Gonorrhea, Diagnosis of Neisseria Gonorrhoeae
- The best sample for men is the urethral discharge smear.
- Females can make a smear from the vagina.
- In female cervical smear can also be taken.
- Anal canal smear can be taken.
- Neisseria gonorrhoeae causes contagious disease and usually sexually transmitted.
- Mother can transmit the disease to the newborn.
- N.Gonorrhoeae can infect any epithelium lined by columnar cells with cilia-like:
- But cannot vagina which is the squamous epithelium.
- There are two pathogenic Neisseria:
- N. Gonorrhoeae (Gonococcus).
- N. Meningitides (Meningococcus).
- These are an obligate parasite of the human urogenital area.
- These are characteristically seen in pairs with adjacent side concave.
- In the purulent material, these are seen intracellularly and as well outside the cells.
- The incubation period is 2 to 10 days.
- These bacteria grow in enriched media (Chocolate agar).
- Incubation is done in a moist atmosphere containing 5 to 10% CO2.
- The optimal temperature is 35 to 37 C.
- These media may contain antibiotics (Lincomycin) to inhibit the growth of other bacteria.
- There are small gray glistening colonies after 24 hours of the incubation and may become larger after 48 hours.
- The identification test is carbohydrate utilization where it will produce acid only from the glucose.
- N.Gonorrhoeae is gram-negative bacteria which can grow in the body like urethra, cervix, uterus, fallopian tubes in female and urethra in the male.
- It grows in the warm, moist area of the female reproductive system.
- It can also grow in the mouth, throat, and anus.
Signs and symptoms :
- This is more symptomatic in men than in women.
- In the male:
- There is urethral purulent discharge.
- There is dysuria.
- There may be proctitis and tenesmus.
- There is pelvic pain.
- In the female:
- Females are usually asymptomatic.
- There is mucopurulent cervicitis.
- There is vaginal discharge.
- There may be dysuria.
- There may be proctitis.
- Transmission from male to female is very efficient than female to male.
- While pharyngeal infections are asymptomatic.
- Ascending pelvic infection occurs in 10 to 20% of the cases and it leads to infertility and ectopic pregnancy.
- This may involve the rectum and oropharynx.
Gonorrhea disease In female:
- Vaginal discharge.
- Swollen lymph nodes.
- Bleeding after intercourse.
Gonorrhea disease in male:
- Urethritis (burning micturition).
- Swollen, painful testes.
- Enlarged lymph nodes in the throat.
Complications of Gonorrhea:
- In females ascending pelvic infection.
- There is salpingitis which leads to infertility.
- There may be gonococcal vulvovaginitis.
- There may be bartholinitis.
- In male:
- There may be cystitis.
- There may be prostatitis.
- There may be a urethral stricture.
- In the untreated mother, newborn babies can have Ophthalmia neonatorum (gonococcal conjunctivitis).
- There may be septicemia, arthritis, and meningitis due to spread through blood.
- In males in the case of urethritis, there is urethral discharge. Make the smear from the urethral discharge.
- Now stain with gram stain which will show gram-negative diplococci and these are intracellular.
- The urethral smear is diagnostic and very specific.
- In the male ask the patient to squeeze the penis to get a good amount of material.
- The patient can apply directly the material on the slide.
- Females can make a cervical smear and do the culture.
- Swab smears are taken from:
- Endocervical canal.
- Anal canal.
- When there is no discharge then insert the swab into the urethra up to 2 cms and gently rotate.
- Can take endocervical specimen under direct vision using a speculum.
- Other sites for the swab are pharynx, anorectal area, blood, CSF, and synovial fluid.
- Ultimately can confirm the diagnosis by culture and these bacteria need nutrient-rich selective agar media.
- Culture needs 48 hours to form colonies.
- It can take conjunctival swab in infants who have conjunctivitis.
- Blood and synovial fluid may be taken in case of arthritis.
- These bacteria are sensitive to penicillin, ampicillin, tetracycline, macrolides, cefuroxime, and ciprofloxacin.
- Give a single one oral dose of Amoxycillin or ampicillin.
- Give probenecid to delay the excretion of medicine.
- Or a single dose of Ceftriaxone 250 mg I/M.
- Or a single dose of Norfloxacin 800 mg.
- Ciprofloxacin is given when an infection is complicated with Chlamydia infection.
- Erythromycin is given to pregnant ladies and children.
- The extragenital infection needs treatment for 5 to 7 days.
- Penicillin-resistant gonorrhea is treated with cefuroxime, cefotaxime, erythromycin, ciprofloxacin, tetracycline, or aztreonam.