Neisseria gonorrhoeae

Neisseria gonorrhoeae are Gram-negative, and microaerophilic (less O2 and more CO2). They are grown out using capneic incubation, which gives them the microaerophilic environment, and on Thayer-Martin selective agar.

Transmission
Mainly an STD, where humans are the only host. Can also cause (gonococcal) opthalmia neonatorum. It can also spread through fomites- lasts about 18-24 hrs on a fomite, but is difficult to transmit this way.

Morbidity
Gonorrhea is a reportable disease, there are 350,000 reported cases each year. There are millions of new healthy carriers every year.

Males
Purulent discharge often referred to as "the drip" from the urethra as a result of WBC trying to engulf Neisseria. The pus is infectious, and the disease is spreadable whenever pus is present. Will cause dysuria, a painful urination, due to release of endotoxin, and an increased frequency of urination.

The UTI will clear up without treatment, and it's hard to identify Neisseria at this stage because these are common symptoms for any UTI (urethritis) even by E. coli. People are often convalescent carriers, who show decreased symptoms but are still contagious.

Complications

 * Urethral stricture, where the urethra closes up due to scar tissue caused by repeated exposure to endotoxin. It can cause sterility- affects the epididymus (sperm factory).
 * Chronic prostatitis, the inflammation of the prostate gland
 * 10-20% of males are asymptomatic

Females
2/3 to 3/4 are healthy carriers, but others show symptoms such as:
 * Purulent discharge from urethra
 * Dysuria
 * In addition to increased frequency of urination
 * Cervicitis
 * PID- pelvic inflammatory disease- Happens with recurring gonorrhea
 * Endometritis, an inflammation of the uterus. May lead to a hysterectomy
 * Salpingitis- Fallopian tubes are inflamed and scarred, leading to sterility
 * About 75,000 women are sterile due to PID, 2/3 from gonorrhea or chlamydia, 1/3 from E. coli

Other Forms
Anal gonorrhea-in the rectum

Pharyngeal gonorrhea- in the throat

Gonococcal Arthritis
 * The most common type of septic arthritis
 * 16-50 y/o group is the common range
 * 1% of arthritis cases is gonococcal.


 * The knee is the most common joint infected

Microscopic Examination
-Take a sample of the drip when it is at its worst, looking for G- intracellular cocci

-99% accurate for males, only 50% accurate for females, who have a lot more organisms growing in their genital regions.

Cultural Examination
-Isolate it on Thayer Martin Selective Agar

-60% accurate for males and 40% accurate for females

(Biochemical Testing)
-Oxidase test

-Carbohydrates help to verify that you have Gonorrhea

(Antigen-Antibody Reactions)
-Looks for antibodies in the blood

-Do not work well with ghonorrhea because it mutates frequently

-This also means that immune system has a hard time stopping recurring infections

(PCR)
-Looks at the DNA of the bacteria

-Works very well, all they need is a urine sample

Treatment:
Ceftriaxone and Tetracycline.

Ceftriaxone is the DOC for gonorrhea, and works for syphilis, but not chlamydia. Therefore, the two drugs of choice are Ceftriaxone and Doxycycline (or Azithromycin), to also cover chlamydia, which can co-infect a gonorrhea patient.

If you only took Ceftriaxone you would get post-gonococcal urethritis from Chlamydia, ½ of the people that have gonorrhea will develop chlamydia if left untreated. Doxycycline works on syphilis as well as chlamydia.

Prevention

 * Many people are healthy carriers.
 * Erythromycin to prevent Opthalmia neonatorum
 * Trace contacts: Expedited partner treatment (EPT), index patient is given drugs to treat partner(s) to prevent spreading the disease.
 * Education: Teach about the seriousness of PID
 * Test all females because they have a greater chance to be healthy carriers
 * If anyone gets an STD, test them for all STDs