NEISSERIA GONORRHOEAE

NEISSERIA GONORRHOEAE

Not part of normal human flora

NEISSERIA GONORRHOEAE

Found on mucous membranes of genitalia, anorectal area, oropharynx, or conjunctiva at time of infection

NEISSERIA GONORRHOEAE

Leading cause of sexually transmitted diseases

1. Person-to-person spread

2. Infected mother to newborn during birth

3. Asymptomatic carriers are a significant reservoir for increased disease transmission

mode of tranmission for NEISSERIA GONORRHOEAE

Person-to-person spread

Sexual contact: Rectal intercourse and Orogenital sex

virulence factors for neisseria gonorrheae

• pili

• Protein II

• Outer Membrane Porin (PorB)

• Capsule

• Lipooligosaccharide

• Outer membrane proteins I-III

Pili

Mediate the exchange of genetic material between strains

Pili

Attachment to human mucosal cell surface

Pili

• Invasion of host cells

• Survival through the inhibition of phagocytosis

Opa and RMP

Protein II is consist of

Opa

facilitates adherence to phagocytic and epithelial cells

RMP

blocks the bactericidal effect of host IgG

Outer Membrane Porin (PorB)

Provides protection from the host’s immune response

Lipooligosaccharide

Endotoxin for Neisseria gonorrheae

Outer membrane proteins I-III

Can cause disease

males and females

Can cause acute purulent urethritis (painful urination along with a purulent urethral discharge)

males

Prostatitis and Epididymitis

females

Acute cervicitis (lower abdominal discomfort, pain with sexual intercourse (dyspareunia), and a purulent vaginal discharge

female

Can lead to Pelvic Inflammatory Disease (PID)

PELVIC INFLAMMATORY DISEASE (PID)

Infection of the uterus (endometritis), fallopian tubes (salpingitis), and/or ovaries (oophoritis)

symptoms for Neisseria gonorrheae

• Fever

• Lower abdominal pain

• Abnormal menstrual bleeding

• Cervical motion tenderness

complications for Neisseria gonorrheae

• Sterility

• Ectopic pregnancy

• Abscesses

• Peritonitis

• Perihepatitis

Sterility

Inability to create offspring

Sterility

Most commonly caused by scarring of the fallopian tubes, which occludes the lumen and prevents sperms from reaching the ovulated egg

Ectopic pregnancy

• Fetus developing at a site other than the uterus

• Most common site: fallopian tubes

Peritonitis

Infection of peritoneal cavity

Perihepatitis

Fitz-Hugh-Curtis syndrome

Perihepatitis

Infection of the capsule that surrounds the liver

Perihepatitis

Sx: right upper quadrant pain and tenderness

localized infections

• Pharyngitis

• Anorectal infections

• Conjunctivitis

Conjunctivitis

Ophthalmia neonatorum of newborns

Conjunctivitis

Acquired during birth from an infected mother

Conjunctivitis

Usually occurs on the first or second day of life and can damage the cornea, causing blindness

DISSEMINATED INFECTIONS

• Bacteremia

• Arthritis

• Metastatic infection at other body sites

specimen collection and transport

Species are sensitive to drying and extremes of temperature, and material must be cultured promptly to enhance recovery

SPECIMEN

Pus and secretions are taken from the urethra, cervix, rectum, conjunctiva, throat, or synovial fluid for culture and smear

specimen

Blood culture is necessary in systemic illness

specimen

N. gonorrhea and meningitidis are sensitive to sodium polyanethol sulfonate (SPS), the preservative typically found in blood culture broths — SPS content should not exceed 0.025%

TRANSPORT for Neisseria gonorrheae

If cotton swabs are used, transport medium should contain charcoal (Ames medium) to inhibit toxic fatty acids present in the fibers

TRANSPORT for Neisseria gonorrheae

Sample should then be placed in a container able to sustain an atmosphere of increased carbon dioxide

TRANSPORT for Neisseria gonorrheae

Specially packaged media contain a CO2- generating system are commercially available (JEMBEC plates – contain MTM and the CO2 generating tablet is composed of sodium bicarbonate and citric acid)

Neisseria gonorrheae

Gram-negative diplococci inside polymorphonuclear leukocytes

Neisseria gonorrheae

Kidney-bean shaped with adjacent sides flattened

chocolate agar

culture used for Neisseria gonorrheae

selective media

1. Thayer-Martin medium

2. Modified Thayer-Martin (MTM)

3. Martin Lewis (ML)

4. GC-LECT agar

5. New York City (NYC)

Thayer-Martin medium

Chocolate agar with VCN

Vancomycin

Inhibit gram-positive bacteria

Colistin

Inhibit gram-negative bacilli

Nystatin

Inhibit yeast

Modified Thayer-Martin (MTM)

Same with Thayer-Martin + Trimethoprim (inhibit swarming Proteus spp)

Martin Lewis (ML)

Same with MTM except that nystatin is replaced with anisomycin, and the concentration of vancomycin is increased

GC-LECT agar

Contains antimicrobials to inhibit bacteria found in oropharyngeal specimens (vancomycin, lincomycin, colistin, amphotericin B and trimethoprim

New York City (NYC)

Contain lysed horse blood, horse plasma, yeast dialysate, and the same antibiotics as MTM

Incubation Conditions and Duration

Incubated at 35° to 37°C for 72 hours in a CO2-enriched (3 to 7%), humid atmosphere

Incubation Conditions and Duration

Achieved using a candle jar, CO2 generating pouch and CO2 incubator

Incubation Conditions and Duration

Humidity can be provided by placing a pan with water in the bottom of a CO2 incubator or by placing a sterile gauze pad soaked with sterile water in the bottom of a candle jar

Colonial appearance

• Small

• Grayish white

• Convex

• Translucent

• Shiny colonies with either smooth or irregular margins

Biochemical and Physiologic Characteristics

• Facultative anaerobe

• Oxidase positive (+)

• Ferments glucose only

• DNAse negative (-)

treatment for Neisseria gonorrheae

Widespread resistance to penicillin, tetracycline, and fluoroquinolones

treatment for Neisseria gonorrheae

extended spectrum cephalosporins

AST for Neisseria gonorrheae

β-Lactamase production can be detected using a chromogenic cephalosporin

AST for Neisseria gonorrheae

• CLSI recommends the agar dilution method or a disk diffusion

• E-test can be performed

prevention for Neisseria gonorrheae

Use of preexposure antibiotics to prevent gonococcal disease is discouraged because of the potential risks of sensitization and the emergence of resistant strains

prevention for Neisseria gonorrheae

Erythromycin ointment to the eyes of newborns to prevent gonococcal (and chlamydial) ophthalmia neonatorum