IDENTIFICATION OF NEISSERIA-GONORRHOEAE IN SYNOVIAL-FLUID USING THE POLYMERASE CHAIN-REACTION

Objective. To analyze synovial fluid (SF) for the presence of Neisseri a gonorrhoeae DNA using the polymerase chain reaction (PCR). Methods. We used a modified, nested PCR to detect the presence of N gonorrhoeae DNA in 41 samples of SF obtained from 10 patients with clinical gonoc occal arthritis whose SF samples were sterile by culture and from 27 c ontrols, including 11 patients with Reiter's syndrome. Results obtaine d using this method were compared with those obtained using the GEN-PR OBE system, an RNA-DNA hybridization technique. Results. With nested P CR, N gonorrhoeae DNA was detected in 11 of 14 SF samples obtained fro m patients with culture-negative clinical gonococcal arthritis but in none of the 11 SF samples from Reiter's syndrome patients. The specifi city of this technique was 96.4%, with a sensitivity of 78.6%. The rat e of false-positive results was 3.6%. The GEN-PROBE technique was unab le to detect N gonorrhoeae ribosomal RNA in any of the samples. Conclu sion. These findings demonstrate the potential utility of the PCR in c onfirming the clinical diagnosis of gonococcal arthritis as well as pr oviding insight into the pathogenesis of this disorder in patients who se SF are sterile by standard culture techniques. PCR may also prove h elpful in differentiating N gonorrhoeae arthritis from acute Reiter's syndrome.