STDs and Joint Pain

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Sexually transmitted diseases are widely known to cause skin problems in the site of infection, long-term consequences in various organs, and severe and life-threatening immune problems. But little has been said about how sexually transmitted diseases can complicate into joint pain and arthritic syndromes. The most widely known case of arthritis as a consequence of joint pain is gonococcal arthritis, but there are many other examples to take into consideration.

So, is it possible to suffer from arthritis after having unprotected sex? In this article, you will learn the various ways and pathologic agents involved in sexually transmitted arthritic syndromes, and how to detect them through a series of warning signs.

STDs causing Joint Pain

An association between Arthritis and STDs

There are many types of arthritis, and a minority of patients with joint pain would have an underlying STD. However, we should not consider STDs unimportant when it comes to looking for the cause of joint pain because the truth is that most of these infectious agents can cause arthritis as well. Some sexually transmitted diseases remain asymptomatic for a while, and many patients consider irrelevant or deny their exposure or previous diagnosis of a sexually transmitted disease. The most common sexually transmitted microbes associated with arthritis are Neisseria gonorrhea, Treponema pallidum, Chlamydia tracomatis, the Hepatitis B virus, and the HIV.

Reactive arthritis” is a common term in rheumatology that refers to a type of arthritis that develops shortly after being infected by certain bacteria in the urinary tract or the gut. Sexually transmitted arthritis is under the spectrum of reactive arthritis and enters into the definition of “Reiter’s syndrome” which has an inflammation in the genital tract, the eyes and the joint, and various symptoms associated with them. Therefore, it is very likely to read or hear about reactive arthritis, sexually transmitted arthritis and Reiter’s syndrome in the same sentence, and it basically refers to the same thing.

This type of arthritis is more common in young males aged 20 to 40 years. They usually start feeling a burning pain while urinating, blood in the urine or urethral discharge before starting joint pain up to 3 weeks after the initial symptoms. In reactive arthritis, joint pain is usually located in the ankle, the knee, or the joints located at the base of the toes. Low back pain and painful red eyes are common symptoms as well, and while it is not commonly destructive, when it’s severe and progressive, it would slowly erode and destroy the articulation.

Viral joint pain (HIV and Hepatitis B)

HIV causes a myriad of health problems, but most of them are related to a dysfunction in the immune system and increased propensity to infections. However, many studies show that HIV itself is capable of causing arthritis and problems in the blood vessels (vasculitis) and muscles (myopathy). Thus, if you visit your rheumatologist for joint pain, he would need to rule out sexually transmitted diseases, including HIV infection as a possible cause.

HIV causes a particular type of arthritis called “aseptic” arthritis, and it is sometimes difficult to detect because it will increase the risk of being infected by many other sexually transmitted diseases. Thus, there might be a point when doctors are not clear whether joint pain is caused by HIV or another sexually transmitted disease.

In the classic presentation of aseptic arthritis, there is no trace of microbial involvement in the joint fluid, and even the HIV virus is not always detected. The articulations in aseptic arthritis due to HIV undergo inflammatory changes, but they are microscopic, and doctors usually need a process of elimination to rule out other causes before diagnosing HIV arthritis.

On the other hand, hepatitis B virus (HBV) is also known to cause joint pain. This type of arthritis is known to start 12 weeks after being infected with the HBV, it is listed among the early signs and symptoms to detect Hepatitis B, and it resolves automatically before the patient’s skin starts to change into a yellowish color (jaundice). These symptoms typically last for 2 weeks, and doctors would need to look for other symptoms such as a skin rash, and ask for risk factors such as multiple sexual partners to diagnose the disease.

Gonococcal Arthritis

Arthritis caused by Neisseria gonorrhea is the most widely recognized sexually-transmitted arthralgia. Gonorrhea usually starts as an infection to the genitourinary tract, but it may become disseminated to other areas of the body, including the joints. Gonococcal arthritis is the most common type of disseminated gonococcal infection, and it is more common in immunocompromised patients.

You may suspect gonococcal arthritis if you have joint pain with a mild fever and urethral discharge. However, the majority of patients do not display any symptoms of a genital, pharyngeal or anal infection. In patients with no urethral discharge or any other genital symptom the diagnosis is not easy because fever, chills, joint pain, and dermatitis may point out to different diseases at the same time. However, skilled doctors will be able to distinguish skin lesions by looking at their progression and localization.

Joint pain in gonococcal arthritis is not always in the same articulation. It is called migratory arthralgia because it spreads to a series of articulation or migrates from one to the other. It is also possible to develop tenosynovitis, which gives out pain, swelling, and changes of color in the affected articulation.

At this point, we are now able to answer whether or not it is possible to suffer from arthritis after having unprotected sex. The answer is yes. Most patients with arthritis do not suffer from sexually transmitted diseases, but the majority of sexually-transmitted pathogens might also cause temporary joint pain or arthritis. Therefore, if your doctor is trying to look for the cause of your articular pain, he might ask for personal questions regarding your sexual life and order lab tests to rule out sexually transmitted diseases.

References:

Shirtliff, M. E., & Mader, J. T. (2002). Acute septic arthritis. Clinical microbiology reviews15(4), 527-544.

Keat, A. (1990). Sexually transmitted arthritis syndromes. Medical Clinics of North America74(6), 1617-1631.

Flores, D., Marquez, J., Garza, M., & Espinoza, L. R. (2003). Reactive arthritis: newer developments. Rheumatic diseases clinics of North America29(1), 37-59.

Rice, P. A. (2005). Gonococcal arthritis (disseminated gonococcal infection). Infectious Disease Clinics19(4), 853-861.

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