Gonococcal
Gonococcal
Gonococcal
infections
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.
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
microorganism of the
species
N. gonorrhoea.
• It is a parasite of the
mucous membrane.
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
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
Selective Culture Medium
• The selective medium is
Thayer – Martin
medium containing
Vancomycin, colistin,
and Nystatin, effectively
inhibits most
contaminants including
non pathogenic
Neisseria
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