Gonococcal

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GONOCOCCAL infections are prevalent all over the world, in particular youth, with disseminated complications. A timely diagnosis and effective treatment reduces the morbidity and mortality associated with the infection.

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Gonococcal

  1. 1. GONOCOCCAL infections Dr.T.V.Rao MD
  2. 2. <ul><li>Albert Ludwig Sigesmund Neisser was a German physician who specialized in dermatology and venereal diseases. He  discovered gonococcus (1879), the small bacterium that causes gonorrhea. </li></ul>Albert Ludwig Sigesmund Neisser
  3. 3. Gonorrhea <ul><li>The name Gonorrhea is derived from Greek words- Gonos ( seed ) rhoia ( flow ) </li></ul><ul><li>Describes a condition in which semen flowed from the male organ without erection, </li></ul>
  4. 4. Gonorrhea – Venereal Disease <ul><li>Gonorrhea is a classcial venereal disease, being spread almost exclusively by sexaul contact having a short incubation period and being relatively easy to diagnose and treat. </li></ul>
  5. 5. Sexual promiscuity spreads Gonorrhea <ul><li>Sexual promiscuity spreads the Gonorrhea among the contacts being named after Roman goddess of love </li></ul><ul><li>Venus </li></ul>
  6. 6. Neisseria gonorrhea <ul><li>Neisseria gonorrhea are gram negative oval cocci with opposing surfaces slightly concave ( Bean shaped ) </li></ul>
  7. 7. Neisseria gonorrhea <ul><li>Neisseria species are Gram-negative cocci, 0.6 to 1.0 µm in diameter. The organisms are usually seen in pairs with the adjacent sides flattened. Pili, hairlike filamentous appendages extend several micrometers from the cell surface. The outer membrane is composed of proteins, phospholipids, and Lipopolysaccharides (LPS) </li></ul>
  8. 8. N.gonnorhea infects mucous membrane <ul><li>Gram-negative intracellular diplococci of the species Neisseria gonorrhoea, the cause of gonorrhoea; a nonmotile aerobic microorganism of the species N. gonorrhoea. It is a parasite of the mucous membrane. </li></ul>
  9. 9. Typing methods in Gonococci <ul><li>N gonorrhoea strains have been typed on the basis of their growth requirements (autotyping) or by antigenic differences in the porin protein (serotyping). More recently, restriction fragment length polymorphisms in genes encoding ribosomal RNA and the separation of large DNA fragments by pulsed- field gel electrophoresis have been used to type isolates. </li></ul>
  10. 10. Pathogenesis <ul><li>N.gonnorhea is Human pathogen. </li></ul><ul><li>Chimpanges can be infected artificially </li></ul><ul><li>Women may remain Aymptomatic </li></ul><ul><li>Gonorrhea infection is generally limited to superficial mucosal surfaces lined by colomonar epithelium. </li></ul>
  11. 11. The Organs and Tissues involved <ul><li>Cervix </li></ul><ul><li>Urethra </li></ul><ul><li>Rectum </li></ul><ul><li>Pharynx </li></ul><ul><li>Conjunctiva </li></ul><ul><li>Vaginal epithelium – covered with squamous epithelium not infected </li></ul><ul><li>However prepubertal vaginal epithelium is infected in young girls present with vulvovaginitis </li></ul>
  12. 12. Manifestations in Gonococcus Infections
  13. 13. Pathogenesis ( contd ) <ul><li>Gonorrhea is Venereal disease </li></ul><ul><li>The disease is acquired by sexaul contact. </li></ul><ul><li>In general incubation is 2 -8 days </li></ul><ul><li>In men the disease starts as purulent discharge containing gonococci in large numbers. </li></ul><ul><li>The disease spreads to prostate, seminal vesicle, and epididymis </li></ul><ul><li>In men chronic urethritis may lead to stricture formation </li></ul>
  14. 14. Clinical Presentation in Males <ul><li>Majority of males present with acute urethritis with purulent discharge </li></ul><ul><li>5% of patients carry bacteria without distress </li></ul><ul><li>Rectal and Pharyngeal infections are less often symptomatic </li></ul>
  15. 15. Clinical Presentation in Females <ul><li>Endocervix infection is the most common presentation in women </li></ul><ul><li>Present with vaginal discharge and Dysuria </li></ul><ul><li>Infection and abscess of Bartholin and Skene’s glands </li></ul>
  16. 16. Other Manifestations <ul><li>Rectal infection (Proctitis) with N.gonnorhea occurs one third of women with cervical infection. </li></ul><ul><li>Rarely symptomatic. </li></ul><ul><li>Acute salphingits </li></ul><ul><li>Pelvic inflammatory disease </li></ul><ul><li>Sterility </li></ul>
  17. 17. Other Manifestations <ul><li>Peritonitis can spread </li></ul><ul><li>Fitz Hugh Curtis Syndrome . </li></ul><ul><li>Disseminated gonococcus infection </li></ul><ul><li>Painful Joints may lead to Arthritis </li></ul><ul><li>Fever, Few septic lesions on the extremities </li></ul><ul><li>Meingitis and Endocarditis </li></ul>
  18. 18. Gonorrhea can manifest as Oral Infection <ul><li>Changing sexual practices and oral sex predisposes the sex partners with involvement of oropharengeal regions </li></ul>
  19. 19. Gonococcal Opthalmia <ul><li>Babies born to infected women suffer, can lead to a serious condition of Opthalmina neonatroum </li></ul><ul><li>Manifest with sever purulent discharge with periorbital oedema within a few days of birth </li></ul><ul><li>Topical application of 1% silver nitrate has drastically reduced the incidence. </li></ul><ul><li>In present contest Topical erythromycin is used. </li></ul>
  20. 20. Gonococcal infection in Prepubertal Girls <ul><li>Vulvovaginitis in prepubertal girls occur in conditions of poor hygiene or by sexual abuse </li></ul><ul><li>All cases to be investigated with care and caution . </li></ul>
  21. 21. Disseminated Infections <ul><li>Seen more commonly in women who may present with painful joints, fever, and few septic lesions or the extremities </li></ul><ul><li>Rarely disseminated infections may present as endocarditis or meningitis . </li></ul>
  22. 22. Laboratory Diagnosis <ul><li>Specimens are collected with care and caution. </li></ul><ul><li>Specimens are collected from sites with scanty commensals eg Endocervix </li></ul>
  23. 23. Transportation of Specimens <ul><li>It Is preferred in culture, specimens should be inoculated in prewarmed plates,immeditely on collection </li></ul><ul><li>If not possible specimen should be collected on charcoal impregnated swabs and sent to laboratory in Stuart’s transport medium. </li></ul>
  24. 24. Gram Staining <ul><li>Gram’s method of staining is sensitive in 95% of infections. </li></ul><ul><li>The demonostration of intracellular Gram negative diplococci in stained smears provides a presumptive evidence of gonorrhea in men. </li></ul><ul><li>Specimens are inoculated onto culture plates freshly prepared. </li></ul><ul><li>Delay in inoculation of specimens on culture media reduces the rate of isolation. </li></ul>
  25. 25. Culturing Gonococci <ul><li>Gonococci are aerobic and may grow aerobically </li></ul><ul><li>It is essential to provide 5 – 10% CO 2 </li></ul><ul><li>They grow well on Chocolate agar and Mueller – Hinton agar </li></ul><ul><li>The colonies are small, convex, translucent, and slightly umbonate.with finely granular surface and lobate margins. </li></ul>
  26. 26. Selective Culture Medium <ul><li>The selective medium is Thayer – Martin medium containing Vancomycin, colistin, and Nystatin , effectively inhibits most contaminants including non pathogenic Neisseria </li></ul>
  27. 28. Problems in Culturing Gonococci <ul><li>Culturing is possible in specialized diagnostic laboratories only. </li></ul><ul><li>The combination of Oxidase positive colonies and Gram negative diplococci provides a presumptive diagnosis. </li></ul>
  28. 29. Fluorescent Methods <ul><li>Florescent methods will help in prompt detection in infected patients </li></ul><ul><li>Various discharges can be examined. </li></ul>
  29. 30. Other Methods in Diagnosis <ul><li>Co agglutination methods </li></ul><ul><li>Biochemical tests to differentiate from other commensals resembling Neisseria spp </li></ul>
  30. 31. Newer Methods in Diagnosis <ul><li>DNA probes can be used for confirmation, and also used for the detection of Gonococci in urethral and cervical specimens. </li></ul><ul><li>PCR methods are available in specialized laboratories </li></ul>
  31. 32. Treatment <ul><li>Pencillin </li></ul><ul><li>was a popularly used antibiotic </li></ul><ul><li>However resistance has reduced it utility </li></ul><ul><li>For a long time the drug resitance has overcome with increased dosage </li></ul><ul><li>Complete resistance to pencillin has made the drug obsolete in several parts of the world. </li></ul>
  32. 33. Genes Code resistance <ul><li>The pencillin resistant strains possess the gene coding for TEM-type ß-lactamase commonly found Escherichia coli </li></ul>
  33. 34. Other Drugs in current use <ul><li>Ceftriaxone </li></ul><ul><li>Cefixime </li></ul><ul><li>Flouroquinolones </li></ul><ul><li>Ciprofloxin </li></ul><ul><li>Tetracycline </li></ul><ul><li>Co-Amoxiclav </li></ul><ul><li>Spectinomycin </li></ul><ul><li>In Disseminated Gonococcal disease and any complicated infection treatment for 7-10 days is necessary </li></ul>
  34. 35. Controlling Gonorrhea <ul><li>The key control measures in gonorrhea are </li></ul><ul><li>1 Rapid diagnosis </li></ul><ul><li>2 Use of effective antibiotics </li></ul><ul><li>3 Tracing, examination and treatment of contacts. </li></ul><ul><li>4 Inappropriate self medication has contributed to widespread antimicrobial resistance. </li></ul>
  35. 36. Created for Medical and Paramedical students in Developing world Dr.T.V.Rao MD Email [email_address]

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