NEISSERIA

GONORRHOEAE
R.Varidianto Yudo T., dr
 CLASSIFICATION
Kingdom : Bacteria
Phylum : Proteobacteria
Class : Beta Proteobacteria
Order : Neisseriales
Family : Neisseriaceae
Genus : Neisseria
Species : N. gonorrhoeae
 EPIDEMIOLOGY
The most common people to contract this disease are
sexually active and most often younger people from
ages 15-30, who have multiple sex partners.
Gonorrhea occurs more frequently in urban areas than
from rural areas.
Adult women have a three times higher chance of
contracting gonorrhea than in men, and girls aged 10 to
14 are four times more likely to get it boys of the same
age.
 Teenagers have the highest rates of infection
than other age groups.
A man, who has intercourse with an infected
partner, has a 30-50% chance of contracting the
disease.
However, a woman who has intercourse has a
much higher chance of 60-90%
 MORPHOLOGY
Neisseria are gram negative cocci 0.6 to 1.0 m in
diameter.
The organisms are usually seen in pairs (diplococci)
with adjacent sides flattened.
N. gonorrhoeae has no capsules. Other Neisseria
species produce surface poly-saccharides as loosely
associated envelopes or intact capsules.
Fimbriae or pili are present on virulent N. gonorrhoeae
Neisseria are not motile.
Left: Neisseria gonorrhoeae Gram stain of pure culture;
Right: Neisseria gonorrhoeae Gram stain of a pustular
exudate
Neisseria gonorrhoeae
 CHARACTERISTIC
Neisseria species of bacteria are highly fastidious gram-
negative cocci, that is, they require special nutrients to
survive.
Strains of N. gonorrhoeae are variable in their cultural
requirements so that media containing hemoglobin,
NAD, yeast extract and other supplements are needed
for isolation and growth of the organism. Cultures are
grown at 35-36 degrees in an atmosphere of 3-10%
added CO2.
The microbe readily grows on complex media and
several of its growth properties are important in
identification.
 N. gonorrhoeae has a very narrow temperature range
for growth of 35-37C.
Drying kills the microbe in 1 to 2 hours, but N.
gonorrhoeae can survive for several hours on clothing and
other surfaces, and bodily fluids seem to have a
preservative effect. For example, it has been known to
survive for 6 to 7 weeks in dried pus. It is an obligate
pathogen, and humans are the only natural host for the
microbe.
 DISEASE
Neisseria gonorrhoeae is a species of Gram-
negative bacteria responsible for the disease
gonorrhoea
Gonorrhoea is a sexually transmitted disease
Symptoms include a purulent (or pus-like)
discharge from the genitals which may be foul
smelling, a burning sensation during urination
and conjunctivitis commonly in neonatal
infection, also occasionally in adults.
 Gonorrhea has many undesirable effects. In
men, the short-term effects include painful
urination, creamy or green pus-like penile
discharge, and testicular pain. The long-term
effects include Epididymitis -which is an
inflammation of the testicles that can cause
sterility. If Gonorrhea is left untreated, the
infection can spread to the testicles, which
results in sterility
 In women, the short-term effects include
creamy or green, pus-like vaginal discharge,
bleeding between and during menstrual periods,
painful urination, painful intercourse, and lower
abdominal pain. The long-term effects include
contracting the Pelvic Inflammatory Disease
which is an infection that spreads from the
vagina and cervix, and then to the uterus and
fallopian tubes. The Pelvic Inflammatory
Disease can lead to sterility
 Other long-term effects are abscesses, ectopic
pregnancy, which is a pregnancy outside of the
uterus, Perihepatitis that is an infection around
the liver, and sterility. If the disease is untreated,
the infection usually spreads from the cervix
into the uterus and Fallopian tubes, causing
pelvic inflammatory disease. Severe pain may
occur, or the infection may linger with few or no
symptoms, gradually damaging the tubes and
rendering the woman sterile.
 Gonorrhea in pregnant women may be
transmitted to the infant during birth and may, if
untreated, cause a serious eye infection
(ophthalmia neonatorum).

In both sexes the bacteria are able to enter the

bloodstream, which can result in arthritis or
heart inflammation.
 PATHOGENESIS
N. gonorrhoeae has a number of virulence
determinants, but the most important is the
production of pili, which have two roles :
1) Proteins at the end of pili are necessary for
attachment to a membrane protein on the surface
of epithelial cells. The microbes are also able to
attach to sperm, and this capability may allow
invasion into the upper urethra. The importance of
pili is demonstrated by the fact that strains unable to
express pili also lose their virulence.
 2) Pili are involved in exchange of genetic material
through natural transformation, because N.
gonorrhoeae expressing pili readily take up DNA and
incorporate it into their chromosome.
This may explain their ability to rapidly
develop drug resistance to the antibiotics that
have been used against them.
 The Opa (for opacity) proteins are also important for
adhesion to hosts. They were originally identified
because their expression lead to changes in colony
opacity and color owing to an increase in bacterial
aggregation. There are 11 different Opa proteins that
help bind to different cell receptors on different types
of cells in the body, including to macrophages. This last
binding mechanism helps N. gonorrhoeae bypasses the
classic phagocytic route into macrophages and prevents
the microbes destruction, allowing it to survive and
grow inside the phagocyte .
 The outer membrane protein Por1, is also a
virulence factor. It serves as a porin in the outer
membrane, but it can cross to the host cell
membrane and bind to actin filaments. This may
cause a remodeling of the host membrane and
assist in invasion. Por1 has also been shown to
protect against the action of complement
 The cell wall components of N. gonorrhoeae also have
roles in its pathogenicity. LPS serves as an endotoxin,
causing damage to epithelial cells and disrupting
complement activation. Toxic peptidoglycan fragments
have cytotoxic activity in mammals. In this case, they
kill ciliated fallopian tube cells and stimulate the
production of interleukin 1 and interleukin 6,
contributing to the inflammatory response. N.
gonorrhoeae also produces an extracellular protease that
cleaves IgA molecules, preventing them from attacking
the microbe
 N. gonorrhoeae has several systems that allow it to
obtain iron from the host. One consists of
receptor proteins that bind lactoferrin and
transferrin, two iron-binding proteins present in
the body. A second secretes iron-binding organic
compounds called siderophores that bind iron
with high affinity and are then transported back
into the microbe. Finally, N. gonorrhoeae makes
several heme-binding proteins that can scavenge
iron present in heme groups.
 The combination of all these virulence factors
makes N. gonorrhoeae a very successful pathogen
of humans. Without antibiotics, these infections
are difficult for the immune system to fend off
and result in long-term colonization. N.
gonorrhoeae is also very good at hiding from the
immune system, either on external tissues or
inside phagocytes, and this is probably why there
is such a high incidence of asymptomatic
infections.
 LABORATORY DIAGNOSIS
Neisseria is usually isolated on a Modified Thayer-
Martin culture plate.
This plate has antibiotics and nutrients which not only
facilitate the growth of Neisseria species, but inhibit the
growth of Gram-positive organisms and most bacilli.
Further testing to differentiate the species usually
includes an oxidase test which will be positive for
Neiserria gonorrhoeae, and testing with the
carbohydrates lactose, sucrose, and glucose.
N. gonorrhoeae will only oxidize (that is, utilize) the
glucose
 TREATMENT
Since N. gonorrhoeae , also called Gonococci, is
resistant to the penicillin family, ceftriaxone (a
3rd generation cephalosporin) is often used now.
Patients should also be tested for Chlamydia
bacteria, since co-infection is frequent.
 For years penicillin was the drug of choice. The emergence of
drug-resistant strains in Asia and the Pacific area has changed the
drug regimen. Antimicrobial resistance in N. gonorrhoeae occurs as
plasmid-mediated resistance to penicillin and tetracycline and
chromosomally mediated resistance to penicillins, tetracyclines,
spectinomycin and fluoroquinolones. These drug-resistant strains
caused an increase in the incidence of infection through 1987. At
that time, the CDC began recommending the exclusive use of
only highly effective drugs such as azithromycin and
erythromycin, to which N. gonorrhea has yet to develop resistance.
This practice has caused a steady decrease in disease incidence
since 1987.