PH 152: MEDICAL & PUBLIC HEALTH MICROBIOLOGY

Neisseria
Dr. Evalyn A. Roxas | February 14, 2017

OUTLINE
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A. Subheading III. Review Questions
B. Subheading Font and IV. Citation
Sub-subheading References

I. NEISSERIA GONORRHOEA
A. CHARACTERISTICS
Morphology
Gram-negative diplococcus (also known as gonococcus)
Fastidious organism that grows only in vitro in a narrow temperature range (35 oC to 38oC) on complex media
Usually found around (extracellular) or inside (intracellular) polymorphonuclear cells, especially neutrophils

Virulence Factors

Pili (Fimbriae)
Hair-like appendages
Enhance attachment to host cells and resistance to phagocytosis

Por
Por protein extends through the gonococcal cell membrane
Form pores in the surface through which some nutrients enter the cell
Prevents phagosome-lysosome fusion

Opa Proteins
Function in adhesion of gonococci within colonies and in attachment of gonococci to host cell receptors

Rmp Protein (Protein III)

Associates with Por in the formation of pores on the cell surface

Lipooligosaccharide (LOS)
Low molecular weight form of bacterial lipopolysaccharide (LPS)
Due to absence of any long O-antigen side chains and lack of polysaccharide capsule
Responsible for the endotoxic effects of bacteria

B. PATHOGENESIS
Exclusive human pathogen
Causes gonorrhea
A sexually transmitted infection (STI)
Refers to a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity
Differing symptoms for men and women:
Men: dysuria; presence of mucopurulent urethral discharge; symptomatic; (distinguishable from Chlamydia trachomatis which has non-
purulent mucoid discharge)
Women: asymptomatic; carriers until complications such as Pelvic Inflammatory Disease (PID) have occurred

Epidemiology
High Risk Populations based on sexual activity
Teenagers and Young Adults (15-24)
Multiple Sexual Partners
Unprotected Sexual Intercourse
Anal Sex
Clinical Syndromes
Urethritis and Cervitis
Can be classified as Gonococcal Urethritis (GU) or Non-Gonococcal Urethritis (NGU)
Vaginal Discharge
Bacterial Vaginosis
Trichomoniasis
Vulvovaginal/Candidiasis
Genital, Anal, or Perianal Ulcers
Chancroid
Genital HSV Infections
Granuloma Inguinale (Donovanosis)
Lymphogranuloma Venereum
Pelvic Inflammatory Disease
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 Epididymitis
Human Papillomavirus Infection (HPV)
Urethritis
Urethral inflammation
Mostly infectious, some secondary to non-infectious
Symptoms include:
Dysuria
Urethral Pruritus
Mucoid, Mucopurulent, or Purulent Discharge
Infectious Urethritis is caused by N. gonorrhea as well as Chlamydia trachomatis and Mycoplasma genitalium
Diagnostic Criteria: any of the following signs or laboratory tests
Mucoid, mucopurulent, or purulent discharge
Mucoid = clear white mucous; Purulent = formation of pus; Mucopurulent = combination of both
Gram stain of urethral secretions demonstrating >2 WBC per oil immersion field
Positive Leukocyte Esterase test on first-void urine or microscopic examination of sediment from a spun first-void urine demonstrating
>10 WBC per high power field
Cervicitis
Inflammation of the cervix
Can be caused by either C. trachomatis or N. gonorrhoaea
Two major diagnostic characteristics:
Mucopurulent cervicitis: purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab
specimen
Sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os
Either or both signs might be present
May be asymptomatic or produce abnormal vaginal discharge, intermenstrual vaginal bleeding
Complications
Males: Prostatitis, epididymitis, urethra stricture
Females: Salpingitis, infertility in males
Rarely septicemia, arthritis, and meningitis
Men are less likely to have complications as they experience tangible symptoms, leading them to get treatment earlier than women, who
might not even realize they are infected [Dr. Roxas]
C. DIAGNOSIS
Most of the time, clinical diagnosis is unnecessary as gonorrhea is easily identifiable based on the distinct mucopurulent discharge in the
patients underwear [Dr. Roxas]
Specimen
biggest clue to the identity of the specimen (i.e. urethral discharge will almost always be N. gonorrhea between the two)
Men: Urethral discharge or swabs (rarely)
Women: Urethral discharge, cervical smears and swabs
Smear
Gram-negative intracellular (sometimes extracellular) diplococcus
Typically found associated with or inside polymorphonuclear cells
Culture Media
Although facultative, N. gonorrhea grows best under aerobic conditions, in an atmosphere containing 5% CO2 (e.g. Candle Jar)
Form convex, glistening, elevated, mucoid colonies 1-5mm in diameter
Colonies are transparent or opaque, nonpigmented, and nonhemolytic
Modified Thayer-Martin Medium
5% Chocolate Sheep Blood
Contains antibiotics and nutrients that facilitate growth of Neisseria species while inhibiting the growth of contaminating bacteria or
fungi (selective medium)
Antibiotics include:
Vancomycin kills Gram-positive organisms (except Lactobacillus)
Colistin kills Gram-negative organisms (except Neisseria, sometimes Legionella)
Nystatin kills fungi
Trimethoprim inhibits other gram-negative organisms not completely killed (i.e. swarming Proteus)
Absence of growth may indicate presence of non-pathogenic Neisseria species (i.e. N. flavescens, N. sicca, and N. subflava) which are
part of the normal flora
Martin-Lewis Medium
Biochemical Tests
Confirmatory identification: to differentiate the species
Sugar Fermentation
N. gonorrhoeae will utilize only glucose and not maltose as opposed to N. meningitidis which utilizes both
Oxidase Test
Bacteria are spotted on a filter paper soaked with tetramethylparaphenylenediamine hydrochloride (oxidase)
Presence of Neisseria indicated by rapid appearance of dark purple color
Latex Agglutination
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 Usually to differentiate N. meningitidis as it makes use of CSF samples
Figure *. Identification Schema of Neisseria species [2017 Trans]

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