Neisseria gonorrhoeae

Question 1

what is the biology of Neisseria gonorrhoeae?

Answer 1

Gram negative diplococcus (kidney-shaped cocci) *

Oxidase +

catalase + *

Breaks down only Glucose (Gonococcus) *

Question 2

where do we find a reservoir of N. gonorrhoeae in the body?

Answer 2

Human genital tract (asymptomatic infected individuals)*

Question 3

how does it spread?

Answer 3

Sexual contact

Neonates – during birth

Question 4

what disease does neisseria gonorrhoeae cause?

Answer 4

• Causes Gonorrhoea – a sexually transmitted disease (STD)
• Rectal infections *
• Pharyngitis *
• Ophthalmia neonatorum *(neonatal conjunctivitis)
• Disseminated infection
• Septic arthritis *

Question 5

what are Gonococcus’s Virulence factors *?

Answer 5

Pili

Outer membrane proteins

IgA protease

Lipooligosaccharide (LOS) *

Antigenic and Phase variation *

Question 6

what will the pili help do?

Answer 6

adherence and colonization *

Question 7

besides the pili, what other virulence factor is important for colonization?

Answer 7

IgA protease

Question 8

what is Antigenic and Phase variation *?

Answer 8

• antigenic variation = the ability to express numerous different pili
• The aminoacid sequences of the pili vary, therefore the pili are antigenically distinct
• During an infection Gonococcus can evade detection by the hosts’ immune system by changing the pili it expresses
• phase variation = turning on or off the production of pili

Question 9

Antigenic variation occurs with what virulence factors?

Answer 9

Pili

Outer membrane proteins

LOS (Lipooligosaccharide)

Question 10

Antigenic variation accounts for what?

Answer 10

chronicity of infections *

lack of protection against subsequent gonococcal infections

Question 11

what is gonorrhea?

Answer 11

• mucous membrane infection
• the site of infection is dependent on type of sexual contact & sexual practices

Question 12

who transmits the disease?

Answer 12

Both asymptomatic and symptomatic persons

Question 13

what will untreated and repeated infections cause?

Answer 13

• cause scarring
• May lead to infertility in both sexes
• may predispose women to ectopic pregnancy

Question 14

what Genito-urinary tract infection will be caused in men?

Answer 14

Urethritis in men

Epididymitis

Prostatitis

Question 15

what is urethritis?

Answer 15

• yellow purulent exudate (gram stain shows numerous PMNs +GN diplococci)
• Frequent, painful urination

Question 16

Gonococcus will lead to what Genito-urinary tract inf. in women?

Answer 16

Endocervicitis (Urethritis in females)

Question 17

what is Endocervicitis?

Answer 17

Purulent discharge (examine cervix)

Frequent, painful urination, lower abdominal pain

Approx. 50% cases go undetected

Question 18

what complicatins can happen with endocervicitis?

Answer 18

Complications include salpinigitis, Pelvic inflammatory disease (PID) and sterility

Question 19

rectal infections iw th neisseria gonorrhoea occur more frequently in whom?

Answer 19

in homosexual men

Question 20

Pharyngitis due to neisseria gonorrhea occurs due to what? what is seen?

Answer 20

Due to oral-genital contact

Purulent exudate is seen

Question 21

neisseria gonorrhea pharingitis will resemble what?

Answer 21

Resembles “Strep” throat

Question 22

what is Ophthalmia neonatorum?

what is another name for this?

what happens if not treated early?

Answer 22

• Redness, swelling of eye, purulent discharge, contracted by newborns during delivery
• Neonatal conjunctivitis
• Rapidly leads to blindness if not immediately treated

Question 23

treatment for Ophthalmia neonatorum?

Answer 23

1% silver nitrate, 1% tetracycline, or 0.5% erythromycin

Question 24

what are the most common STDs that cause septic neonatal conjunctivitis*?

Answer 24

Chlamydia and N.gonorrhea

Question 25

what is Gonococcemia?

Answer 25

Disseminated infection - untreated infection which has invaded bloodstream that will Also produces necrotic skin lesions on a erythematous base

Question 26

Gonococcemia Most commonly results in what?

Answer 26

septic arthritis \*

Question 27

what is Septic Arthritis?

Answer 27

Arthritis is inflammation of the joint

Question 28

what is the most common cause of septic arthritis in the sexually active age group?

Answer 28

Gonococcus

Question 29

what is the most common cause of septic arthritis in children and adults over 50yrs?

Answer 29

Staph. aureus

Question 30

how is Gonococcus diagnosed?

Answer 30

Gram stain: (only in male patients \*) - In males: urethral discharge Culture: Thayer Martin media (chocolate agar with antibiotics to supress other bacteria – normal flora) \* Provide 5-10% CO2 \*

Question 31

Patients with gonorrhea should be tested for what else?

Answer 31

Chlamydia trachomatis infection also (concurrent infection) \*

Question 32

what is the Gonococcus – Treatment\* \* for resistnat to penicillin N.gonorrhea? what is its mechanism of resistance? how do you treat Due to the many cases of co-existing infection with C. trachomatis ?

Answer 32

- Third generation cephalosporins - Ceftriaxone \* - Changes in penicillin-binding proteins - Doxycycline is added to treatment regime \*