Neisseria-gonorrhea-A-Comprehensive-Overview.pptx

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It primarily affects the genitals, rectum, and throat and is transmitted through unprotected sexual contact (vaginal, anal, or oral).

Key Features:
Symptoms: In men – burning sensation during urination, penile discharge; in women – vaginal discharge, pelvic pain, and irregular bleeding (many cases are asymptomatic).
Complications: If untreated, it can lead to pelvic inflammatory disease (PID) in women, infertility in both men and women, and increased risk of HIV infection.
Diagnosis: Laboratory tests, including nucleic acid amplification tests (NAATs) from urine or swabs.
Treatment: Typically antibiotics (e.g., ceftriaxone), but antibiotic resistance is a growing concern.
Prevention: Safe sex practices, consistent condom use, and regular STI screenings.

1. Neisseria gonorrhea: A Comprehensive Overview Neisseria gonorrhea is a gram-negative diplococcus bacterium responsible for gonorrhea, a prevalent sexually transmitted infection. This presentation will delve into the structure, transmission, pathophysiology, and complications associated with this STI, highlighting the importance of early diagnosis and treatment. by Agboola Michael

2. Bacterial Structure and Virulence Gram-Negative Diplococcus Neisseria gonorrhea is a gram-negative, fastidious diplococcus bacterium characterized by a cell envelope consisting of an inner cytoplasmic membrane, a peptidoglycan layer, and an outer membrane. Lipo-Oligosaccharides (LOS) The outer membrane contains lipo-oligosaccharides (LOS), which serve as an endotoxin, as well as phospholipids and proteins that enhance cell adherence and tissue colonization.

3. Transmission and Risk Factors 1 Sexual Transmission Neisseria gonorrhea is primarily transmitted through sexual contact, including oral, genital, and anal routes. 2 Perinatal Transmission The bacteria can also be transmitted perinatally from mother to infant during childbirth. 3 Risk Factors Key risk factors include being aged 20 to 29, having multiple sexual partners, engaging in unprotected sex, and having sexual partners known to have gonorrhea.

4. Pathophysiology of Infection Neisseria gonorrhea infection primarily occurs through sexual contact, specifically targeting columnar epithelial cells within the urethra or vaginal epithelium. The bacteria utilize dynamic polymeric protein filaments known as pilli for attachment to and movement across cell surfaces. Understanding the pathophysiology of this STI underscores how gonorrhea can lead to various complications, particularly among individuals with a history of sexually transmitted infections.

5. Immune Evasion Mechanisms IgA Protease Neisseria gonorrhea produces IgA protease, which cleaves immunoglobulin IgA, a key component of the mucosal immune system. Protective Capsule The bacteria possess a capsule that prevents phagocytosis by macrophages and neutrophils, further hindering immune recognition. Porin Proteins Porin proteins facilitate mucosal invasion, leading to a local inflammatory response and the production of exudate.

6. Complications in Males 1 Urethritis Neisseria gonorrhea can ascend the urogenital tract in males, leading to complications such as urethritis, epididymitis, and prostatitis. 2 Symptoms Over 90% of infections show symptoms, with males often experiencing dysuria (painful or uncomfortable urination), purulent urethral discharge that is yellow or green, and abdominal discomfort.

7. Complications in Females Cervicitis Females infected with Neisseria gonorrhoeae may experience cervicitis, characterized by inflammation and pain, along with purulent cervical discharge, dysuria, and abdominal pelvic pain. Pelvic Inflammatory Disease (PID) In females, urogenital gonorrhea can lead to severe complications such as acute endometritis, salpingitis, and pelvic inflammatory disease, which may result in infertility, chronic pelvic pain, and ectopic pregnancy. Fitz-Hugh-Curtis Syndrome The infection can also spread from the Fallopian tubes to the liver, causing peripatitis known as Fitz-Hugh-Curtis syndrome.

8. Disseminated Infections Lymphadenopathy 1 Abscesses 2 Endocarditis 3 Disseminated Gonococcal Infection 4 Gonorrhea can lead to severe complications such as lymphadenopathy, abscesses, endocarditis, and disseminated gonococcal infection, which presents with a classic triad of symptoms: fever, tenosynovitis, and polyarthralgia.

9. Diagnosis and Treatment Nucleic Acid Amplification Tests (NAT) Diagnosis is primarily conducted through nucleic acid amplification tests (NAT), utilizing urine or cervical discharge samples. Bacterial Cultures Bacterial cultures from the cervix or blood may be performed if disseminated infection is suspected. Treatment Treatment for gonorrhea includes Ceftriaxone, often accompanied by Azithromycin or Doxycycline.

10. Standard Treatment Guideline for gonorrhoea First-line Options Effective substitutes Ceftriaxone 250 mg, intramuscularly, single dose plus Azithromycin 1 gram, orally, single dose Cefixime 400 mg, orally, single dose plus Azithromycin 1 gram, orally, single dose Ceftriaxone 250 mg, intramuscularly, single dose plus Azithromycin 1 gram, orally, single dose or Cefixime 400 mg, orally, single dose plus Azithromycin NOTE: People should wait 7 days after taking the medicine before having sex. They should notify their sexual partner(s) to get tested or treated.

11. Key Takeaways and Next Steps Neisseria gonorrhea is a serious STI that can lead to severe complications if left untreated. Early diagnosis and treatment are crucial for preventing long-term health consequences. It is essential to practice safe sex, including the use of condoms, and to get tested regularly for STIs. After treatment for Neisseria gonorrhea, sexual contact should be avoided for seven days, and partners from the last two months must be tested and treated if necessary.