Neisseria Gonorrhoea

What sample is needed for the diagnosis of Neisseria Gonorrhoea?

1. The sample for the diagnosis of Gonorrhea is taken from:
   1. The urethra in the male.
   2. The endocervical area in the female.
   3. Oropharynx.
   4. Rectal swab.

How do I get the sample for Neisseria Gonorrhoea?

Urethral smears:

1. It is a preferred site for men.
2. Ask the patient to squeeze the penis and rub it on the slide to get a good smear.

3. Delay is needed for obtaining specimens until 2 hrs after the patient has last voided.
4. Obtain specimens on the slide for gram stain. (can take gonorrhea culture). Ask the Patient to squeeze the penis to get secretions. OR.
   1. Gently insert the urogenital swab into the urethra.
      1. Rotate the swab in one direction for at least one revolution for a minimum of 10 seconds.
      2. Withdraw the swab and smear it on the slide.

The endocervical specimen:

1. The endocervical specimen is the preferred site in females.
2. Specimen collection should be done with a sterile swab or culturette.
   1. Rotate the swab against the wall of the endocervical canal several times for 20 – 30 seconds and withdraw without touching the vaginal surface.
   2. Inoculate for culture.
3. Cytobrush is not recommended as it may cause trauma and bleeding that can render the specimen unsatisfactory.

What is the Microbiology of Neisseria Gonorrhoea?

1. Neisseria gonorrhea, also called gonococcus.
2. It causes the second most common sexually transmitted disease.
3. This is an obligatory parasite of the human urogenital system.
4. The incubation period is 2 to 8 days.
5. These are gram-negative diplococci.
6. These are oval cocci measuring 0.6 to 1.0 µm.

What are the culture characteristics of Neisseria Gonorrhoea?

1. These occur in pairs with flattened adjacent sides or concave, bean-shaped.
2. Culture media is an enriched medium like chocolate agar in the presence of CO² (5% to 10%).
3. The best temperature for growth is 35 to 37 °C.
4. Selective media can also be used by adding antibiotics that inhibit the growth of other bacteria but not the Neisseria, e.g., Thayer-Martin medium, which contains vancomycin, colistin, trimethoprim, and nystatin.
5. There are small grey glistening colonies after 24 hours of incubation.
6. These become larger, opaque, and somewhat irregular at 48 hours.
7. These bacteria produce acid from glucose and no other sugars.
8. These bacteria survive in the pus but can’t outside the body and die soon.

What are the virulence factors of gonorrhea?

1. Pili over the surface of the bacteria.  It will attach to the host cells and give rise to disease.
   1. It holds close to host cells and avoids phagocytosis by the macrophagic cells and poly (PMN).
2. Membrane proteins cause penetration into the host cells.
3. Opa protein is also another outer membrane protein. It causes adherence and penetration into the host cells.

Is Neisseria Gonorrhoea a sexually transmitted disease (STD)?

1. In the USA, there are an estimated 820,000 new patients with gonorrhea occur every year.
2. This is the second most common sexually transmitted disease. (CDC).
3. N. gonorrhea infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and the urethra in women and men.
4. These bacteria have fast growth in these mucous membranes.
5. N. gonorrhea can also infect the mouth, throat, eyes, and anus mucous membranes.

What is the Mode of the spread of Neisseria Gonorrhoea?

1. Gonorrhea bacteria can survive in the infected warm and moist areas like the urethra, cervix, and rectum.
2. The spread is by:
   1. Sex when done without any protection, oral or anal.
   2. People with multiple sexual partners.
   3. Using contaminated sex vibrators or devices.
   4. Some of the sex partners have more risk of getting this infection.
   5. The patient may develop anal pain and discharge.
3. Most common in the age group of 15 to 29 years.

What are the Signs and Symptoms of Neisseria Gonorrhoea?

In the female:

1. There are mild symptoms of vaginal infection.
   1. Symptoms appear after 2 to 5 days in males, while in females, these bacteria may be present for over 30 days.
   2. There are painful urination and blood in the urine.
   3. There is a yellow vaginal discharge.
   4. If females are not treated, then it may lead to pelvic inflammatory disease.
   5. There may be conjunctivitis.
   6. Infected ladies may feel pain and bleeding after the coitus.
   7. On examination, there may be a swollen vulva.

In the Males:

1. It may have painful and swollen testicles due to epididymitis.
2. There is a yellowish or greenish discharge from the penis.
3. There may be conjunctivitis.
4. There are swollen and painful tests.
5. The patient may develop anal pain and discharge.

What are the complications of Neisseria Gonorrhoea?

1. Untreated gonorrhea can cause serious and permanent health problems in both women and men.
2. There may be the possibility of septic arthritis.
3. There may be gonococcal bacteremia.

In women, complications are:

1. Gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID).
2. PID can lead to internal abscesses and chronic pelvic pain.
3. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.
4. Complications in females are:
   1. Urethritis.
   2. Cervicitis.
   3. Dyspareunia.
   4. Purulent vaginal discharge.
   5. Pelvic inflammatory disease (PID).
      1. Infertility.
      2. Ectopic pregnancy.
      3. Abscess.
      4. Peritonitis.
      5. Peri-hepatitis.
   6. Endometritis.
   7. Salpingitis.
   8. Oophoritis.

In men, complications are:

1. Gonorrhea may be complicated by epididymitis.
2. In rare cases, this may lead to infertility.
3. Complications in males are:
   1. Urethritis.
   2. Epididymitis.
   3. Prostatitis.
   4. Urethral stricture.
   5. Rectal gonococcal infection.
4. Untreated, gonorrhea can also spread to the blood and cause:
   1. Disseminated gonococcal infection (DGI).
   2. DGI is usually characterized by the following:
      1. Arthritis, tenosynovitis, and/or dermatitis.
      2. This condition can be life-threatening.

In pregnancy, complications are:

1. A woman with gonorrhea can give the infection to her baby while passing through the birth canal during delivery.
2. The baby may develop:
   1. Blindness.
   2. Joint infection.
   3. Or a life-threatening blood infection in the baby.

Complications of Pelvic inflammatory disease (PID):

1. Infertility. The risk of infertility increases with each attack of gonorrhea.
2. Ectopic pregnancy. It increases due to previous inflammation of the fallopian tubes.
3. Abscess formation in fallopian tubes, ovaries, and peritoneum.
4. Peritonitis, where bacteria spread from the ovaries and fallopian tubes.
5. Peri-hepatitis may be seen in gonorrhea infection.

Complications in infants:

• Gonococcal infection can spread from the mother to the newborn and gives rise to ophthalmia neonatorum.

How will you diagnose Neisseria Gonorrhoea?

1. A swab or urethral smear is quick and accurate if the sample is adequate.
2. Culture the material obtained by swab or brush from the endocervical area in females and urethral swabs in males.
3. CDC recommends that NAAT (nucleic acid amplification test) is a rapid test.
   1. For NAAT, the specimen can be taken from endocervical, vaginal, and urethral swabs.
   2. Also, NAAT can use urine from both men and women.

What will be the result of Gram stain for Neisseria Gonorrhoea?

1. Stain the smears with gram stain.
2. There are intracytoplasmic gram-negative cocci.
3. These are seen as diplococci.

Intracellular organisms

How will you Prevent Neisseria Gonorrhoea?

1. This needs the education of young couples.
2. Mechanical means like condoms can be used.
3. Chemical prophylaxis is also effective.
4. If there is exposure to gonorrhea patients, antibiotics within 24 hours are effective.

How will you treat Neisseria Gonorrhoea?

1. This is a treatable disease.
2. These are sensitive to penicillin, tetracycline, macrolides, ciprofloxacin, and cefuroxime.
3.  Most people (CDC) recommend dual antibiotic therapy.
   1. A single dose of Ceftriaxone 250 mg I/M.
   2. Azithromycin 1 gram oral dose.
4. There are reports of resistant N. gonorrhea.

Questions and answers: