Objectives

To be able to know the proper

specimen collecton for Neisseria
Gonorrhoeae
To be able to determine how N.
gonorrhoeae is identified; and
To be able to know the preparation
is done before its identification

Reference
Introduction to Diagnostic
Microbiology
By: Maria Dannessa Delost
Internet

GONORRH
EA
Reported by: Anne
Franceleen U. Dalura

Table of Contents
Introduction ---------------------------------- 3
Infectious Process --------------------------- 4
Specimen Collection and Processing -------- 7
Identification ---------------------------------- 9
Auxotypes------------------------------------------ 12

 Neisseria gonorrhoeae is the agent of

Gonorrhoeae
It is an acute pyogenic infection mainly of the
mucous membranes of the endocervix in
females and urethra in males
In females, lone term effects of this infection
may result in: Scarred fallopian tubes,
Ectopic pregnancy, and Sterility
In males, acute urethritis is associated with:
Dysuria and a Urethral discharge
In Homosexual and bisexual males and
females, Oropharyngeal and Rectal
infections can be seen.

 Not all gonorrhea infections are

symptomatic
It is needed to culture both
symptomatic and asymptomatic sexual
contacts, and those who have multiple
sex partners, in homosexual
population, and are positive for other
sexually transmitted diseases (STDs)
Today, the rate of this infection has
increased in teenagers, young
adults, urban drug abusers,
prostitutes, and past history of
gonorrhea

 Extragenital infections include

Opthalmia neonatorum, a
conjunctivitis acquired by newborns
from an infected mother during
delivery. For this reason, all newborns
are prophylactically treated with
antibiotic drops or cream to prevent
infection from occuring
N. gonorrhoeae can disseminate into
the blood, causing disseminated
goncoccal infection (DGI), a
septicemia characterized by
hemmorhagic skin eruptions; to the

Attaches by Pili to I P
susceptible cells of the
N R
mucous membranes,
F O
whichThe
initiates
infection
Pili inhibits

E C
phagocytosis by interfering
with the functionCof E
neutrophils
Lipopolysacchari
T S
de produces I S

endotoxic effects
Protein I allowsOfor the
organism to insert
U into
host cellsS
Protein II allows the
organism to attach to
neutophils and epithelial cells

SPECIMEN COLLECTION AND

PROCESSING
Females: Endocervical specimens
Males: Urethral specimens
> Anorectal, Oropharyngeal, and conjunctivital speciemns
may also be warranted based on parients age,
symptoms, and medical history
Blood or synovial fluid may be cultured for suspected DGI
NOTE:
The use of disinfectants must be avoided because the
organism is susceptible to these agents
Use of cotton swabs is discouraged because fatty acids
are toxic to bacterium
Instead it must be pretreated with charcoal to absorb
fatty acids same as with Dacron, Rayon, and Calcium
alginate

 Medium recommended are:

Modified Thayer-Martin, Martin-Lewis, or New York
City (NYC)
In addition, Chocolate agar are also inoculated for
rare strains of N. gonorrhoeae
Transport method

Transgrow bottles- consists of flat bottle

coated with modified Thayer-Martin and
increased CO2
JEMBEC (John E. Martin Biological Environmental
System) plate- replaced Transgrow system.
Consists of a flat plastic dish containing medium
selective for gonococcus and tablet that acts as a
CO2 generator, incubated for 18-24hrs and sent to
laboratory

IDENTIFICATION
Gram stain serves as a presumptive
identification in smears is highly
specific for males butnlower for
females.
This results from the presence of lookalike bacteria or short gram-negative
rods/coccobacilli, including Moraxella,
and Acinetobacter
Note approximate amount of PMNs
and approximate amount of bacteria.
Reporting: Few, moderate, many

 Plates should be streak in a Z motion. Next,

the plate is streaked with a loop for isolation
Incubated at 35 to 37C in the candle jar, CO2
incubator, or plastic bag or pouch, providing
atmosphere of 3% to 5% CO2
Examine growth at 24hrs.
Negative growth should be reincubated at 48
hrs.
Colonial types:
Appear clear gray to medium gray in color and
opaque
Type 1 appear small, raised and moist. Type 2:
small, raised and dry
Posess pili and are therefore virulent
Type 3 and 4: lacks pili and are larger, flatter,

AUXOTYPES
Auxotype > refers to the strains that have
different nutritional requirements to promote
growth in artificial media
Auxotype can be used as an aid in
determining the potential virulence, degree of
invasiveness, and antibiotic resistance of the
different strains of N. gonorrhoeae
Example is auxotype AHU which requires
Arginine, Hypoxanthine, and Uracil that is
known to be sensitive to penicillin and is
likely to cause urethritis in males,
asymptomatic gonorrhea, and DGI in females

END