gonorrhea
...through incidental contact with an infected person such as shaking hands, the sharing eating utensils or other social interaction. Laboratory diagnosis × The bacteria can be detected through obtaining a smear from the urethra, the neck of the uterus, the throat or the rectum then examining it under a microscope. × Microscopy and culture are the two methods used for diagnosis. In male patients with urethritis, the diagnosis can be made by direct microscopy of stained smears of urethral discharge. × Recently developed tests using cycling probe technology, such as examination of urine by PCR, allow diagnosis to be made without the need for culture. However, culture is essential for surveillance of antimicrobial susceptibility. × Gonococci are Gram-negative diplococci with adjacent sides flattened, 0.5–1.5 µm diameter. A typical picture shows intracellular Gram-negative diplococci (within polymorphonuclear leukocytes). Good samples would have numerous polymorphs, while inadequate samples may show mostly epithelial cells. A positive smear should have many Gram-negative intracellular diplococci. What is gonorrhea? Gonorrhea is caused by the gonococcus, a bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. In women, the cervix is the most common site of infection. However, the disease can spread to the uterus (womb) and fallopian tubes, resulting in pelvic inflammatory disease (PID); this can cause infertility and ectopic (tubal) pregnancy. Gonorrhea is most commonly spread during genital contact, but it can also be passed from the genitals of one partner to the throat of the other during oral sex Gonorrhea is resistant to penicillin, ampicillin, and amoxicillin The pathogenic mechanism involves the attachment of the bacterium to nonciliated epithelial cells via pili (fimbriae) and the production of endotoxin. The disease gonorrhea is a specific type of urethritis that, in adults, practically always involves mucous membranes of the urethra, resulting in a copious discharge of pus, more obvious in the male than the female. Gonorrheal infection is generally limited to superficial mucosal surfaces lined with columnar epithelium. The areas most frequently involved are the urethra, cervix, rectum, pharynx, and conjunctiva. Squamous epithelium, which lines the adult vagina, is not susceptible to infection by the N. gonorrhoeae. However, the prepubertal vaginal epithelium, which has not been keratinized under the influence of estrogen, may be infected. Hence, gonorrhea in young girls may present as vulvovaginitis. Mucosal infections are usually characterized by a purulent discharge. There is intense burning and pain upon urination. In the days before diagnostic bacteriology, it was said that one could diagnose gonorrhea (as opposed to other types of "nonspecific urethritis") by having the patient urinate while holding a ten-penny nail between the teeth. Biting through the nail while urinating was taken as evidence of gonorrhea. The bacteria adhere to columnar epithelial cells, penetrate them, and multiply on the basement membrane. Adherence is mediated through fimbriae and opa (P.II) proteins. although nonspecific factors such as surface charge and hydrophobicity may play a role. Fimbriae undergo both phase and antigenic variation. The bacteria attach only to microvilli of nonciliated columnar epithelial cells. Attachment to ciliated cells does not occur. bacteria enter the epithelial cells by a process called parasite-directed endocytosis. During endocytosis the membrane of the mucosal cell retracts, pinching off a membrane-bound vacuole that contains the neisseriae; this vacuole is rapidly transported to the base of the cell, where bacteria are released by exocytosis into the subepithelial tissue. T...