GONOCOCCAL

INFECTIONS
I. Background
GROUP 5 | GONOCCAL INFECTION

GONORRHEA
•Sexually transmitted infection (STI) of epithelium
•Commonly manifests as cervicitis, urethritis,
proctitis, and conjunctivitis

N. Gonorrhoeae
•Non-spore-forming, non
motile bacterium
•Gram-negative coccus
•Gonococci are adapted to growth on mucous membranes
and therefore cannot tolerate drying
 I. EPIDEMIOLOGY

• Gonorrhea remains a major public health problem worldwide, is asignificant cause of

morbidity in developing countries, andmayplay arole in enhancingtransmission of HIV.
•Gonorrhea predominantly affects young, nonwhite, unmarried, less educated members of
urban populations
• The numberof reported cases probably represents half of the true number of cases
• The incidence of gonorrhea is higher in developing countries than in industrialized nations
•Gonorrhea is transmitted from males to females more efficiently than in the
opposite direction
EPIDEMIOLOGY
 II. PATHOPHYSIOLOGY

N. Gonorrhoeae
• Generally limited to superficial mucosal surfaces lined bycolumnarepithelium
• It commonlyaffects the host’s the mucous membranes of reproductive tract
• It has virulence factors suchas pili that attack anddestroy host cells
• Contains antigenic proteins that varies with eachinfection
• Also produces toxins like IgA protease in order to attack reproductiveorgans
 II. PATHOPHYSIOLOGY
TRANSMISSION
SEXUAL Vertical
transmission
CONTACT
during
childbirth
Often In babies, gonorrhea
affects the cervix ,urethra, most commonly
rectum or throatT affects the eyes
III.WORKUPS
G r a m S t a i n i n g & Microscopic E x a m i n a t i o n

Gram's stain of urethral discharge

from a male patient withgonorrhea

Gram-negative intracellular monococci/diplococci (+) >30 Polymorphonuclear leukocytes or PMN (+)

Urethritis (men) - highly specific and sensitive Endocervix
Cervicitis (women) - only 50%sensitive
III.WORKUPS
C U LT U R E
MODIFIED T H AY E R - M A R T I N A G A R C H O C O L AT E A G A R

Typical colonies of N. gonorrhoeae Neisseria gonorrhoeae grows on

on MTM Chocolate Agar

Selective for Neisseriagonorrhoeae Cultivation of Neisseria gonorrhoeae

Samples are collected with Dacron or rayon swabs
Process samples immediately
Gonococci do not tolerate drying
III.WORKUPS
B L O O D C U LT U R E
For suspected cases of DGI
Synovial fluid should beinoculated
into blood culture broth mediumand
plated onto chocolate agar

NUCLEIC ACID PROBE TEST

Substitute for culture for direct detection
of N. gonorrhoeae in urogenitalspecimens
Use non-isotopic chemiluminescent DNA
probe
III.WORKUPS
N U C L E I C A C I D A M P L I F I C AT I O N
T E S T S ( N A ATs )
Include Roche Cobas Amplicor, Gen-Probe Aptima Combo2,
BD ProbeTec ET
Semiautomated or fully automated platforms
Most common
More sensitive than culture for identification of eitherN.
gonorrhoeae or C.trachomatis
Wide variety of specimen types may be sampled
Used when examination and mucosal swab are difficult
IV. C L I N I C A L
M AN IF E S T AT IO N S

General Signs &Symptoms

Discharge Dysuria

Anal itching AnorectalPain

Conjunctivitis Sore throat

Multiple Asymptomatic
joint inflammation
IV. C L I N I C A L
M AN IF E S T AT IO N S

Gonococcal Infections inMen

•Acute Urethritis
•Urethral discharge
•Dysuria
IV. C L I N I C A L
M AN IF E S T AT IO N S
Gonococcal Infections inMen
Other unusual localcomplications:
Epididymitis
Gonococcal prostatitis
Edema of the penis
Periurethral abscess
Abscess of Cowper's Gland
Seminal Vesiculitis
Balanitis - may develop in uncircumcisedmen
IV. C L I N I C A L
M AN IF E S T AT IO N S
Gonococcal Infections inWomen
GONOCOCCAL CERVICITIS
Scant vaginal discharge issuing fromthe
inflamed cervix
Mucopurulent discharge
Dyspareunia
Lower abdominal or back pain
- Pelvic Inflammatory Disease
Dysuria
Pyuria
IV. C L I N I C A L
M AN IF E S T AT IO N S

Gonococcal Infections inWomen

GONOCOCCAL VAGINITIS
Red and edematous vaginal mucosa
Abundant purulent discharge
Urethritis
Inflamed cervical erosion
Abscess in nabothian cysts
 DIAGNOSIS

Gram-stain Bacterial Culture Urinalysis

V. T R E A T M E N T / M A N A G E M E N T
Pharmacological Treatment
Antibiotics
Non-pharmacological Treatment

Limit the direct contact that occurs during

sexual intercourse
Use condoms for vaginal or anal sex
Use dental dams for oral sex
Childbirth- treat Mother
Spermicidal Preparations
VI. P R O G N O S I S
COMPLICATIONS IF LEFT UNTREATED:

fo r W O M E N
endometritis
salpingitis
tubo ovarian abcess
bartholinitis
peritonitis
perihepatitis
VI. P R O G N O S I S
C O M P L I C A T I O N S IF L E F T U N T R E A T E D :

fo r M E N
periurethritis
epididymitis
fo r N E W B O R N S
opthalmia neonatorum
VI. P R O G N O S I S

S o m e compl i cati ons :

Infertility in women
Infertility in men
Increased risk of
HIV/AIDS Complications
in babies
THANK Y OU FOR
LISTENING!
SO U R C E S
https://www.medscape.com/answers/218059-68139/what-causes-
gonorrhea#qna[2]
https://www.medscape.com/answers/218059 -68137/what-is-the-
pathophysiology-of-gonorrhea#qna[3]
https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms -
causes/syc-20351774
https://www.slideshare.net/doctorrao/gonococcal
https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-
infections-(stis)
http://www.antimicrobe.org/b105.asp
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064409/#R13
https://pedsinreview.aappublications.org/content/34/5/228
https://apnews.com/press-release/pr-
businesswire/608e0c5f8af44bcdb49945a31f82d1e5
H a r r i s o n ’ s P r i n c i p l e s of I n te r n a l Medicine.pdf