gonorrhoeae (the gonococcus)
- Humans are the only natural host.
- Transmitted sexually by contact
with an infected individual; may be transmitted from mother to baby during
- CDC estimates that more than 700,000
persons in the U.S. get new gonorrheal infections each year. Only about half
of these infections are reported to CDC. In 2002, 351,852 cases of gonorrhea
were reported in thr U.S..
- Neisseria gonorrhoeae typically
infects the mucous membranes causing infections such as urethritis (def),
pelvic inflammatory disease (def),
and pharyngitis (def).
- In males there is typically a
2-3 day incubation period after which a purulent (def)
discharge from the urethra and dysuria (def)
develops. Around 95% of infected males are symptomatic. Rare complications
include prostatitis (def),
and periurethral abcesses (def).
- The gonococcus primarily infects
the cervix in women. Symptoms include vaginal discharge, dysuria (def),
and abdominal pain. Complications from an ascending infection include absesses
of the ovarian tubes and pelvic inflammatory disease (def).
Around 10%-20% of infected women develop these complications.
- In 1%-3% of infected women and
a lower percentage of infected men the bacterium disseminates via the blood
causing bacteremia (def)
and arthritis (def).
- Congenital gonorrhea typically
appears as ophthalmia neonatorum (def)
and occurs as a result of the eyes of newborns becoming infected as the baby
passes through the birth canal. Antibiotic drops are put in the eyes of newborns
to prevent congenital gonorrhea and congenital Chlamydia infection.
- In the outer membrane of the gram-negative
cell wall, the lipooligosaccharide (LOS) functions as an endotoxin . Endotoxin,
especially when in the blood, can lead to inflammation, high fever, hypotension,
capillary damage, intravascular coagulation, tissue degradation, and irreversible
shock. Death is a result of what is called the shock cascade (see
- Various types of pili
enable the bacterium to initially adhere to epithelial cells of the mucous
membranes. Gonococci are constantly losing and reforming pili as they grow
in the body and the same bacterium may switch the adhesive tips of the pili
in order to adhere to different types of host cells and evade immune defenses
- A variety of cell wall adhesins
enable the bacterium to make a more intimate contact with the mucous membranes.
- Por protein (protein I) prevents
phagosomes from fusing with lysosomes to promote survival within phagocytes.
- Opa protein (protein II) allows
for firm attachment to host cells. Like pili, there are multiple alleles
for Opa protein enabling the bacterium to adhere to different host cell
- Rmp protein (protein III)
protects other surface proteins and LOS from antibody attack.
- Transferrin-binding proteins,
lactoferrin-binding proteins, and hemoglobin-binding proteins allow the gonococcus
to obtain iron bound to human iron-binding proteins.
- IgA1 protease degrades
the human antibody IgA1 (def).
- Uncomplicated gonorrhea can be
treated with ceftriaxone, cefixime, ciprofloxacin, or ofloxacin; doxycycline
or azrithromycin (see antibiotic table) is added
for those infected with both Neisseria gonorrhoeae and Chlamydia
*Drugs may change with time.
For a more detailed article on Neisseria
gonorrhoeae infections, see
by Larry I Lutwick, MD, Director,
Division of Infectious Diseases, Veterans Affairs New York Harbor Health Care
System, Professor, Department of Internal Medicine, State University of New
York at Downstate; Renuka Heddurshetti, MD, Fellow in Infectious Diseases, Department
of Internal Medicine, State University of New York at Brooklyn; and Sanda Cebular,
MD, Fellow, Department of Medicine, Section of Infectious Diseases, State University
of New York at Brooklyn.
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Updated: Feb. 1, 2005
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