Neisseria gonorrhoeae (Gonococcus)

N. gonorrhoeae causes the sexually

transmitted disease gonorrhoea.

The gonococcus was first described by

Neisser in 1879 in gonorrheal pus.

Gonococci resemble meningococci very

closely in many properties.
MORPHOLOGY:
Gram negative diplococci with adjacent sides

concave, being typically kidney shaped.

They are usually found with in the
polymorphs.
They possess pili on their surface.
CULTURE & CULTURAL CHARACTERISTICS:

Gonococci are fastidious organisms do not grow on

ordinary culture media.

They are aerobic but may grow anaerobically also.

The optimum temperature for growth is 35-36C &

optimum pH is 7.2-7.6.

It is essential to provide 5-10% CO2.

Media used:

a) Non selective media: Chocolate agar,

Mueller-Hinton agar.

b) Selective media: Thayer Martin medium

with antibiotics (Vancomycin, Colistin &
Nystatin.
Colony morphology: Colonies are small,
round, translucent, convex or slightly
umbonate with finely granular surface &
lobate margins.
Biochemical reactions:

1) Oxidase test: Positive

2) Ferments only glucose

but not maltose.
PATHOGENICITY:

Source of infection:
1. Asymptomatic carriers
2. Patients

Mode of infection:
1. Venereal infection (sexual contact)
2. Nonvenereal infection
Antigenic structure & virulence factors:

1. Pili: They help in adherence of bacteria to host

epithelial cells & they are antiphagocytic.

2. Lipooligosaccharide: Endotoxic.

3. Outer membrane proteins: 3 types

a) Protein I (por)- it is a porin & helps in adherence.
b) Protein II (opa)- helps in adherence.
c) Protein III (rmp)- it is associated with protein I.

4. IgA1 protease: Splits & inactivates IgA.

Antigenic structure & virulence factors
Mechanism of pathogenesis:

Gonococci adhere to epithelial cells of urethra or

other mucosal surface through pili

Cocci penetrate through the intercellular space

They reach the sub epithelial connective tissue &

causes inflammation

Leads to clinical manifestations

Incubation period: 2-8 days.

Disease:
A) In men:

The disease starts as an acute urethritis with a

mucopurulent discharge

The infection extends to the prostate, seminal

vesicles & epididymis

In some it may become chronic urethritis leading to

stricture formation

The infection may spread to the periurethral tissues,

causing abscesses & multiple discharging sinuses
(Watercan perineum)
B) In women:

The initial infection is urethritis & cervicitis but vaginitis

does not occur in adult female (vulvovaginitis can
occur in prepubertal girls)

The infection may extend to Bartholins glands,

endometrium & fallopian tubes causing
Pelvic Inflammatory Disease (PID)

Rarely peritonitis may develop with perihepatic

inflammation (Fitz-Hugh-Curtis syndrome)
C) In both the sexes: Proctitis, pharyngitis,
conjunctivitis, bacteraemia which may lead to
metastatic infection such as arthritis,
endocarditis, meningitis, pyemia & skin rashes.

D) In neonates: Opthalmia neonatorum (a

nonvenereal gonococcal conjunctivitis in the
newborn) results from direct infection during
passage through birth canal.
LABORATORY DIAGNOSIS:

Specimens collected:
A) In men:
a) Acute infection- Urethral discharge
b) Chronic infection-
i) Morning drop
ii) Discharge collected after prostatic massage
iii) Centrifuged deposit of urine

B) In women:
i) Urethral discharge
ii) Cervical swabs
C) In both the sexes: Blood, CSF, synovial fluid,
throat swab, rectal swab & material from skin
rashes.
Transport: If there is delay in processing than the
specimens should be sent in Stuarts medium.
Methods of examination:

A) Direct microscopy:

1. Gram staining:
Smear provides a
presumptive
evidence
of gonorrhea in men.
Gram negative
diplococci are found.
But it is unreliable
in women.
2. Immunofluorescence:
B) Culture:

Media used:

Colony morphology:

Grams smear:
Reveals Gram negative
cocci in pairs with
adjacent sides concave.

Biochemical reactions:
C) Serology:

Complement fixation test,

Precipitation,

Passive agglutination,

Immunofluorescence,

Radioimmunoassay.
TREATMENT:

Previously Penicillin was drug of choice but

resistance developed rapidly.

Penicillin resistant is due to production of

penicillinase enzyme & the strains are called
as penicillinase producing Neisseria
gonorrhoeae (PPNG).

Now Ceftriaxone or Ciprofloxacin plus

Doxycycline or Erythromycin is useful.
EPIDEMIOLOGY:

Gonorrhoea is an exclusively human disease.

The only source of infection is a human

carrier or less often a patient.

Asymptomatic carriage in women makes

them a reservoir to spread infection among
their male contact.

Gonorrhoea is an venereal disease (STD).

PROPHYLAXIS:

Early detection of cases,

Tracing of contacts,

Health education,

General measures,

Vaccination has no role in prophylaxis.

NONGONOCOCCAL (NONSPECIFIC) URETHRITIS
Urethritis due to causative agents other than
gonococcus.
Etiology:
a) Bacteria- Chlamydia trachomatis
Mycoplasma urealyticum
Ureaplasma urealyticum
b) Parasites- Trichomonas vaginalis
c) Viruses- Herpes simplex
Cytomegalovirus
d) Fungi- Candida
NGU can be a part of Reiters syndrome- a clinical
condition characterized by urethritis, arthritis &
conjunctivitis.
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