Neisseria Gonorrhoea, Urethral / Cervical smear For Gonorrhoea

Sample

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

Procedure to get the sample

1. Urethral smears are a preferred site for men.
   1. Ask the patient to squeeze the penis and rub it on the slide to get a good smear.

2. Delay is needed for obtaining specimens until 2 hrs after the patient has last voided.
3. 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.
4. The endocervical specimen is the preferred site in females.
   1. 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.
5. Cytobrush is not recommended as it may cause trauma and bleeding that can render the specimen unsatisfactory.

Pathophysiology

1. Microbiology:
   1. This is an obligatory parasite of the human urogenital system.
   2. The incubation period is 2 to 8 days.
      1. These are gram-negative diplococci.
      2. These are oval cocci measuring 0.6 to 1.0 µm.

         

         Gonorrhoea Intracellular Organism

Culture:

1. 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 the addition of antibiotics which 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 the glucose and no other sugars.
   8. These bacteria survive in the pus but can’t outside the body and dies soon.
2. Gonorrhea is a sexually transmitted disease (STD).
   1. In the USA there is an estimate of 820,000 new patients with gonorrhea occurs 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. These bacteria have fast growth in these mucous membranes.
   4. N. gonorrhea can also infect the mucous membranes of the mouth, throat, eyes, and anus.

Mode of spread

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 to get this infection.
   5. The patient may develop anal pain and discharge.
3. Most common in the age group of 15 to 29 years.

Signs and Symptoms

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

Complications of Gonorrhoea

1. Untreated gonorrhea can cause serious and permanent health problems in both women and men.
2. In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID).
   1. PID can lead to internal abscesses and chronic pelvic pain.
   2. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.
3. In men, gonorrhea may be complicated by epididymitis.
4. In rare cases, this may lead to infertility.
5. Untreated, gonorrhea can also spread to the blood and cause:
   1. Disseminated gonococcal infection (DGI).
   2. DGI is usually characterized by :
      1. Arthritis, tenosynovitis, and/or dermatitis.
      2. This condition can be life-threatening.
6. A pregnant woman with gonorrhea can give the infection to her baby while passing through the birth canal during delivery.
   1. The baby may develop :
      1. Blindness.
      2. Joint infection.
      3. Or a life-threatening blood infection in the baby.

Diagnosis

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

Result

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

Prevention

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 then antibiotics within 24 hours of exposure are effective.

Treatment

1. This is a treatable disease.
2. These are sensitive to penicillin, tetracycline, macrolides, ciprofloxacin, and cefuroxime.
3.  Most people (CDC) recommends 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.

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