GONOCOCCAL

infections

Dr.T.V.Rao MD
Albert Ludwig Sigesmund
Neisser
 Albert Ludwig
Sigesmund Neisser
was a German
physician who
specialized in
dermatology and
venereal diseases.
He discovered
gonococcus (1879),
the small bacterium
that causes
gonorrhea.
 Gonorrhea
 The name Gonorrhea
is derived from Greek
words- Gonos
( seed ) rhoia ( flow )
 Describes a condition
in which semen
flowed from the male
organ without
erection,
Gonorrhea – Venereal Disease
 Gonorrhea is a
classcial venereal
disease, being spread
almost exclusively by
sexaul contact having
a short incubation
period and being
relatively easy to
diagnose and treat.
Sexual promiscuity spreads
Gonorrhea
 Sexual promiscuity
spreads the
Gonorrhea among
the contacts being
named after Roman
goddess of love
Venus
 Neisseria gonorrhea
 Neisseria gonorrhea
are gram negative
oval cocci with
opposing surfaces
slightly concave (
Bean shaped )
Neisseria gonorrhea
 Neisseria species are
Gram-negative cocci, 0.6
to 1.0 µm in diameter.
The organisms are
usually seen in pairs with
the adjacent sides
flattened. Pili, hairlike
filamentous appendages
extend several
micrometers from the cell
surface. The outer
membrane is composed
of proteins,
phospholipids, and
Lipopolysaccharides
(LPS)
 N.gonnorhea infects mucous
membrane
 Gram-negative
intracellular diplococci of
the species Neisseria
gonorrhoea, the cause
of gonorrhoea; a
nonmotile aerobic micro
organism of the species
N.
gonorrhoea. It is a
parasite of the mucous
membrane.
Typing methods in Gonococci
 N gonorrhoea strains have
been typed on the basis of
their growth requirements
(autotyping) or by antigenic
differences in the porin
protein (serotyping). More
recently, restriction
fragment length
polymorphisms in genes
encoding ribosomal RNA
and the separation of large
DNA fragments by pulsed-
field gel electrophoresis
have been used to type
isolates.
 Pathogenesis
 N.gonnorhea is Human pathogen.
 Chimpanges can be infected artificially
 Women may remain Aymptomatic
 Gonorrhea infection is generally limited to
superficial mucosal surfaces lined by
colomonar epithelium.
 The Organs and Tissues
involved
 Cervix
 Urethra
 Rectum
 Pharynx
 Conjunctiva
 Vaginal epithelium – covered with squamous
epithelium not infected
 However prepubertal vaginal epithelium is
infected in young girls present with
vulvovaginitis
Manifestations in Gonococcus
Infections
 Pathogenesis ( contd )
 Gonorrhea is Venereal disease
 The disease is acquired by sexaul contact.
 In general incubation is 2 -8 days
 In men the disease starts as purulent discharge
containing gonococci in large numbers.
 The disease spreads to prostate, seminal
vesicle, and epididymis
 In men chronic urethritis may lead to stricture
formation
 Clinical Presentation in Males
 Majority of males
present with acute
urethritis with
purulent discharge
 5% of patients carry
bacteria without
distress
 Rectal and
Pharyngeal infections
are less often
symptomatic
Clinical Presentation in Females
 Endocervix infection
is the most common
presentation in
women
 Present with vaginal
discharge and
Dysuria
 Infection and abscess
of Bartholin and
Skene’s glands
 Other Manifestations
 Rectal infection
(Proctitis) with
N.gonnorhea occurs
one third of women
with cervical infection.
 Rarely symptomatic.
 Acute salphingits
 Pelvic inflammatory
disease
 Sterility
Other Manifestations
 Peritonitis can spread
 Fitz Hugh Curtis
Syndrome.
 Disseminated
gonococcus infection
 Painful Joints may lead to
Arthritis
 Fever, Few septic lesions
on the extremities
 Meingitis and
Endocarditis
Gonorrhea can manifest as Oral
Infection
 Changing sexual
practices and
oral sex
predisposes the
sex partners with
involvement of
oropharengeal
regions
Gonococcal Opthalmia
 Babies born to infected
women suffer, can lead to
a serious condition of
Opthalmina neonatroum
 Manifest with sever
purulent discharge with
periorbital oedema within
a few days of birth
 Topical application of 1%
silver nitrate has
drastically reduced the
incidence.
 In present contest Topical
erythromycin is used.
 Gonococcal infection in
Prepubertal Girls
 Vulvovaginitis in
prepubertal girls
occur in conditions of
poor hygiene or by
sexual abuse
 All cases to be
investigated with
care and caution.
Disseminated Infections
 Seen more commonly
in women who may
present with painful
joints, fever, and few
septic lesions or the
extremities
 Rarely disseminated
infections may
present as
endocarditis or
meningitis.
 Laboratory Diagnosis
 Specimens are
collected with care
and caution.
 Specimens are
collected from sites
with scanty
commensals eg
Endocervix
 Transportation of Specimens
 It Is preferred in culture,
specimens should be
inoculated in prewarmed
plates,immeditely on
collection
 If not possible specimen
should be collected on
charcoal impregnated
swabs and sent to
laboratory in Stuart’s
transport medium.
Gram Staining
 Gram’s method of
staining is sensitive in
95% of infections.
 The demonostration of
intracellular Gram
negative diplococci in
stained smears provides
a presumptive evidence
of gonorrhea in men.
 Specimens are inoculated
onto culture plates freshly
prepared.
 Delay in inoculation of
specimens on culture
media reduces the rate of
isolation.
 Culturing Gonococci
 Gonococci are aerobic
and may grow aerobically
 It is essential to provide 5
– 10% CO2
 They grow well on
Chocolate agar and
Mueller – Hinton agar
 The colonies are small,
convex, translucent,
and slightly
umbonate.with finely
granular surface and
lobate margins.
Selective Culture Medium
 The selective medium
is Thayer – Martin
medium containing
Vancomycin,
colistin, and
Nystatin, effectively
inhibits most
contaminants
including non
pathogenic Neisseria
 Problems in Culturing
Gonococci
 Culturing is possible
in specialized
diagnostic
laboratories only.
 The combination of
Oxidase positive
colonies and Gram
negative diplococci
provides a
presumptive
diagnosis.
 Fluorescent Methods
 Florescent
methods will help
in prompt
detection in
infected patients
 Various
discharges can
be examined.
 Other Methods in Diagnosis
 Co agglutination methods
 Biochemical tests to differentiate from
other commensals resembling Neisseria
spp
 Newer Methods in Diagnosis

 DNA probes can be

used for confirmation,
and also used for the
detection of
Gonococci in urethral
and cervical
specimens.
 PCR methods are
available in
specialized
laboratories
Treatment
 Pencillin
was a popularly used
antibiotic
However resistance has
reduced it utility
For a long time the drug
resitance has overcome
with increased dosage
Complete resistance to
pencillin has made the
drug obsolete in several
parts of the world.
Genes Code resistance
 The pencillin resistant
strains possess the
gene coding for TEM-
type ß-lactamase
commonly found
Escherichia coli
 Other Drugs in current use
 Ceftriaxone
 Cefixime
 Flouroquinolones
 Ciprofloxin
 Tetracycline
 Co-Amoxiclav
 Spectinomycin
In Disseminated Gonococcal disease and any
complicated infection treatment for 7-10 days
is necessary
 Controlling Gonorrhea
 The key control measures in gonorrhea
are
1 Rapid diagnosis
2 Use of effective antibiotics
3 Tracing, examination and treatment of
contacts.
4 Inappropriate self medication has
contributed to widespread
antimicrobial resistance.
Created for Medical and
Paramedical students in
Developing world
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com