(I) Gram Negative Cocci - (1) * Neisseria gonorrhoeae Flashcards
Which Neisseria species is facultative intracellular?
N. gonorrheae
(In PMNs)
Which Neisseria species is encapsulated?
N. meningitidis
Name 4 possible sequelae of untreated gonorrhea
In women,
(1) Pelvic inflammatory disease
(2) ⇒ Fitz-Hugh-Curtis syndrome
(3) Transmission to newborn
In men and women,
(4) Asymmetric arthritis
Describe the discharge of gonorrhea
“White purulent discharge”
(∝ Hot wax. Thicker and more purulent than with chlamydia)
What buzzword is associated with Fitz-Hugh-Curtis syndrome?
“Violin string” adhesions
(Form to liver capsule)
What joint is most commonly affected by gonococcal septic arthritis?
Knee
How can you differentiate neonatal conjunctivitis due to gonorrhea from chlamydia?
(1) Gonorrhea: Early onset
(2) Chlamydia: Later onset
(Shielding eyes so baby can’t see event that just occured = Early onset)
Treatment: N. gonorrheae
Ceftriaxone + Azithromycin/Doxycycline
Diagnosis for N. gonorrhoeae in
Gram Stain:
- Male :[…]
- Female: […]
Tests:
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Diagnosis for N. gonorrhoeae in
Gram Stain:
- Male :Gram stain for urethral discharge/joint fluid samples (clean sites), usually diagnostic
- Female: Gram stain NOT done for endocervical samples (too many other organisms)
Tests:
- Nucleic Acid Test from urine samples (easiest to collect). **Otherwise, urethral swap from male, endocervical or LVS from female. Throat and rectal swaps** also ok
- Culture is done in CO2 enriched atmosphere, gonococcus very delicate so have to be transported in charcoal medium + chocolate agar
N. gonorrhoeae virulence factors?
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N. gonorrhoeae virulence factors?
- LOS (elicits SIRS)
- Fimbriae (antigenic variation)
- IgA protease
- Other outer membrane proteins (antigenic variation)
The consequence of antigenic variation is that prior infection by gonococcus does NOT result in protective immunity being developed, hence pt is open to recurrent infections.
LOS is present in both gonococcus and meningococcus
Transmission of Neisseria Gonorrhoeae:
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Transmission of Neisseria Gonorrhoeae:
Sexually-transmitted disease
2nd most common STD. First is Chlamydia.
Treatment of Neisseria Gonorrhea
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Treatment of Neisseria Gonorrhea
- Ceftriaxone (empiric choice, as most strains are resistant to penicillin and ciprofloxacin)
AND
- Azithromycin (due to increasing ceftriaxone resistance, and to tackle chlamydia if present)
**Chlamydia & gonococcus are best friends. Always assume co-infection. **
Btw Chlamydia is beta lactam resistant.
Prophylatic antibiotic eyedrop for neonates
What is the clinical presentation of N. gonorrhoeae infection in (vvvvvvv IMPT!!!)
Males:
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Females:
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Both:
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Neonates:
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What is the clinical presentation of N. gonorrhoeae infection in (vvvvvvv IMPT!!!)
Males:
- acute urethritis (discharge, dysuria, epididymitis,urethral stricture without repeated infection)
Females:
often asymptomatic. But can have
- Endocervical infection (may develop vaginal discharge, dysuria, intermenstrual bleeding)
- Pelvic Inflammatory Disease, PID (acute salpingitis + oophoritis + endometritis) (Seen in Chlamydia trachomatis infection as well)
- Fitz-Hugh-Curtis (FHC) syndrome
- vulvovaginitis (pre-pubertal girls or post-monopausal women)
Both:
- Disseminated Gonococcal Infection (DGI) (fever, polyarthritis, small pastular skin lesions)
- Throat infection (often asymptomatic)
- Proctitis (rectal infection) (receptive anal sex)
- Cojunctivitis
- Gonococcal arthritis (often asymmetrical, at knee)
Neonates:
- Ophthalmia Neonatorum (gonococcal conjunctivitis in neonate transmitted from infected mother)
**Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions.
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