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Gonorrhea • Leading cause of sterility in women • Caused by bacteria Neisseria gonorrhoea • One million cases/yr • Treated with antibiotics • May cause arthritis and endocarditis (inflammation of heart) • Diagnosed by a smear of the discharge
Morphology • 0.8μm, Gram negative, diplococci (pairs of cocci) • most in neutrophil cells
Cultivation • Culture • Obligatory aerobic • grow best on chocolate agar, containing heated blood, brown in color • Thayer Martin Chocolate Agar • A modified (selective) chocolate agar • Biological reactions • Glucose fermentation only • Can not use other sugars
Surface Antigens • Pili • Adherence factor, weak antigenic • LPS • Out membrane protein (OP) • PI: major OP, 18 serotypes • based on PI • PII: adherence factor
Resistance • Extremely sensitive to environmental conditions, e.g., heat and cold • Sensitive to penicillin • Drug resistance is quite common • Penicillin doesn’t work well • New beta-lactam drugs are recommended • R plasmid
Virulent Substances • Pili • Involved in the initial adhesion of the organism to genital epithelium • LPS (Endotoxin) • IgA1 proteinase • Exotoxins are not believed to be of importance in pathogenesis
Pathogenesis • The only natural host is human • Gonococci attack mucous membranes of the genitourinary tract, eye, and rectum • Cause acute suppuration that lead to tissue invasion • Followed by chronic inflammation and fibrosis • Exclusive pathogenic • Diseases result from exogenous infection
Diseases • Adult • Gonorrhea • STD,The second most common venereal disease • Skin lesions • Results of gonococcal bacteremia • Neonate • Gonococcal Ophthalmia Neonatorum • Gonococcal conjunctivitis • Blindness
Gonorrhea • Women • 80% of women asymptomatic carriers • May cause Pelvic Inflammatory Disease (PID) • Men • Develop a drip, pus exudate 3-8 days after exposure • Painful urination • If newborn has contact with the bacteria during birth may cause blindness • Silver nitrate is put into the newborns eyes to prevent blindness
Gonorrhea In Males • Usually urethritis, with yellow, creamy pus and painful urination, but may be asymptomatic • As suppuration subsides in untreated infection, fibrosis occurs, sometimes leading to urethral strictures
Gonorrhea In Females • Primary infection is in the endocervix and extends to the urethra and vagina, giving rise to mucopurulent discharge • Chronic gonococcal cervicitis is often asymptomatic • It may progress to the uterine tubes, causing salpingitis, fibrosis of the tubes • Infertility occurs in 20% of women with gonococcal salpingitis
Gonococcal Ophthalmia Neonatorum • Also, gonococcal conjunctivitis • An infection of the eye of the newborn • acquired during passage through an infected birth canal • The initial conjunctivitis rapidly progresses and, if untreated, results in blindness • To prevent • Instillation of tetracycline, erythromycin, or silver nitrate into the conjunctival sac of the newborn is compulsory in most countries
Gonococcal Bacteremia • A common feature of disseminated gonoccocal disease is arthritis • Commonly considered a form of septic arthritis • In many cases gonococci cannot be isolated from the joint (i.e. they are "reactive" in nature) • Dermatitis (skin lesion) is also common
Immunity • Can be infected repeatedly • due to the variations of antigenecities of gonococci proteins
Diagnosis • Specimens • Pus and secretions taken from the urethra, cervix, rectum, conjunctiva • Smear and microscopy exam • A smear may show the presence of G- cocci present in polymorphonuclear cells • Cultivation and isolation • Culture is essential for definitive diagnosis • Special care is needed to keep the temperature and moisture to preserve the bacteria • Bacterial antigen detection • Nucleic acid detection
Prevention and Treatment • There is no vaccine • since strains are highly variable in their external antigens (both outer membrane and pili) • Social management, surveillance, and prevention are more effective than drug • Instillation for neonates
Antibiotic Therapy • Penicillin therapy is still usually effective • Because of the problems with antimicrobial resistance in N gonorrhoeae, it is recommends that uncomplicated genital infections be treated with ceftriaxone given intramuscularly as a single dose • Additional therapy • doxycycline orally twice a day for 7 days, is recommended for the possible concomitant chlamydial infection • Erythromycin base orally four times a day for 7 days, is substituted for doxycycline in pregnant women • ceftriaxone • A beta-lactamase-resistant cephalosporin
Syphilis • Caused by bacteria treponema pallidum • Found in the remains of American natives 5000 years old • AIDS of the 16th century • Columbus, Beethoven, Goya, Keats, James Joyce, Oscar Wilde, Peter the Great, Napoleon, and a few popes all had syphilis • Bacteria enters through the mucous membranes of mouth, genital tract, rectum
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