The time from sexual contact to the onset of DGI varies from 1 day to 2 months. Only 25% of patients with DGI manifest genitourinary or pharyngeal symptoms of the precedent mucosal infection.
DGI usually presents with the clinical triad of polyarthritis, tenosynovitis, and dermatitis. N gonorrhoeae accounts for only 20% of cases of monoarticular septic arthritis in young adults, since the most common joint presentation of DGI involves an oligoarthritis or polyarthritis. The initial symptoms include fevers, chills, and migratory symptoms of polyarthralgias, which usually progress to frank monoarthritis or polyarthritis in the knees, ankles, or wrists. Migratory symptoms of tenosynovitis occur in two thirds of patients and are most often present over the dorsum of the hand, the wrist, the ankle, or the knee. Skin lesions are seen in approximately two thirds of patients with DGI, although they are usually painless and patients may be unaware of them. Biopsy of these skin lesions demonstrates perivascular inflammation, leukocytoclastic vasculitis, intra-epidermal neutrophilic infiltration, and microthrombi; N gonorrhoeae can be cultured from biopsy specimens of the skin lesions approximately 10% of the time.
Unusual clinical manifestations of DGI include pericarditis, meningitis, aortitis, endocarditis, myocarditis, pyomyositis, and osteomyelitis.