Gonococci

1. Mr. Naresh Pokhrel
M.Sc Clinical Microbiology
Department of Microbiology
Father Muller Medical College, Mangalore

2. 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

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

5. 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?

6. Morphology of “Neisseria gonorrhoeae?”
a gram-negative (coffee bean shaped) diplococcus
shifting from 0.6 to 1.0μm 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

9. Cultural Characteristics :
Delicate organism with fastidious growth requirements
5-10% CO2 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)

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

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

12. Virulence Factor

13. 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.

14. 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

15. 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.

16. 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.

17. 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.

18. 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.

19.  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.

20. 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.

21. Laboratory diagnosis
1. 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.

22. 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.

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

24. Molecular Method:-
1) 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.

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

26. 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

27. 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

28. 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 ,13th Edition.