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    Neisseria Gonorrhoea

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    prabad dunusinghe
    1. A 20-year-old man presented with urethral discharge and dysuria for two days after unprotected sex with a commercial sex worker. Examination of a smear found Gram-negative diplococci inside polymorphs. Culture on Thayer-Martin medium was positive, leading to a diagnosis of gonorrhea. 2. Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea. It is Gram-negative diplococci that predominantly infects non-cornified epithelium. Diagnosis involves microscopy, culture, and molecular methods. Treatment originally involved penicillin but resistance has reduced its effectiveness.

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    Neisseria Gonorrhoea

    Uploaded by

    prabad dunusinghe
    29 views33 pages
    1. A 20-year-old man presented with urethral discharge and dysuria for two days after unprotected sex with a commercial sex worker. Examination of a smear found Gram-negative diplococci inside polymorphs. Culture on Thayer-Martin medium was positive, leading to a diagnosis of gonorrhea. 2. Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea. It is Gram-negative diplococci that predominantly infects non-cornified epithelium. Diagnosis involves microscopy, culture, and molecular methods. Treatment originally involved penicillin but resistance has reduced its effectiveness.

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    1. A 20-year-old man presented with urethral discharge and dysuria for two days after unprotected sex with a commercial sex worker. Examination of a smear found Gram-negative diplococci inside polymorphs. Culture on Thayer-Martin medium was positive, leading to a diagnosis of gonorrhea. 2. Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea. It is Gram-negative diplococci that predominantly infects non-cornified epithelium. Diagnosis involves microscopy, culture, and molecular methods. Treatment originally involved penicillin but resistance has reduced its effectiveness.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    29 views33 pages

    Neisseria Gonorrhoea

    Uploaded by

    prabad dunusinghe
    1. A 20-year-old man presented with urethral discharge and dysuria for two days after unprotected sex with a commercial sex worker. Examination of a smear found Gram-negative diplococci inside polymorphs. Culture on Thayer-Martin medium was positive, leading to a diagnosis of gonorrhea. 2. Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea. It is Gram-negative diplococci that predominantly infects non-cornified epithelium. Diagnosis involves microscopy, culture, and molecular methods. Treatment originally involved penicillin but resistance has reduced its effectiveness.

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    of 33

     A Lecture By – Dr. D. W.

    DESHKAR
     ASSISTANT PROFESSOR DEPT.OF MICROBIOLOGY
     D.Y.PATIL MEDICAL COLLEGE,KOLHAPUR
     A 20 year old man presented with urethral discharge &
    2
    dysuria for previous two days. H/O unprotected sex
    with a commercial sex worker a week back.

     On examination of a smear of pus – Gram negative


    diplococci were seen inside polymorphs.

     Culture on Thayer – Martin medium - Positive

     Diagnosis – Gonorrhoea
     N.gonorrhoeae causes the
    3 venereal disease
    gonorrhoea.

     Gonococcus was first


    described in gonorrheal pus
    by Neisser in 1879.

     Bumm in 1885 cultured the


    coccus & proved its
    pathogenicity by inoculating
    human volunteers.
    The name Gonorrhea is derived from
    4 Greek words- Gonos ( seed ) rhoia ( flow ).

    Describes a condition in which semen


    flowed from the male organ without
    erection,
     Gram – ve diplococcus.

     With adjacent sides


    concave (kidney shaped)

     Predominantly in the
    polymorphs ( Intracellular)

     Some cells may contain as


    many as 100 cocci.
     Gonococci possess pilli on
    their surface.
     Pilli facilitate adhesion of the
    cocci to mucosal surface &
    promote virulence by
    inhibiting phagocytosis.
     Gonococci infect non –
    cornified epithelium.
     They agglutinate human
    RBCs. Haemagglutination not
    inhibited by mannose.
     Gonococci are non motile. More difficult to grow.
     Are aerobic. But may grow anaerobically also.
     Growth occurring best at pH 7.2 – 7.6 Optimum
    0
    temperature for growth – 35 – 36 C.
     Essential to provide 5 – 10 % CO2.
     Grow well on CHOCOLATE AGAR & MUELLUR – HINTON
    AGAR.
     Selective medium – THAYER – MARTIN medium
    (contains Vancomycin + Colistin + Nystatin which
    inhibit most of the contaminants).
     Are oxidase positive .
     Are Catalase positive

     Rapid Carbohydrate Utilization


    test:

    Glucose Maltose
    N.gonorrhoeae + -
    (Acid)
    1. CAPSULE 2. PILLI
     It is polyphosphate and not  Are hair like structures extending
    polysaccharide. from the surface
     Most evident on freshly isolated  Piliated organisms produce altered
    gonococci. appearance of colonies on culture.
     Is loosely associated with cell  Pilli enhance attachment of organism
    surface. to host cells & prevent phagocytosis.
     It inhibits phagocytosis.  Act as virulence factor .
     Are made up of pillin proteins.
     Pillin proteins are antigenically
    different in almost all strains.
     A single strain can produce several
    antigenically distinct pilli.
    3.LIPOOLIGOSACCHARIDE
    4.OTHER PROTEINS
    (LOS)
     There is absence of long O –  IgA1 protease is produced by
    antigenic side chains in the gonococci. It splits and
    chemical structure of inactivates IgA which plays a
    Lipooligosaccharide (LOS) major role in mucosal defense.
    which differentiates it from
    lipopolysaccharide of Gram – ve
    bacilli.  Two other proteins H8 and Iron
    binding protein are also
    produced but their role in
     Toxicity in gonococci is due to pathogenicity is unknown.
    LOS.
     5. Proteins – The outer membrane antigens ( proteins ) are the
    porins.
    i. Protein I (por) – Forms pore on surface. Each strain expresses
    one type of protein I. It helps in serotyping of gonococci. Two
    variants of protein I – IA & IB. Any one strain carries either IA or IB
    but not both. 24 serovers of type IA & 32 serovers of type IB.
    ii. Protein II (opa) – One part of protein II is in outer membrane & the
    rest is exposed on the surface of bacteria. It takes part in adhesion
    of bacterium and its attachment to host cell. Type II protein is
    present in those strains which form opaque colonies, so it is also
    c/a opacity associated protein.
    iii. Protein III – is associated with protein I in the formation of pores
    on the cell surface & hence plays a role in the exchange of
    molecules across the outer membrane.
    RESISTANCE PLASMID

     Is very delicate organism  Gonococci contains several


     Readily killed by drying, heat & cryptic plasmids.
    antiseptics.
     Is a strict parasite & dies in
    1 – 2 hrs in exudate outside  Two other transmissible
    the body. plasmids contain genes that
     In culture, the coccus dies in code for beta lactamase which
    3 – 4 days but survives in slant
    culture at 350C if kept under causes resistance to penicillin.
    sterile paraffin oil.
     Cultures – preserved for years
    if frozen quickly & stored at – -
    - 70 0C.
    N.gonorrhoeae is Human pathogen.

    Chimpanzees can be infected artificially

    Women may remain Asymptomatic

    Gonorrhea infection is generally limited to


    superficial mucosal surfaces lined by
    columnar epithelium.
    THE ORGANS & 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
     Gonorrhea is a Venereal disease.
     The disease is acquired by sexual contact.
     In general incubation period 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.
     The infection may spread to the periurethral tissues,
    forming abscesses & multiple discharging sinuses --------
    ----- “ Watercan perineum”.
    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

     Peritonitis can spread.


     Fitz Hugh Curtis Syndrome ---
    Perihepatic inflammation.
     Disseminated gonococcus
    infection
     Painful Joints may lead to
    Arthritis
     Fever, Few septic lesions on
    the extremities
     Meningitis and Endocarditis
    – GONORRHOEA CAN
    MANIFEST AS ORAL
    INFECTION -

     Changing sexual practices


    and oral sex predisposes the
    sex partners with involvement
    of oropharengeal regions
    – DISSEMINATED INFECTION -

     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
    1. SPECIMENS -
    • Discharge or urethral swab,
    Endocervical swab –
    - The meatus is cleaned with a gauze
    soaked in saline & a sample of the
    discharge collected with a platinum
    loop for culture, or directly on the slide
    for smears.
    - Cervical swabs are collected carefully,
    using speculum.
    - In chronic cases morning drop of
    secretion is examined.
    - Centrifuged deposits of urine also
    demonstrate gonococci.
    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.
    - MICROSCOPY – GRAM STAINING
    • Gram’s method of staining is sensitive
    in 95% of infections.
    • The demonstration of intracellular
    Gram negative diplococci in stained
    smears provides a presumptive
    evidence of gonorrhea in men.
    • Diagnosis of gonorrhoea by smear
    exam. is unreliable in females.
    • Specimens are inoculated onto culture
    plates freshly prepared.
    • Delay in inoculation of specimens on
    culture media reduces the rate of
    isolation.
    - CULTURE -

    • 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
    - SEROLOGY -
    • Complement fixation test
    • Precipitation Reaction
    • Passive agglutination Using whole cell lysate, pilus protein
    • Immunofluorescence & lipopolysaccharide Ags.
    • Radioimmunoassay
    • Coagglutination

    - Biochemical Tests –
    • Catalase Test - +ve, Oxidase Test - +ve
    • Ferments glucose with acid production. Maltose not fermented.
    - MOLECULAR METHODS -

    • 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
    - PENICILLIN -

     Was a popularly used antibiotic.

     However resistance has reduced


    its utility.

     For a long time the drug


    resistance has overcome with
    increased dosage.

     Complete resistance to penicillin


    has made the drug obsolete in
    several parts of the world.
    - PENICILLIN - GENES CODE
    RESISTANCE

     The penicillin resistant strains


    possess the gene coding for TEM-
    type ß-lactamase commonly found
    in Escherichia coli.
    - OTHER DRUGS USED -

     Ceftriaxone
     Cefixime
     Flouroquinolones
     Ciprofloxin
     Tetracycline
     Co-Amoxi - clav
     Spectinomycin

    In Disseminated Gonococcal disease and any complicated infection


    treatment for 7-10 days is necessary
     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.
    33

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