Gonorrohea

by Megan Cowley

 

Name:

Gonorrhea “the clap”

Scientific Classification:

Kingdom: Bacteria

Phylum: Proteobacteria

Class: Beta Proteobacteria

Order: Neisseriales

Family: Neisseriaceae

Genus: Neisseria

Species: Neisseria gonorrhoeae

 

Means of Transmission and Reservoirs:

 

Gonorrhea is generally passed through sexual contact of an infected penis or vagina, although it can be passed anally or by mouth. Gonorrhea is a bacterium that grows in warm moist areas of the body, such as the vagina, and reproductive tract of a female (cervix, uterus, fallopian tubes).  In men and women it can grow in the urethra, anus, throat, and mouth.  During childbirth an infected mother can pass it to her new born. [6]

 

 

Etiology Agent and Characteristics:

 

The bacteria Neisseria Gonorrhoeae cause the cause of gonorrheaNeisseria has a large number of species that are normal flora or pathogens to humans and animals.

 

Neisseria are Gram-negative, non-capsulated kidney bean shaped diplococci with adjacent sides that are flattened.  Neisseria are aerobic, strongly oxidase-positive, have an oxidative metabolism, are very susceptible to drying, and are incredibly fastidious (growth is inhibited by free fatty acids).  There are four types of N. gonorrhoeae, T1, T2, T3, and T4.  It depends on the presence or non-presence of fimbriae; the bacteria uses the fimbriae to attach onto host cells and are avirulent without them. [2][6]

 

 

Key Tests:

 

Although enzyme substrate tests are intended to be used only for the identification of Neisseria, it also isolates other strains of Neisseria that end up having the same reaction (hydroxyprolyaminopeptidase-positive).  Therefore, additional tests must be performed to differentiate between the different strains of Neisseria.

 

Late in the 1990's, testing for Neisseria gonorrhoeae was revolutionized by the introduction of nucleic acid amplification tests (NAAT).  These tests achieve much greater sensitivity than traditional culture methods by exponentially replicating the nucleic acid of these organisms. The specimens collected are easier to transport and easier to collect by the use of less invasive samples for testing, urine or vaginal swabs rather than urethral or endocervical swabs.  Even though these tests have somewhat higher costs, both patients and clinicians prefer them. 

NAAT tests are approved by the FDA to test genital specimens such as cervical swabs, male/female urethral swabs and urine samples.  NAAT tests have not been adequately evaluated for the correct diagnosis of rectal or pharyngeal infections.  This is dangerous due to the fact that there is an increasing number of heterosexual people who possibly are engaging in oral or rectal sexual activity, especially in adolescents and young adults who view such activities are less risky.

 

Nitrate reduction, superoxol, gram stain, and catalase tests are also used to diagnose Gonorrhea. [2]

 

 

History:

 

Gonorrhea is an ancient disease; in 150 AD it was described and given its present day name by a Greek physician named Galen (gon=semen+rhea=flow; ---a flow of semen), apparently he had confused pus for semen.  It was in 1897, when Albert Neisser, a German physician discovered the bacteria that causes gonorrhea. [2]

 

Historically, the popular English name of gonorrhea has been "the clap." [6] There is a unique history of how the name was derived, it has been suggested that when men or women urinate there is a clapping sensation that stings the genitals.  Another etymology suggests there is a technique to remove the puss from the male's penis by vigorously clapping the penis on both sides attempting to remove the puss from the urethra. The third links the clap to a famous French term for brothel, "clapier," where gonorrhea could have been widespread. [2]

 

 

Signs and Symptoms:

 

Gonorrhea has an incubation period of about 10-20 days.  Most symptoms start to show between the fifteenth and twentieth days after being infected. A small number of people can be asymptomatic for their entire life.

Women usually have mild or no symptoms.  Sometimes gonorrhea is often mistaken for a yeast infection, bladder or vaginal infection.  Initial symptoms are painful/burning urination.  If symptoms increase they can include vaginal discharge, difficulty urinating, abdominal or pelvic pain, bleeding between regular cycles, or bleeding after sexual intercourse. The cervix may appear normal or show extreme cervical inflammation with pus. If infected the urethra also discharges pus. The combination of both an infected uterus and an infected cervix strongly supports a diagnosis of gonorrhea.  Women are at risk of developing serious complications from the infection regardless if symptoms are present or not.

Men have symptoms of burning during urination, white/yellow/green discharge from the penis, or swollen testicles.

Women and men can suffer from discharge of the anus, itching, soreness, bleeding, and painful bowel movements.  Also, Gonorrhea can get into the throat and cause a sore throat, but usually is asymptomatic.  

In adults if the infection remains untreated, it can travel through the bloodstream and infect joints, causing gonococcal arthritis. The bacteria can also multiply in the bloodstream, therefore causing septicemia, which is a blood disease and ultimately spread to major organs of the body.

An infected mother can possibly transmit gonorrhea to her newborn during childbirth.  In newborns the infection is called gonococcal ophthalmia.  The symptoms appear 1-4 days after birth and can affect just one eye, although it is more likely to affect both eyes. Symptoms include redness and swelling of the eyes, swelling and pussy discharge from the eyelids.  If untreated, the infection can attack the eye's cornea and cause blindness. [1][2][3][4][5][6]

 

Microbial Virulence:

In order to infect, the gonococcus must attach to the mucosal cells of the epithelial wall by means of fimbriae, without fimbriae they are avirulent.  The pathogen invades the spaces separating columnar epithelial cells, which are found in the opening of the cervix, external genitalia of prepubertal females, urethra, rectum, eyes and the oral-pharyngeal area.  The invasion creates inflammation then leukocytes move into the inflamed area, creating pus.  It also produces cytotoxic substances, one of which is the LPS endotoxin, that damage epithelial cells with cilia found in fallopian tubes. In reaction to host immune responses, N. gonorrhoeae produces an extracellular protease that cleaves a proline-threonine bond in immunoglobulin IgA, which causes loss of antibody activity.  In men, a single unprotected exposure results in infection 20 to 30% of the time.  Women become infected 60 to 90% of the time from a single exposure. [2] [5]

 

Control and Treatment:

The first successful treatment for gonorrhea happened in the beginning of the twentieth century with the use of penicillin. 

Today there are several antibiotics that can treat Gonorrhea.  However, since the 1970’s there are drug resistant strains of Gonorrhea that are increasing in many areas of the world and the U.S.  It is becoming more difficult to treat because people with Gonorrhea also have Chlamydia.  In this situation a combination of antibiotics is usually given for both.  If you have Gonorrhea or Chlamydia you should be tested for other STD’s.  It is important to take all of the medication that the doctor gives you.  Although the medication will stop the infection but it will not repair any permanent damage done.  It is possible to be re-infected by Gonorrhea if you have sexual relations with another infected person.  The Center for Disease Control has now added Gonorrhea to the list of “super bugs” that are becoming more and more resistant to most of the common antibiotics.  Almost everyone who is diagnosed early will be able to be treated effectively with antibiotics, but it is getting more difficult all the time.  So make sure you are very careful not to contract Gonorrhea a 2nd time. [3] 

The antibiotics that are recommended for treatment include, ceftriaxone and spectinomycin.  Doxycycline is also used as a common treatment for a co-pathogen present in Chlamydia.  Due to high rates of resistance Ciprofloxacin and ofloxacin are no longer recommended.  Because of resistance, a repeat culture and an alternate antibiotic may be needed if the symptoms persist. [3]

Listed below are specific dosages of antibiotics prescribed for Gonorrhea.  They are the updated recommended treatment regimens for gonococcal infections, as of April 2007.  This information is directly from the CDC’s website. [3]

Gonococcal Infections of the cervix, urethra, and rectum:

Ceftriaxone 125mg IM (single dose)

Cefixime 400mg orally (single dose) or 400mg by suspension (200mg/5ml)

Alternate treatments

Spectinomycin 2g IM (single dose)

Cephalosporin regimens (single dose)

Gonococcal Infections of the pharynx:

Ceftraxone 125mg IM (single dose) [3]

 

Prevention:

To reduce your risk of infection, use latex condoms every time you have sex, limit your sexual partners, or have a mutual monogamous relationship.  The best way to prevent contracting Gonorrhea is to abstain from having sex.  Be sure if you are having symptoms you seek medical advice. [6]

 

Current research of a vaccine:

Scientists are researching for a way to develop new and more effective ways of diagnosing/treating gonorrhea.  Reuters Health reports that a new study on mice has suggested a good target for an intransally administered vaccine as of July 2005.  Currently there is no vaccine for Neisseria gonorrhoeae, unlike its cousin Neisseria meningitides, N. gonorrhoeae does not have a capsule.  Therefore, testing has been focused on targeting the bacterium’s surface proteins. [4] 

Since the organism has the ability to rapidly vary it’s surface structures, the efforts to find a vaccine have been extremely non-effective. [4] [5]

 

Current cases/outbreaks Locally and Globally:

Following the implementation of the National Gonorrhea Control Program in the mid 1970’s, from 1975-1997 there was a decrease of cases.  After several years of stable Gonorrhea rates, the national rate has now started to increase.  In 2007 the CDC estimated more than 700,000 new cases in the U.S. a year, however, only about half of the cases are reported.  In 2006 there were 358,366 cases reported. [3]

In the U.S. there is an increasing number of reported cases in teens, young adults, and blacks.  About 75% of all the cases reported are young kids from 15-19 years old.  Although, the highest rates have been found in 15-19 year old women and 20-24 year old men. [3]

Globally there are 62 million cases reported annually. [5]

As reported in 2007, the number of people in Texas who were infected was 32,073.  Which is an increase from 2004, 20,000 cases were reported.  [1] 

 

Rescources:

Keiser Family Foundation, http://www.statehealthfacts.org/profileind.jsp?ind=102&cat=2&rgn=45 [1]

Microbiology an Introduction. 2007 Pearson Education.  Gerard J. Tortora, Berdell R. Funke, Christine L. Case-9th Edition, website updated 2009,   www.microbiologyplace.com [2]

 

Center for Disease Control, last updated June 2007, http://www.cdc.gov/std/stats07/gonorrhea.htm [3]

 

http://www.urotoday.com/browse_categories/sexually_transmitted_disease/promising_target_identified_for_gonorrhea_vaccine.html [4]

 

WHO 2009, https://acconline.austincc.edu/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2fwebapps%2fblackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_7243_1%26url%3d [5]

 

2005-2009 WebMD, LLC. All rights reserved  http://www.webmd.com/sexual-conditions/gonorrhea?page=2 [6]