Gonococci

Gonococci

1. Neisseria gonorrhoeae (Gonococcus) Mr. Naresh Pokhrel M.Sc Clinical Microbiology Department of Microbiology Father Muller Medical College, Mangalore

2. Major STD Syndromes and Sexually Transmitted Microbial Etiologies SYNDROMES Sexually Transmitted Microbial Etiologies AIDS HIV Type- 1 and 2 Urethritis-male Neisseria gonococcus , Chlamydia trachomatis, Epididymitis C.trachomatis, N.gonococcus Lower genital tract infections : females Cystitis/urethritis C.trachomatis, N.gonococcus , HSV Mucopurulent cervicitis C.trachomatis, N.gonococcus Vulvitis Candida albicans , HSV Vulvovaginitis C.albicans, T.vaginalis Bacterial vaginosis Gardnerella vaginalis Acute pelvic inflammatory disease N.gonnococcus, C.trachomatis , Mycoplasma spp, Group B Streptococci Infertility N.gonorrhoeae, C.trachomatis Ulcerative lesions of the genitalia HSV- 1&2, Treponema pallidum, Haemophillus ducreyi, C.trachomatis (LGV strain), Calymmatobacterium granulomatis Complications of pregnancy/pueperium Various organisms

3. COVERING : ● The history: Who? When was it discovered? ● Morphology of “ Neisseria gonorrhoeae ?” ● Cultural Character ● Biochemical Reactions ● Virulence factor ● Clinical Manifestations ● Laboratory Diagnosis ● Treatment ● Prophylaxis

4. Neisseria gonorrhoeae was discovered in 1879. By (and named after) a German physician and bacteriologist, Albert Ludwig Sigesmund Neisser. The history: Who? When was it discovered?

5. Morphology of “ Neisseria gonorrhoeae ?” a gram-negative (coffee bean shaped) diplococcus shifting from 0.6 to 1.0 μ m in diameter. It has 2069 genes, 2002 protein genes, and 67 structural RNAs. They grow on chocolate agar with Carbon Dioxide. A bacterium responsible for the sexual transmitted

6. Cultural Characteristics : Delicate organism with fastidious growth requirements 5-10% CO 2 is essential for growth pH : 7.2 – 7.6,Temp : 35 - 36  °C Grow well on Chocolate agar , Mueller Hinton Agar Selective medium –Thayer Martin medium (Choc. Agar- Vancomycin , Colistin, & Nystatin) Colonies- Small, translucent, convex 5 types- T1, T2 ( Virulent) T3, T5 (Non virulent)

7. Growth characteristics: Colonies are small,round,gray,translucent, convex with finely granular surface. They are easily emusifiable.

8. Biochemical Reactions: Catalase & Oxidase +ve Only Glucose - Utilized with acid production This Can be tested by rapid carbohydrate utilization test(RCUT)

9. Virulence Factor

10. A) Pili Pili are the hair like appendages that extend up to several micrometers from the gonococcal surface. It mediates the exchange of genetic material between strains and attachment to human mucosal cell surface, invasion of host cells, and survival through the inhibition of phagocytosis. Genetic-phase variation of pilus structure between types T1 through T5 allows the organism to vary its antigenic structure, preventing recognition by host immune cells.

11. B) Porin proteins (por proteins) Por protein extends through the gonococcal cell membrane. It forms pores in the surface through which some nutrients enter the cell. Two Major Types of Serotypes:- 1) PorB.1A :- associated with both local and disseminated gonococcal infections 2) PorB.1B :- usually cause local genital infections only

12. C) Opacity proteins (opa proteins) It helps in adhesion to neutrophils and other gonococci; and also responsible for other opaque nature of gonococcal colonies D ) Lipooligosaccharide Gonococcal lipopolysaccharide (LPS) does not have long O-antigen side chains and is called a lipooligosaccharide(LOS). Toxicity in gonococcal infections is largely attributable to the endotoxic effects of LOS. Capsule, lipooligosaccharide (endotoxin), and outer cell membrane proteins I-III are important in antigenic variation and for eliciting an inflammatory response.

13. E) Transferin- binding and Lactoferin binding Proteins: They Help in uptake of iron from tranferin and Lactoferin . F) IgA1 protease: It protects the organism from the action of mucosal IgA antibody.

14. Clinical manifestation of Neisseria gonorrhoeae Gonorrhea It is a sexually transmitted disease involving urethra in both sexes but in females, the endocervix is the primary site of infection. The incubation period is 2-8 days. The disease is an acute urethritis chracterised by purulant urethral discharge.

15. In males the acute urethritis may extend to the prostate, seminal vesicles and epididymis. If untreated it may lead to fibrosis. Infection may Spread to periurethral tissues causing abscess with sinus formation ( water-can perineum ). In females the primary infection may spread from urethra and cervix to Bartholin’s gland, uterus, fallopian tubes, ovaries and may cause pelvic inflammatory diseases.

16. Rarely,peritonitis may develop with perihepatic inflammation ( Fitz-Hugh-Curtis syndrome ) Occasionally hematogenous spread of bacteria may lead to septicaemia, endocarditis or acute purulent arthritis.

17. In Both Sexes Ophthalmia Neonatorum It is a nonvenerial gonococcl conjunctivitis in the newborn through infected birth canal. Gonococcal vulvovaginitis It is occur in prepubertal girls. Other infections Sometime the disease may involve rectum(proctitis)or oropharynx following rectal intercourse or by orogenital contact respectively. Involvement of oropharynx may lead to gonococcal pharyngitis.

18. Laboratory diagnosis Specimens Urethral discharge and cervical discharege or cervical swabs are collected in acute urethritis. In chronic urethritis , exudate obtained after prostatic massage or centrifuged deposit of urine. 2 . Transport All the specimens should be transported and processed immediately. If not possible it should be collected with charcoal coated swabs and transported to the laboratory in Stuart’s transport medium.

19. 3 . Direct microscopy Gram staining of the smear provides a presumptive evidence of gonorrhoea . Gram negative diplococci are found in smear. 4 . Culture Specimen should be inoculated directly on preheated plates immediately on collection. CA is used for culture. In chronic cases Thayer-Martin medium is used.

20. Serology Complement Fixation Test Precipitation Immunofluorescence Passive agglutination ELISA Radioimmunoassay Fluorescent antibody tests are more sensitive and specific method for diagnosis.

21. Molecular Method:- NAAT:-opa gene of Neisseria Gonococci with 16s ribosomal gene to determine the presence of gonorrhea May not be possible to isolate gonococci from patients with metastatic lesions such as arthritis. PCR molecular methods have improved the sensitivity of the assay.

22. Treatment Drug of Choice : 3 rd Generation Cephalosporin's for Uncomplicated gonococcal infection. Ceftriaxone ( 250 mg given IM,single dose ) Cefixime ( 400 mg given orally, single dose)

23. Prophylaxis: There is no vaccination available for gonococci. The General prophylactic measures include: - Early detection of cases - Treatment of both partners - Tracing of contacts - Health education about safe sex partners , such as use of condoms

24. Non Gonococcal (non specific) urethritis: SNO CAUSATIVE AGENTS MICROORGANISM 1 Bacterial Chlamydia trachomatis Ureaplasma urealiticum Mycoplsma hominis Gardnerella vaginalis Acinetobacter lwoffi 2 Viral Herpes virus Cytomegalovirus 3 Fungal Candida albicans 4 Protozoal Trichomonas vaginals

25. References: Essential of Medical Microbiology by Apurba Sankar Sastry and Sandhya Bhat K Textbook of Microbiology Ananthanarayanan and Panikers. Bailey and Scott’s,Dignostic Microbiology ,13 th Edition.