative persons. Neoplastic, or tumor-causing, conditions are other disorders prevalent in HIV patients as the immune system deteriorates. Non-Hodgkin lymphoma, for example, is the second most common type of tumor in HIV patients after Kaposi sarcoma and is 60 times more prevalent among HIV patients than in the general population.

HIV patients with musculoskeletal symptoms can be a diagnostic and treatment challenge for orthopedic surgeons, who must not only manage the symptoms of these patients but also be aware of the outcomes and risks of HIV patients during either emergency or elective orthopedic surgery. Bone and soft-tissue healing as well as resistance to infection may be impaired in individuals with weakened immune systems. Orthopedic surgeons should perform a thorough preoperative evaluation, including assessment of the patient's immune system, before surgery. Biviji and colleagues recommend a multidisciplinary approach to treating HIV patients, especially for surgeons who do not routinely treat such individuals. The researchers also highly recommend HIV testing in patients with unusual musculoskeletal complaints who are at risk for or have been exposed to HIV.

Reiter's syndrome involves both inflammation within and around the joints, and particularly where ligaments and tendons attach to bones. Reiter's syndrome usually develops following an intestinal or a genital/urinary tract infection and is more likely to occur in individuals who have a particular genetic makeup. People with Reiter's have arthritis and one or more of the following: urethritis, prostatitis, cervicitis, cystitis, eye problems, or skin sores. Many people have only one episode which goes away, while some people have repeated recurrences of the illness.

Many people develop Reiter's syndrome 1 to 3 weeks following a mild or severe case of diarrhea which is often, but not always, due to food poisoning. Reiter's syndrome also develops following certain types of infections of the genital/urinary tract. These infections may be transmitted during sexual contact.

Arthritis is the major symptom. It generally appears several weeks or months after other symptoms. People with Reiter's may experience swelling and tenderness of one ankle or knee; pain in the heel of the foot; inflammation and pain of the Achilles tendon (located along the back of the heel); or swollen toes and fingers (often called "sausage digits" because of their shape).

Inflammation of the lower back joints can cause back pain and stiffness, which often improves with movement and exercise. Inflammation can also occur around the ribs, which may cause chest pain. Urethritis is a common condition of Reiter's. This is inflammation of the urethra. It is often, but not always, the first condition of Reiter's syndrome.

Prostatitis, inflammation of the prostate gland in men, often accompanies the urethritis. Cervicitis is inflammation of the cervix. There are no obvious symptoms of this condition, but it is observed on pelvic exam.

Cystitis, a bladder or urinary tract infection, may also occur. It may be accompanied by frequent and burning urination and fever. Eye problems such as conjunctivitis may develop. This results from inflammation of the delicate membrane that lines the inner eyelids. Iritis and uveitis are less common. Skin sores may appear anywhere on a person's body. Small, painless sores may appear on the head of the penis, roof of the mouth or tongue.

Diagnosis is based upon the findings of the classic triad of problems.

The objective of treatment is to reduce joint pain and inflammation; prevent or decrease the amount of joint damage; and restore the function of damaged joints.

Treatment includes medications, rest, joint protection, and special exercises. The most common drugs used are non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin, diclofenac, tolmetin, sulindac or phenylbutazone. In severe cases, folic acid antagonists such as methotrexate may relieve joint inflammation. Physical therapy can be useful. Urethritis, prostatitis and cervicitis may need treatment with antibiotics. Conjunctivitis, iritis, or uveitis are often treated with prescription eye drops. Skin sores may be treated with a prescription cream.

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