Gonorrhea pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Pathophysiology
Gonorrhea is a sexually transmitted disease (STD) that is caused by a gram negative diplococcus (Neisseria gonorrhea). It can infect both men and women. Neisseria gonorrhoeae is usually transmitted via the sexual contact.
- Vaginal
- Anal
- Oral
The main pathogenicity of the Neisseria gonorrhea obtains from the surface pili. The pili helps Neisseria gonorrhea to attach on the surface of the urethra, fallopian tubes and endocervix and survive the host defence mechanism by following methods:
- Preventing phagocytosis by neutrophils
- Producing IgA protease
allowing attachment to these surfaces. Adherence to the surface of spermatozoa allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate. The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction. It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary. In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture