In-Depth Notes on Neisseria Gonorrhoeae and Gonorrhea

Overview of Neisseria Gonorrhoeae

  • The study of Gram Negative Diplococci Neisseria encompasses twelve species, out of which two are primary pathogens:

    • Neisseria gonorrhoeae

    • Neisseria meningitidis

Virulence Factors of Neisseria Gonorrhoeae

  • Neisseria has three key virulence factors necessary for its infectious capabilities:

    • Fimbria (Pili): Hair-like structures that facilitate attachment to host cells.

    • Capsules: Help the bacteria evade the immune system.

    • Lipooligosaccharide (LOS): A combination of Lipid A and sugars, contributing to the bacteria's structural integrity.

  • If any of these virulence factors are lost, Neisseria becomes non-infectious.

Disease Information

  • Gonorrhea: One of most common sexually transmitted disease (STD) caused by Neisseria gonorrhoeae.

    • aka as the clap or the drip.

    • One of the oldest known diseases, historically recorded by Galen in 150 AD.

    • It is the second most commonly reported infectious disease in the U.S., following chlamydia, with around 62 million cases globally per year.

    • Attatches to mucosal cells using fibria, can infect mouth, anus, cerfix urethra and eye.

Symptoms of Gonorrhea

In Males

  • 80% of males have symptoms in 1st week of exposure

    • Painful urination

    • Pus discharge from the urethra.

    • Can cause scarring and blockage of the urethra, potentially leading to sterility if the testes or vas deferens are affected.

In Females

  • Primarily infects very internal cervical cells; symptoms can be unnoticed:

    • Possible urethritis or increased vaginal discharge.

    • If untreated, may lead to Pelvic Inflammatory Disease (PID), characterized by:

    • Abdominal pain

    • Fever

    • Chills

    • PID can result in serious complications, including permanent sterility or ectopic pregnancy.

Concurrent Risks and Complications

  • Can dissemiate and become a systemic infection in 0.5-3% of patients

  • can involve joints, heart, meniges, eyes and pharynx

  • Ophthalmia Neonatorum: Newborn infection from vaginal delivery in infected mothers, potentially causing:

    • Blindness

    • Corneal scarring

    • Inflammation of the iris

    • Perforation of the cornea

    • Pneumonia

  • Preventative treatment includes silver nitrate or antibiotic ointment (tetracycline or erythromycin) applied to newborns' eyes shortly after birth.

Diagnosis of Gonorrhea

  • For Males:

    • For MalesA gram stain of urethral pus should reveal white blood cells containing intracellular gram-negative diplococci.

  • For Females:

    • For Females,Cultures are needed due to the presence of non-pathogenic gram-negative diplococci in normal vaginal flora.

    • The use of chocolate agar with antibiotics (e.g., Thayer-Martin New-york Citymedium) to inhibit normal flora growth.

  • Rapid diagnostic methods for men and women include ELISA, DNA, or RNA probes, and monoclonal antibody test which are all faster than culture.

  • For both men and women Samples must be handled properly to maintain bacterial viability before analysis.

  • N.gonnorehea is very sensitive to cold, poor CO2 levels, so specimen must be collected and promptly delivered to lab or put in an enriched CO2 atmosphere if held at room temperature.

Treatment of Gonorrhea

  • Treatment has evolved from penicillin (now ineffective) to ceftriaxone (single intramuscular dose) with oral Azithromycin as a companion treatment.

  • It's crucial for partners to be tested and treated, regardless of whether they show any symptoms.

Historical Treatment

  • Initially, silver nitrate was utilized in the 19th century, later replaced by Protargol (colloidal silver) from 1897.

  • The transition to antibiotics occurred in the 1940s, improving treatment efficacy against gonorrhea.