Gonorrhea: Pathogen and Symptoms of the gonococcal Urethritis (1/2)
- Gonorrhea (1/2): Etiology, Signs and Symptoms
- Gonorrhea (2/2): Diagnosis and Treatment
Review-Literature: (CDC Guidelines, 2006) (Moran, 2003) (Schneede et al, 2003).
Definition of Gonorrhea
Gonorrheal urethritis (GU), is a venereal disease caused by Neisseria gonorrhoeae with purulent urethral discharge.
Epidemiology of Gonorrhea
150-400/100 000 new cases per year, downward trend in Europe (but not in the risk population).
Etiology of Gonorrhea
Bacterial pathogen:
gram-negative diplococcus Neisseria gonorrhoeae. Strictly aerobic. Unencapsulated.
Morphology of Gonococcus:
gram-negative diplococci with a diameter of about 1 micron (coffee bean-shaped). Frequently intracellular in granulocytes [fig. gonorrhea (microscopy)].
 |
fig. gonorrhea: schematic drawing of the microscopic finding of urethral discharge. Neisseria gonorrhoeae are gram-negative diplococci (coffee bean-shaped), often intracellular in granulocytes. Figure from Dr. Norman Jacobs, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Virulence factors:
there are pili for the attachment to human epithelial cells and secretion of proteins as virulence factors: porins, IgA-ase, penicillinase. The contact of gonococci leads to endocytosis and basal exocytosis. This results in an infection of the lamina propria.
Transmission of gonorrhea:
mucus membrane infection due to vaginal, oral or anal sexual contact. The risk of infection per intercourse for men is around 17%. Rare transmission occurs through birth or as aerosol infection (conjunctivitis). Humans are the only reservoir for Neisseria gonorrhoeae.
Gonorrhea: Signs and Symptoms
Urethritis:
the incubation period is 3-10 days with a large variance depending on the bacterial strain. Typical symptoms are purulent discharge from the urethra [fig. purulent discharge (gonorrhea)], dysuria, pain in the urethra, inguinal lymphadenopathy. The extent of the symptoms is variable, normally women experience less symptoms than men.
 |
fig. urethral discharge due to gonorrhea: with purulent abscess lesion on the glans. Figure from the image collection of the Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Extragenital Infections:
Proctitis, conjunctivitis (ophthalmia neonatorum), particularly in neonates [fig. neonatal conjunctivitis], pharyngitis, arthritis, gonococcal sepsis.
 |
fig. gonococcal neonatal conjunctivitis: purulent conjunctivitis of the newborn. Figure from the image collection of the Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Complications of Gonorrhea
Complications in men:
Acute prostatitis, epididymitis, urethral strictures, infertility.
Complications in women:
Bartholinitis, cervical endometritis, pelvic inflammatory disease, infertility.
Fitz-Hugh-Curtis syndrome:
ascending pelvic inflammatory disease with peritoneal infection. Often right-sided abdominal pain due to infection of the hepatic peritoneum (perihepatitis).
Reiter's syndrome:
due to a mixed infection with Chlamydia, the Reiter's syndrome can also be possible in gonorrhea. See also chapter non-gonococcal urethritis.
| STD | Index | Gonorrhea Treatment |
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References
- Center for Disease Control and Prevention.:
- Sexually transmitted diseases treatment guidelines 2006.
in: MMWR
2006; 55 (No. RR-11): 1–93.
- Moran 2003 MORAN, J.:
- Gonorrhea.
In: Clin Evid
(2003), Nr. 10, S. 1854–62
- Schneede u.a. 2003 SCHNEEDE, P. ; TENKE, P. ; HOFSTETTER, A. G.:
- Sexually transmitted diseases (STDs)-a synoptic overview for
urologists.
In: Eur Urol
44 (2003), Nr. 1, S. 1–7
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Deutsche Version: Gonorrhoe: Erreger und Klinik gonorrhoischen Urethritis.
Last update:
Dr. med. Dirk Manski (E-Mail)