Neisseria gonorrhoeae (gonorrhea), also known as "the clap", is one of the most common occurring STD's. Humans are the only known hosts and it is mainly transmitted through some sort of sexual contact including vaginal, anal and oral intercourse or contact. Gonorrhea affects both men and women and can also affect a newborn baby if the mother is a carrier.
Gonorrhea was given its name by a Greek physician named Galen in AD 150. The word meant "a flow of semen" and it was later discovered that Galen must have confused semen with the pus from the gonorrhea. The number of cases of gonorrhea increased from 1964-77 but have dropped a little every year since 1984. The cases are still considered very high with, "more than 400,000 cases of gonorrhea a year reported to the CDC [5]." There are even several thousand people who are asymptomatic (without symptoms) and don't know they are infected. There may also be many cases that are treated and are never reported, although gonorrhea is a reportable disease and "all state governments require that cases of diagnosed gonorrhea be reported to health authorities. This allows for adequate follow up and testing of sexual contacts [5]."
Gonorrhea affects both men and women differently. Women who become infected may experience no symptoms at all which leaves the bacteria untreated. If symptoms do occur in women it usually takes about 10 days after contact for them to appear. "Because GC often goes untreated in women, they serve as the major reservoir [11]." If symptoms occur in men they show up faster, 3 to 5 days after contact. The first place a woman can get gonorrhea is in the cervix. Symptoms of gonorrhea in women may include lower back pain, vaginal discharge and painful urination. If gonorrhea goes untreated in women it can, "spread into the womb or fallopian tubes, resulting in Pelvic Inflammatory Disorder. PID affects more than 1 million women in this country each year and can cause infertility in more than 10% of infected women and tubal (ectopic) pregnancy [2]." Since gonorrhea is spread through mucous membranes (mouth, eyes, urethra, anus), if a mother is infected it is likely that she could pass it on to her newborn because the bacteria could get into the baby's eyes. If this occurs it is called Ophthalmia Neonatorum which is, "an eye infection during the passage of the birth canal [3]." If this occurs the worst outcome could lead to blindness. "This complication is rare because newborn babies receive eye medicine to prevent infection [2]." Men are far more likely to have symptoms than women. Men may start off by having a pus spot on the penis or have pain when urination. If the gonorrhea goes untreated it could scar or partially block the urethra. This could eventually lead to sterility due to the build up of scar tissue. In both men and women gonorrhea, "can also spread deeper into the body and cause infection in the abdomen (peritonitis), blood stream (gonococcemia) and joints (gonococcal arthritis) [13]."
Gonorrhea has been shown to occur more in, "large metropolitan areas, inner city areas, populations with lower overall levels of education and people with lower socioeconomic status [5]." Gonorrhea has also been shown to occur more in people between the ages of 15 and 29 years old.
Gonorrhea is a Gram negative diplococci which means it is a cocci that remains in pairs after it divides. "Doctors or other health care workers usually use three laboratory techniques to diagnose gonorrhea: staining biological samples directly for the bacterium, detection of bacterial genes or nucleic acids (DNA) in urine, and growing the bacterium in lab cultures [2]." Not all of these tests are used but it helps to make the diagnosis more accurate. Diagnosis in men is usually done by finding gonococci in a stained smear from discharge off the man's penis. This gram stain test is not as reliable for women since the bacteria actually live inside the woman's cervix and cannot survive long outside of the cervix. Doctors will usually use a culture from the cervix and grow it on media in an incubator to keep it alive and growing so they can correctly diagnose it. Another test that is now being used to help in detecting gonorrhea is the ELISA 9enzyme-linked immunosorbent assay) test. The ELISA test can find gonorrhea by using urethral pus or a cervical swab and can give accurate results in about three hours. It is becoming widely used because it is so fast and is read accurately by a computer. To use it, doctors put a known sample of N. gonorrheae antibodies into a well of a micro plate and then they add a sample of the patients bacteria and compare that bacteria to the known. "A reaction between the known antibodies and the bacteria provides identification of the bacteria [1].'
Gonorrhea is transmitted by direct contact and require no fomite because the bacteria cannot live outside of a host. For someone to get infected the organisms attach themselves to a mucous membrane. Bacteria from the genus Neisseria are usually considered to be part of normal flora. N. gonorrhea is an exception to this because it is considered to be very pathogenic. The organism attaches to mucosal epithelium proteins on the surface of the bacteria called pili. "Pili are small hair-like protein projections from the cell which are important as adherence structures [8]." Once the bacteria invades the body it, "sets up inflammation and when leukocytes move into the inflamed area, the characteristic pus formation results [1]." This pus forms because gonococcal infections have bacterial colonization on the mucous surfaces that attack the mucosal barrier.
In the beginning, cases of gonorrhea were treated with either penicillin or tetracycline which are, "antibiotics that interfere with protein synthesis [1]." Due to the amount of use of these antibiotics for several different bacteria, gonorrhea developed some strains that were penicillin and tetracycline resistant. There are now several antibodies that doctors can choose from to prescribe in order to treat gonorrhea. These antibiotics include: ceftriaxone, cefixime, ciprofloxacin, and ofloxacin. Each of these antibiotics are taken as a single dose. Many times gonorrhea an chlamydia occur at the same time. "Therefore, doctors usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases [2]."
There are several ways a person can prevent becoming infected with gonorrhea. The best ways are to use precautions that will help you to stay free from the infection. Abstinence is the number one, most sure, way to stay absolutely "gonorrhea free". This is not a decision that is for everyone, though. If you are sexually active, you and your partner should try to stay monogamous and if not, you should be aware of your partners background. You and your partner could agree to take a test to determine if either of you tested positive for an STD. Basically, just safer sex behaviors will reduce the risk of becoming infected with gonorrhea. If you or someone you know is infected or thinks they may be, the best thing to do is to catch it early. When treated immediately the outcome will not be so bad. You will prevent the scarring of the urethra and the spread of gonorrhea to any other parts of the body. The later someone waits for treatment the more likely for complications.
REFERENCES:
(1) "Microbiology, An Introduction" 7th ed. Torta, Gerard J.; Funke, Berdell R.; Case, Christine L. Benjamin Cummings Inc. 2001.
(2) National Institute of Allergy and Infectious Disease; FACT SHEET, "Gonorrhea" October 2000. URL: http://www.niaid.nih.gov/factsheets/stdgon.htm accessed on 4/30/02
(3) Lecture Notes "PATHOGENIC BACTERIOLOGY" by: Dr. Glenn Songer URL: http://microvet.arizona.edu/Courses/MIC420/lecture_notes/neisseria/neisseria_disease2.html accessed on 4/25/02
(4) Medical Microbiology and Infectious Diseases "Neisseria Gonorrhoeae" April 24,2001. URL: http://www.medinfo.ufl.edu/year2/mmid/bms5300/bugs/neigonor.html accessed on 4/23/02
(5) Medline Plus Health Information; Medical Encyclopedia "Gonorrhea" 19 April 2002. URL: http://www.nlm.nih.gov/medlineplus/ency/article/000623.htm accessed on 4/25/02
(6) Columbia University College of P & S Complete Home Medical Guide; Infectious Diseases "Sexually Transmitted Diseases" URL: http://cpmcnet.columbia.edu/texts/guide/hmg18_0016.html accessed on 4/25/02
(7) Centers for Disease Control and Prevention "Neisseria gonorrhoeae Gonorrhea" February 10, 2002. URL: http://www.cdc.gov/ncidod/dastlr/gcdir/gono.html accessed on 4/23/02
(8) Medical Microbiology by: Neal Chamberlain "Sexually Transmitted Diseases" 11/20/00. URL: http://www.kcom.edu/faculty/chamberlain/Website/lectures/lecture/std.htm accessed on 5/02/02
(9) Wisconsin Department of Health and Family Services - Programs and Services; Disease Fact Sheet Series "Gonorrhea" July 10, 2001. URL: http://www.dhfs.state.wi.us/healthtips/BCD/Gonorrhea.htm accessed on 4/30/02
(10) Other Gram Negative Bacteria by: Dr. J Bliska URL: http://www.uhmc.sunysb.edu/microbiology/gramneg2.html
(11) Microbiology 101 Internet text "Chapter XVII: Sexually Transmitted Diseases" by: Dr. R. E. Hurlbert 12/3/96. URL: http://www.gch.ulaval.ca/~agarnier/Hur_c17.htm accessed on 5/2/02
(12) Digital Journal of Ophthalmology: Diagnosis and Discussion "Gonococcal Ophthalmia" URL: http://www.djo.harvard.edu/meei/GR/Watkins091096/Watkins091096Dx.html accessed on 5/2/02
(13) Neisseria gonorrhoeae : Gonorrhea by: Nicholas L. Thompson Jr. URL: http://www.geocities.com/nltjr/Ngonorrhoeae.html accessed on 5/2/02