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Gonorrhea
This is a disease caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in
mucus membranes of the body especially reproductive tract, including the cervix , uterus , and
fallopian tubes in women, and in the urethra in women and men. The bacteria can also grow in
the mouth, throat, and anus.
Morphology
Under oil immersion, they are intracellular Gram-negative kidney-shaped diplococci in
polymorphonuclear leukocytes, the presence of which is required for the presumptive diagnosis
of gonorrhea. The presence of extracellular Gram-negative diplococci is an equivocal finding
that must be confirmed by culture or nucleic acid test. The endocervical smears from females or
rectal specimens are more difficult to interpret due to the presence of other Gram-negative
coccobacilli, including Moraxella osloensis, Moraxella phenylpyruvica, Kingella
denitrificans and Acinetobacter species (Nancy, seifert, koomey,580)
Gram stain
Gram-negative diplococcic
Pigmentation
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N. gonorrhoeae colonies are pinkish-brown in color. Clear, golden-brown pigmentation apparent
after incubation for 48 h. cultures results from autolysis of the cells (Nancy, seifert, koomey,578)
Oxidase Test
Oxidase test positive
Acid Production
Acid only from glucose
Enzyme Substrate Test
Hydroxyprolylaminopeptidase positive
Nitrate Reduction Test
Nitrate negative
Polysaccharide from Sucrose
Strains of some organisms do not grow on medium on which polysaccharide is detected,
polysaccharide may be found in the growth inoculated onto the plate (Nancy, seifert, koomey,
583) N. gonorrhoeae does not produce polysaccharide from sucrose. Production of
Deoxyribonuclease (DNase)
DNase negative
Superoxol Test
Reaction with 30% hydrogen peroxide
Superoxol positive; all strains give positive reaction
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Catalase Test
Reacts with 3% hydrogen peroxide
The Disease
Gonorrhea disease transmitted through sexual contact with an infected person. Gonorrhea may
also be spread by contact with infected bodily fluids, so that a mother could transmit the
infection to her newborn during birth.
The most usual site of Neisseria gonorrhea infection is the urogenital tract. Men with this
infection may also experience dysuria with penile discharge, and women might also have slight
vaginal mucopurulent discharge, extreme pelvic pain, or no symptoms. A different N. gonorrhea
infection occurs around anorectal, conjunctival, pharyngeal, and ovarian/uterine. Infections that
arise inside the neonatal length may also cause ophthalmic neonatorum. If left untreated, N.
gonorrhea infections can disseminate to other regions of the body, which generally reasons
synovium and pores and skin infections(Susan,850). Disseminated gonococcal contamination
presents as a few pores and skin lesions which can be restricted to the extremities. Those legions
start as papules and progress into bullae, petechia, and necrotic lesions.
Gonorrhea Symptoms in women
Lower abdominal pain, burning urine, red itchy eyes, Bleeding between periods, Spotting during
intercourse, vulvitis and Burning throat.
In some women, symptoms mild and go unnoticed.
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Many women with gonorrhea discharge think they have a yeast infection and self-treat with over-thecounter yeast infection drug (Douglas S, 1275)
Gonorrhea symptoms in men
Greenish yellow discharge from penis, burning urine, burning throat, swollen testicles, and swollen
glands in the throat.
Treatment
Treatment is always (1) outpatient for genital infection; however, (2) admission may be
necessary for complicated disseminated gonococcal infection (DGI) or gonococcal arthritis.
In females, the risk of complications is much higher. In light of high rates of noncompliance,
reinfection, and poor follow-up, clinicians advocate admitting a female patient whenever a
question of a complication of pelvic inflammatory disease (PID) is present. Institutions have
attempted to quantify abnormalities found on pelvic examination in an attempt to admit those
patients with a higher likelihood of complications (Susan, 852)
Cases with future fertility at risk, physicians are fairly aggressive, especially in situations in
which the patient is young and unfamiliar to them.
Physicians admit patients with corneal involvement for treatment with IV antibiotics.
Drugs

Ceftriaxone 250 mg intramuscular (IM) single dose and

Azithromycin 1 g PO single dose
Because of multidrug-resistant gonorrhea, treatment recommendations are as follows

Treat gonorrhea with a single intramuscular injection of 250 mg ceftriaxone plus
azithromycin 1 g PO as a single dose
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
If ceftriaxone is unavailable, patients be given a single oral dose of cefixime 400 mg and a
single dose of azithromycin 1 g PO
Ceftriaxone mode of action
Ceftriaxone inhibits the mucopeptide synthesis in the bacterial cell wall. The beta-lactam part of
Ceftriaxone binds to carboxypeptidases, endopeptidases, and transpeptidases in the bacterial
cytoplasmic membrane. (Susan,852)
The above enzymes are involved in cell-wall synthesis and cell division. By binding to these
enzymes, Ceftriaxone results in the formation of defective cell walls and cell death.
Azithromycin mode of action
Azithromycin a macrolide antibiotic inhibits bacterial protein synthesis, quorum-sensing and
reduces the formation of biofilm. Accumulating effectively in cells, particularly phagocytes, it is
delivered in high concentrations to the site of infection, as reflected in rapid plasma clearance
and extensive tissue distribution.
Prevention as a form of long term treatment

abstaining from sexual intercourse

using condom every time you have vaginal, oral, or anal sexual intercourse

having only one sexual partner who is uninfected and who is also sexually monogamous

Since gonorrhea doesn’t cause symptoms, it’s good to get tested regularly. Consult your
doctor about frequency of testing gonorrhea and other STIs.

Avoid having sexual intercourse for at least seven days after completion of treatment.
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Treatment side effects
Side effects of certain medications are another concern regarding antibiotic therapy. All the
recommended antibiotic medications can cause changes in the bacteria that normally inhabit the
bowel or vagina (Michael A, 642) this makes women more susceptible to diarrhea or vaginal
yeast infections because the bacteria treatment kills the normal flora.
Gastrointestinal discomfort is another common side effect of antibiotics.
Others include;

Ceftriaxone and cefixime can trigger allergic reactions.

May cause kidney damage.

Ciprofloxacin and ofloxacin, have been linked to problems in the nervous system like
headaches, dizziness, and convulsions.
For me I would prefer the short term treatment since the infection is somehow shameful but I
would back on doctor’s advice.
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Work cited
Freitag, Nancy E., H. Steven Seifert, and Michael Koomey. "Characterization of the pilF—pilD
pilus‐assembly locus of Neisseria gonorrhoeae." Molecular microbiology 16.3 (1995): 575-586.
Wang, Susan A., et al. "Multidrug-resistant Neisseria gonorrhoeae with decreased susceptibility
to cefixime—Hawaii, 2001." Clinical Infectious Diseases 37.6 (2003): 849-852.
Kellogg, Douglas S., et al. "Neisseria gonorrhoeae I. Virulence genetically linked to clonal
variation." Journal of Bacteriology 85.6 (1963): 1274-1279.
Apicella, Michael A., et al. "The pathogenesis of gonococcal urethritis in men: confocal and
immunoelectron microscopic analysis of urethral exudates from men infected with Neisseria
gonorrhoeae." Journal of Infectious Diseases 173.3 (1996): 636-646.
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