Negative Urine Nucleic Acid Amplification Testing in a Case of Disseminated Gonococcal Infection Presenting as Migratory Arthritis

Disseminated gonococcal infection (DGI) is a well-documented complication of Neisseria gonorrhoeae infection, most characteristically presenting as migratory arthritis, tenosynovitis, and dermatitis. Although modern nucleic acid amplification tests (NAATs) and cultures from mucosal sites have significantly improved diagnostic capabilities, discrepancies between clinical manifestations and laboratory findings still occur.1 One such challenge arises when the urine gonorrhea test returns negative despite strong clinical evidence pointing toward gonococcal involvement. Migratory arthritis—a transient, shifting pattern of joint inflammation—has long been recognized as a hallmark of DGI.2 Typically, the pathogen is detected in blood, synovial fluid, or from mucosal specimens; however, negative urine testing can complicate the clinical picture and delay definitive diagnosis.