Gonorrhea overview: Difference between revisions
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===Historical Perspective=== | ===Historical Perspective=== | ||
Gonorrhea is an ancient disease with Biblical Testament references. However, the exact time of onset of gonorrhea cannot be accurately determined from the historical record.<ref name=History-Gonorreha> Genco, Caroline Attardo. Neisseria: molecular mechanisms of pathogenesis. Horizon Scientific Press, 2010.</ref> In 1879, gonorrhea was referred to as “the clap” by German bacteriologist Albert Neisser.<ref name=Gonorrhea> Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev 2014;27:587–613. </ref> The first reliable antibiotic ([[sulfonamides]]) prove effective against gonorrhea in 1930s.<ref name=History-Gonorreha> Genco, Caroline Attardo. Neisseria: molecular mechanisms of pathogenesis. Horizon Scientific Press, 2010.</ref> | Gonorrhea is an ancient disease with Biblical Testament references. However, the exact time of onset of gonorrhea cannot be accurately determined from the historical record.<ref name=History-Gonorreha> Genco, Caroline Attardo. Neisseria: molecular mechanisms of pathogenesis. Horizon Scientific Press, 2010.</ref> In 1879, gonorrhea was referred to as “the clap” by German bacteriologist Albert Neisser.<ref name=Gonorrhea> Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev 2014;27:587–613. </ref> The first reliable antibiotic ([[sulfonamides]]) prove effective against gonorrhea in 1930s.<ref name=History-Gonorreha> Genco, Caroline Attardo. Neisseria: molecular mechanisms of pathogenesis. Horizon Scientific Press, 2010.</ref> | ||
===Classification=== | ===Classification=== | ||
Based on anatomic location gonorrhea may be classified into three subtypes: urogenital, extragenital, and disseminated gonococcal infection. | Based on anatomic location gonorrhea may be classified into three subtypes: urogenital, extragenital, and disseminated gonococcal infection. | ||
Additionally, gonococcal infections may be classified according to the affected organ system into many subtypes.<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815 }} </ref><ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626 }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736 }} </ref> | Additionally, gonococcal infections may be classified according to the affected organ system into many subtypes.<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815 }} </ref><ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626 }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736 }} </ref> | ||
===Pathophysiology=== | |||
Gonorrhea is a sexually transmitted disease (STD) that is caused by ''[[Neisseria gonorrhea]]''. | |||
It can infect mucus-secreting epithelial cells both in men and women. | |||
The recognized routes of transmission of the ''[[Neisseria gonorrhoeae]]'' include vaginal intercourse, rectal intercourse, fellatio, cunnilingus, and [[perinatal]]. | |||
The main pathogenicity of the ''[[Neisseria gonorrhea]]'' obtains from the attachment ability of the [[pili|surface pili]] to the surface of the [[urethra]], [[fallopian tubes]] and [[endocervix]].<ref name="pmid4958881">{{cite journal| author=Sparling PF| title=Genetic transformation of Neisseria gonorrhoeae to streptomycin resistance. | journal=J Bacteriol | year= 1966 | volume= 92 | issue= 5 | pages= 1364-71 | pmid=4958881 | doi= | pmc=276432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4958881 }} </ref><ref name="pmid4631989">{{cite journal| author=Swanson J| title=Studies on gonococcus infection. IV. Pili: their role in attachment of gonococci to tissue culture cells. | journal=J Exp Med | year= 1973 | volume= 137 | issue= 3 | pages= 571-89 | pmid=4631989 | doi= | pmc=2139381 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4631989 }} </ref><ref name="pmid9701824">{{cite journal| author=Wolfgang M, Lauer P, Park HS, Brossay L, Hébert J, Koomey M| title=PilT mutations lead to simultaneous defects in competence for natural transformation and twitching motility in piliated Neisseria gonorrhoeae. | journal=Mol Microbiol | year= 1998 | volume= 29 | issue= 1 | pages= 321-30 | pmid=9701824 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9701824 }} </ref> | |||
Anotehr virulence factors of gonorrhea is [[porin]]. two main porin serotypes include PorB.1A strains (resulting in a disseminated gonococcal infection) and PorB.1B strains (resulting in local genital infections).<ref name="pmid6407021">{{cite journal| author=Young JD, Blake M, Mauro A, Cohn ZA| title=Properties of the major outer membrane protein from Neisseria gonorrhoeae incorporated into model lipid membranes. | journal=Proc Natl Acad Sci U S A | year= 1983 | volume= 80 | issue= 12 | pages= 3831-5 | pmid=6407021 | doi= | pmc=394146 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6407021 }} </ref><ref name="pmid11157049">{{cite journal| author=Ram S, Cullinane M, Blom AM, Gulati S, McQuillen DP, Monks BG et al.| title=Binding of C4b-binding protein to porin: a molecular mechanism of serum resistance of Neisseria gonorrhoeae. | journal=J Exp Med | year= 2001 | volume= 193 | issue= 3 | pages= 281-95 | pmid=11157049 | doi= | pmc=2195916 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11157049 }} </ref><ref name="pmid9705949">{{cite journal| author=Ram S, McQuillen DP, Gulati S, Elkins C, Pangburn MK, Rice PA| title=Binding of complement factor H to loop 5 of porin protein 1A: a molecular mechanism of serum resistance of nonsialylated Neisseria gonorrhoeae. | journal=J Exp Med | year= 1998 | volume= 188 | issue= 4 | pages= 671-80 | pmid=9705949 | doi= | pmc=2213355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9705949 }} </ref> | |||
In '''pregnancy''', gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the [[Neonatal Conjunctivitis|conjuctiva]]. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. | |||
Additionally, development of '''disseminated gonococcal infection''' is the result of ''Neisserial'' organisms dissemination to the blood due to a variety of predisposing factors, such as change in PH, pregnancy, menstruation, PorB.1A strains, and complement deficiencies.<ref name=DGI>WATRING, WATSON G., and DANIEL L. VAUGHN. "Gonococcemia in pregnancy." Obstetrics & Gynecology 48.4 (1976): 428-430.</ref><ref name=DGI-2> Angulo, Juan M., and Luis R. Espinoza. "Gonococcal arthritis." Comprehensive therapy 25.3 (1999): 155-162.</ref><ref name="pmid3088132">{{cite journal| author=Bohnhoff M, Morello JA, Lerner SA| title=Auxotypes, penicillin susceptibility, and serogroups of Neisseria gonorrhoeae from disseminated and uncomplicated infections. | journal=J Infect Dis | year= 1986 | volume= 154 | issue= 2 | pages= 225-30 | pmid=3088132 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3088132 }} </ref><ref name="pmid6415361">{{cite journal| author=O'Brien JP, Goldenberg DL, Rice PA| title=Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. | journal=Medicine (Baltimore) | year= 1983 | volume= 62 | issue= 6 | pages= 395-406 | pmid=6415361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6415361 }} </ref> | |||
===Causes=== | |||
'''''Neisseria gonorrhoeae''''', also known as '''''gonococci''''' (plural), or '''''gonococcus''''' (singular), is a species of [[Gram-negative]] coffee bean-shaped [[diplococci]] [[bacteria]] responsible for the [[sexually transmitted infection]] [[gonorrhea]].<ref name=Sherris>{{cite book |editor1-last=Ryan |editor1-first=KJ |editor2-last=Ray |editor2-first=CG |title=Sherris Medical Microbiology | edition = 4th | publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref> | |||
===Slang terms=== | ===Slang terms=== | ||
==="The clap"=== | ==="The clap"=== | ||
Revision as of 02:42, 3 October 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, MBBS [2]
Overview
Gonorrhea (gonorrhoea in British English) is amongst the most common sexually transmitted diseases in the world and is caused by Gram-negative bacterium Neisseria gonorrheae. The term comes from Ancient Greek γονόρροια (gonórrhoia), literally "flow of seed"; in ancient times it was incorrectly believed that the pus discharge associated with the disease contained semen.[1]
The first place this bacterium infects is usually the columnar epithelium of the urethra and endocervix. Non-genital sites in which it thrives are in the rectum, the oropharynx and the conjunctivae of the eyes. The vulva and vagina in women are usually spared because they are lined by stratified epithelial cells—in women the cervix is the usual first site of infection.
Gonorrhea spreads during sexual intercourse. Infected women also can pass gonorrhea to their newborn infants during delivery, causing eye infections (conjunctivitis) in their babies (which if left untreated, can cause blindness). Doctors have often attempted to treat this immediately by applying small amounts of silver nitrate to the eyes of all newborn babies. Gonorrhea among females can also be transmitted from one individual to another via contact to surfaces that may still be damp from prior contact.
Historical Perspective
Gonorrhea is an ancient disease with Biblical Testament references. However, the exact time of onset of gonorrhea cannot be accurately determined from the historical record.[2] In 1879, gonorrhea was referred to as “the clap” by German bacteriologist Albert Neisser.[3] The first reliable antibiotic (sulfonamides) prove effective against gonorrhea in 1930s.[2]
Classification
Based on anatomic location gonorrhea may be classified into three subtypes: urogenital, extragenital, and disseminated gonococcal infection. Additionally, gonococcal infections may be classified according to the affected organ system into many subtypes.[4][5][6]
Pathophysiology
Gonorrhea is a sexually transmitted disease (STD) that is caused by Neisseria gonorrhea. It can infect mucus-secreting epithelial cells both in men and women. The recognized routes of transmission of the Neisseria gonorrhoeae include vaginal intercourse, rectal intercourse, fellatio, cunnilingus, and perinatal. The main pathogenicity of the Neisseria gonorrhea obtains from the attachment ability of the surface pili to the surface of the urethra, fallopian tubes and endocervix.[7][8][9] Anotehr virulence factors of gonorrhea is porin. two main porin serotypes include PorB.1A strains (resulting in a disseminated gonococcal infection) and PorB.1B strains (resulting in local genital infections).[10][11][12]
In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. Additionally, development of disseminated gonococcal infection is the result of Neisserial organisms dissemination to the blood due to a variety of predisposing factors, such as change in PH, pregnancy, menstruation, PorB.1A strains, and complement deficiencies.[13][14][15][16]
Causes
Neisseria gonorrhoeae, also known as gonococci (plural), or gonococcus (singular), is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.[17]
Slang terms
"The clap"
Gonorrhea is also commonly known by the slang term "the clap". One suggested etymology refers to a traditional treatment used to clear the blockage in the urethra from gonorrheal pus, where the penis would be "clapped" on both sides simultaneously.[18] It could also refer to the painful sting in the male urethra, which feels like the sting of a clap (as in clapping hands) when infected with the disease. Yet another suggested source is from the old French word "clapier", meaning "brothel". Another suggested source for the term is from a notorious 18th century keeper of a brothel, Margaret Clap (better known as "Mother Clap"), though perhaps her name itself was derived from the slang term. This term has, in recent years, come to be used by extension to refer to any unspecified sexually transmitted disease.
Causes
Gonorrhea (gonorrhoea in British English) is amongst the most common sexually transmitted diseases in the world and is caused by Gram-negative bacterium Neisseria gonorrheae. The term comes from Ancient Greek γονόρροια (gonórrhoia), literally "flow of seed"; in ancient times it was incorrectly believed that the pus discharge associated with the disease contained semen.[19]
Diagnosis
History and Symptoms
Half of women with gonorrhea are asymptomatic while others have vaginal discharge, lower abdominal pain or pain with intercourse. Most men who are infected have symptoms such as urethritis associated with burning with urination and discharge from the penis. Either sex may also acquire gonorrhea of the throat from performing oral sex on an infected partner, usually a male partner. Such infection is asymptomatic in 90% of cases, and produces a sore throat in the remaining 10%. The incubation period is 2 to 14 days with most of these symptoms occurring between 4–6 days after being infected. Rarely, gonorrhea may cause skin legions and joint infection (pain and swelling in the joints) after traveling through the blood stream. Very rarely it may settle in the heart causing endocarditis or in the spinal column causing meningitis (both are more likely among individuals with suppressed immune systems.
References
- ↑ Definition of the term gonorrhea
- ↑ 2.0 2.1 Genco, Caroline Attardo. Neisseria: molecular mechanisms of pathogenesis. Horizon Scientific Press, 2010.
- ↑ Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev 2014;27:587–613.
- ↑ Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
- ↑ Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK (1987). "The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis". Arch Intern Med. 147 (2): 281–3. PMID 3101626.
- ↑ Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
- ↑ Sparling PF (1966). "Genetic transformation of Neisseria gonorrhoeae to streptomycin resistance". J Bacteriol. 92 (5): 1364–71. PMC 276432. PMID 4958881.
- ↑ Swanson J (1973). "Studies on gonococcus infection. IV. Pili: their role in attachment of gonococci to tissue culture cells". J Exp Med. 137 (3): 571–89. PMC 2139381. PMID 4631989.
- ↑ Wolfgang M, Lauer P, Park HS, Brossay L, Hébert J, Koomey M (1998). "PilT mutations lead to simultaneous defects in competence for natural transformation and twitching motility in piliated Neisseria gonorrhoeae". Mol Microbiol. 29 (1): 321–30. PMID 9701824.
- ↑ Young JD, Blake M, Mauro A, Cohn ZA (1983). "Properties of the major outer membrane protein from Neisseria gonorrhoeae incorporated into model lipid membranes". Proc Natl Acad Sci U S A. 80 (12): 3831–5. PMC 394146. PMID 6407021.
- ↑ Ram S, Cullinane M, Blom AM, Gulati S, McQuillen DP, Monks BG; et al. (2001). "Binding of C4b-binding protein to porin: a molecular mechanism of serum resistance of Neisseria gonorrhoeae". J Exp Med. 193 (3): 281–95. PMC 2195916. PMID 11157049.
- ↑ Ram S, McQuillen DP, Gulati S, Elkins C, Pangburn MK, Rice PA (1998). "Binding of complement factor H to loop 5 of porin protein 1A: a molecular mechanism of serum resistance of nonsialylated Neisseria gonorrhoeae". J Exp Med. 188 (4): 671–80. PMC 2213355. PMID 9705949.
- ↑ WATRING, WATSON G., and DANIEL L. VAUGHN. "Gonococcemia in pregnancy." Obstetrics & Gynecology 48.4 (1976): 428-430.
- ↑ Angulo, Juan M., and Luis R. Espinoza. "Gonococcal arthritis." Comprehensive therapy 25.3 (1999): 155-162.
- ↑ Bohnhoff M, Morello JA, Lerner SA (1986). "Auxotypes, penicillin susceptibility, and serogroups of Neisseria gonorrhoeae from disseminated and uncomplicated infections". J Infect Dis. 154 (2): 225–30. PMID 3088132.
- ↑ O'Brien JP, Goldenberg DL, Rice PA (1983). "Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms". Medicine (Baltimore). 62 (6): 395–406. PMID 6415361.
- ↑ Ryan, KJ; Ray, CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.
- ↑ http://std-gov.org/stds/gonorrhea.htm
- ↑ Definition of the term gonorrhea