Neisseria gonorrhoeae

the genus Neisseria is composed of ____ species

11

what are the significant human pathogens?

1. N. gonorrhoeae

2. N. miningitidis

the genus Moraxella was formerly names _______

Branhamella catarrhalis

it is considered a normal flora of the nasopharynx and may also cause respiratory tract infection

Moraxella

he came up with the name N. gonorrhoeae

Galen

N. gonorrhoeae came from the Greek words ____ which means _____ and ______ meaning _______

gonos - seed; rhoia - flow

what are the only human Neisseria species that are rod shaped

1. N. elongata

2. N. weaveri

3. N. baciliformis

0.6 to 1.0um in diameter, usually seen in pairs with adjacent flattened sides; sometimes discribed as “coffee=bean" shaped.

gram negative coccus

true/ false

is N. gonorrhoeae very susceptible to adverse environmental conditions such as drying?

true

yes/no

is N. gonorrhoeae aerobic?

yes

N. gonorrhoeae requires an atmoshhere of ____ and incubation temperature of _____ for growth in culture

5%CO2; 35-37C

physiological characteristics of N. gonorrhoeae

1. capsulated

2. beta lactamase poducer

3. piliated

4. non motile

5. non sporeformning

6. cytochrom oxidase (+)

7. catalase (+)

8. carbohydrates are utilized oxidatively

they are catalist negative and cytochrome oxidase negative

1. N. elongata

2. N. reduscens

3. N. bacilliformis

what are the natural habitats of Neisseria spp.?

1. mucous membranes of the respiratory and urogenital tracts

virulence factors:

1. pilus

2. por protein (protein I)

3. opacity protein (opa or protein II)

4. lipooligosaccharide (LOS)

5. reduction modifiable protein (Rmp or protein III)

6. IgA protease

7. capsule

Mediates initial attachmentto human cells including epithelium of the vagina, fallopian tube & buccal cavity

pilus

Form pores in the outermembrane

por protein (protein I)

Promotes intracellular survival by preventingphagolysosome fusion in neutrophils

por protein (protein I)

mediates firm attachment to epithelial cells & invasion into cells

opacity protein (opa or protein II)

has endotoxin activity; composed ofLipid A & core oligosaccharide similar to Gm(-) LPS

Lipooligosaccharide (LOS)

protects othersurface antigens(Por protein, LOS) from bactericidal antibodies

reduction modifiable protein (Rmp or protein III)

destroys IgA

IgA protease

antiphagocytic

capsule

among the N. gonorrhoeae's morphologically distinct colony types (tpes T1, T2, T3, T4, and T5), which of them possesses pili?

T1 and T2

among the N. gonorrhoeae's morphologically distinct colony types (types T1, T2, T3, T4, and T5), which of them are devoid of pili and are avirulent?

T3, T4, and T5

cell outer membrane proteins ____, ____, ____, and ____ srrve as protective devices of the organism and important in antigenic variation

membrane proteins I, II, III, and LOS

it is the most common of the classic venereal diseases

Gonorrhoeae

N. gonorrhoeae infects both males and females and is common among the __ to __ years age and slightly less common among the 15-19 and 25-30 years old.

20-24 years age group

it is only found in humans; it has no known reservoir host except in asymptomatic infected individuals

N. gonorrhoeae

asymptomatic carriage is more common in ____ than in ___

more common in women than in men

incidence increases with ___________

multiple sexual partners

it is spread primarily through sexual intercoarse: ___, _____, and _____

vaginal, oral and anal

in anal, the miroorganism is found in the ___

rectum

in children, them microorganism is found in

1. genital tract

2. throat

3. rectum

in women, the gonorrhoeae can also infect the ______

endocervix

_____ and ______ infections are usually asymptomatic than are genital infections

rectal and pharyngeal

in babies, most commonly affects the

eyes

incubation period in females

2-8 days

most cases occur within ___ days of infection i females

4 days

There is burning or painful sensation on urination and a yellow purulentdischarge (drip) that signifies

acute anterior urethritis

95% ofi nfected cases have _____ in males

acute symptoms

10% of cases may be ___ in males

asymptomatic

in males, 1% of infected cases may develop complications, the most common being

1. urethral structures

2. prostitis

3. periurethral abscesses

less common complications of infected cases in men

1. septicemia

2. periotonitis

3. meningitis

4. subsequent development of nongonococcal urethritis

20 – 80% of women with gonorrheae are asymptomatic but, symptoms mayappear, i.e:

1. burning or frequency of urination/ dysuria

2. vaginal discharge

3. fever

4. abdominal pain (lower) or pelvic pain

5. vaginal bleeding betqeen periods, such as after vaginal intercoarse

what is the most common site of infection in women?

endocervix

signs and symptoms of gonorrhoeae in the rectum

1. anal itching

2. pus like discharge from the rectum

3. spots of bright red blood on toilet tissue

4. having to strain during bowel movements

signs and symtoms of gonorrhoeae in the eyes

1. eye pain

2. sensitivity to light

3. pus like discharge from one or both eyes

signs and symtoms of gonorrhoeae in the throat

1. sore throat

2. swollen neck lymph nodes

signs and symtoms of gonorrhoeae in the joints

1. septic arthritis

2. affected joints might be warm, red, swollen, and extremely painful (especially during movement)

untreated gonorrhea can lead to major complications such as:

1. infetility in women

2. infertility in men

3. infection that spreads to the joints and other areas of the body

Babies who contract gonorrhea from their mothers during birth can develop

1. blindness

2. sore on the scalp

3. infections

complications in babies

1. opthalmia neonatorum

2. neonatal gonococcal arthritis

3. gonorrheal vulvovaginitis

infection of the conjunctival sac acquired by  the newborn during passage through an infectedbirth canal.

opthalmia neonatorum

a highly destructive form of infectious arthritis.

neonatal gonococcal arthritis

sources of specimen in males

1. urethra

2. oropharynx

3. rectum

sources of specimens in females

1. endocervix

2. urethra

3. oropharynx

4. rectum

what is the preferred swab?

1. dacron

2. rayon

Smears for direct Gram stain should come from urogenital specimens, _______________ is not recommended because of the presence of Commensal Neisseria spp.

pharyngeal specimen

intracellular diplococci, gram-negative, “coffee-bean-shaped”, intracellularly located in PMNs

Gram staining

Can be reliably used to diagnose infections in men with purulent discharges/ urethritis but all negative results in women and asymptomatic men must be confirmed by culture

gram staining

it is useful for the early diagnosis of purulent arthiritis but insensitie for the detection in patients with skin lesions, anorectal infections or pharyngitis

gram staining

presumptive diagnosis

1. colony morphology

2. miscrosopic morphology

3. oxidase test

definitive diagnosis

1. carbohydrate utilization

2. chromogenic substrates

3. immunoassays

4. MALDI-TOF MS

5. NAATs

Strains of gonococci that have specific requirements for certain nutritional factors to promote growth on artificial media

auxotype

they form small, atypical colonies that are very sensitive to Penicillin and are associated with both asymptomatic urethritis and disseminated gonococcal infection

auxotype

what is the indicator dye for the oxidase test?

tetramethyl-p-phenylenediamine dihydrochloride

colonies of N. gonorrhoeae turns _________ when exposed to tetramethy-p-phenylenediamine dihydrochloride

pink to maroon to dark purple to black

it is the recommended base medium

Cystein Trypticase Agar (CTA)

in the CTA, N. gonorrhoeae ferments _____

glucose alone

in CTA, N. meningitides ferments ________

glucose and maltose

in CTA, other species of Neisseria ferments ___________

glucose, maltose, & sucrose

when results are inconclusive the _______ test is performed

superoxyl test

what is added to a colony of N. gonorrhoeae in a superoxyl test?

30% H202

immediate vigorous bubbling during a superoyl test indicates the presence of ______

N. gonorrhoeae

delayed, weak bubbling during a superoxyl test indicates the presence of

N. menigitides & N. lactamica

delayed, wek bubbling or none at all during a superoxyl test indicates the presence of

other neisseria species

CDC recommends a dose of ____ of ________ and ___ of _____ as treatment.

250 mg of intramuscular ceftriaxone; 1g of oral azithromycin

Penicillin sensitive N. gonorrhoeae

2.5 mega units Penicillin

penicillin resistant N. gonorrhoeae

4-9 mega units Penicillin

is very effective drug for N. gonorrheae infection but it is reserve for TB

Rifampin or Rifadin

prevention

1. avoid sexual promiscuity

2. early diagnosis & treatment

3. case finding & screening of contacts

4. use of prophylaxis

5. pili vaccine

as for Mayo clinic, one can reduce the risk of contracting gonorrhoeae by

1. use condom during sexual intercoarse

2. limit the number of sex partners

3. be sure that you and your partner are tested for STIs

4. don't have sex with someone who appears to have STIs

5. consider regular gonorrhoeae screening