Gonococcal Infections

Nneka A. Holder

doi:10.1542/pir.29-7-228

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Nneka A. Holder, MD, MPH*

^*Center for Adolescent Health, Children's Hospital Medical Center of Akron, Akron, Ohio

Objectives

After completing this article, readers should be able to:

Understand the clinical importance of recognizing and treating gonococcal infections.
Describe the different types of infections that are caused by Neisseria gonorrhoeae.
Differentiate between cervicitis and pelvic inflammatory disease.
Discuss treatments for gonococcal infections.

Causes

Neisseria gonorrhoeae is a gram-negative diplococcus that is oxidase-positive and produces beta-lactamase. (1) This quality differentiates it from other species of Neisseria because it requires iron for growth and can metabolize only glucose, lactate, and pyruvate. It is nonmotile and does not produce spores. There are at least 70 different strains, characterized by the absence or presence of pili, opacity of colonies, auxotyping (nutritional requirements), serotyping, and genotyping. (2) Only humans have been reported to be infected by N gonorrhoeae.

Pathophysiology

Gonococcal infections tend to be associated with the acute onset of symptoms and purulent mucosal drainage due to the organism's ability to recruit polymorphonuclear leukocytes (PMNs). Piliated strains increase adherence and virulence of such organisms by enhancing their attachments to human cells (including sperm). Opacity-associated proteins also affect virulence by enhancing gonococcal adherence to host cells. The organism attacks cuboidal or columnar epithelial surfaces on mucosal cells. Subsequent mucosal damage and invasion lead to an inflammatory response due to PMN recruitment. N gonorrhoeae also has an affinity for blood. Hence, transmission may occur from lower genital structures (vagina and cervix) to higher genital structures (endometrium, fallopian tubes, ovaries) and possibly spread into the peritoneal space via refluxed menstrual blood or by attachment to sperm. It is common for female patients who have a gonococcal infection to present during menses with fever due to the inflammatory response.

Epidemiology

Gonococcal infection is the second most common bacterial disease in the United States that is classified as a reportable and notifiable infection. In 2005, the national rate was reported …