Neisseria gonorrhoeae

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Neisseria gonorrhoeae
Neisseria gonorrhoeae cultured on two different media types.
Neisseria gonorrhoeae cultured on two different media types.
Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Beta Proteobacteria
Order: Neisseriales
Family: Neisseriaceae
Genus: Neisseria
Species: N. gonorrhoeae
Binomial name
Neisseria gonorrhoeae
Zopf, 1885

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Neisseria gonorrhoeae (also known as Gonococci) is a species of Gram-negative bacteria responsible for the sexually transmitted disease gonorrhoea.[1] Neisseria are highly fastidious cocci, requiring nutrient supplementation to survive. Thus, they grow on Chocolate agar (heated blood agar) with carbon dioxide. These cocci are facultatively intracellular and typically appear in pairs (diplococci).

Gonorrhoea symptoms include a purulent (or pus-like) discharge from the genitals which may be foul smelling, a burning sensation during urination and conjunctivitis commonly in neonates; that's why silver nitrate is used as a preventive measure. It also occurs occasionally in adults. Neisseria is usually isolated on a Thayer-Martin agar — an agar plate with 3 different antibiotics and nutrients which not only facilitate the growth of Neisseria species, but inhibit the growth of Gram-positive organisms and most bacilli and fungi. Further testing to differentiate the species includes testing for oxidase (all Neisseria show a positive reaction) and the carbohydrates maltose, sucrose, and glucose test in which N. gonorrhoeae will only oxidize (that is, utilize) the glucose.

If N. gonorrhoeae is resistant to the penicillin family of antibiotics, then ceftriaxone (a third-generation cephalosporin) is often used.

Patients should also be tested for Chlamydia infections, since co-infection is frequent.

Diagnosis

Pathology

Treatment

  • Neisseria gonorrhoeae infections[3]
  • 1. Gonococcal infections in adolescents and adults
  • 1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)
  • 1.2 Uncomplicated gonococcal infections of the pharynx
  • 1.2.1 Management of sex partners
  • Expedited partner therapy: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose
  • Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
  • If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
  • To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
  • 1.2.2 Allergy, intolerance, and adverse reactions
Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
  • 1.2.3 Pregnancy
  • 1.2.4 Suspected cephalosporin treatment failure
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Gemifloxacin 320 mg PO single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
  • Alternative regimen (2): Gentamicin 240 mg IM single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
  • Alternative regimen (3): Ceftriaxone 250 mg IM as a single dose AND Azithromycin 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
  • 1.3 Gonococcal conjunctivitis
Note: Consider one-time lavage of the infected eye with saline solution.
  • 1.3.1 Management of sex partners
  • Patients should be instructed to refer their sex partners for evaluation and treatment.
  • 1.4 Disseminated gonococcal infection
  • 1.4.1 Arthritis and arthritis-dermatitis syndrome
  • 1.4.2 Gonococcal meningitis and endocarditis
  • 2. Gonococcal Infections Among Neonate
  • 2.1 Ophthalmia neonatorum caused by N. gonorrhoeae
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
  • Disseminated Gonococcal Infection and Gonococcal Scalp Abscesses in Neonates
  • Preferred regimen : Ceftriaxone 25-50 mg/kg/day IM/IV qd for 7 days OR Cefotaxime 25 mg/kg IV /IM q12h for 7 days.
  • Note:The duration of treatment is 10-14 days if meningitis is documented
  • Treatment of Neonates Born to Mothers Who Have Gonococcal Infection in the Absence of Signs of Gonococcal Infection
  • Preferred regimen : Ceftriaxone 25-50 mg/kg/day IM/IV in a single dose, not to exceed 125 mg
  • Gonococcal Infections Among Infants and Children
  • Infants and Children Who Weigh ≤45 kg and Who Have Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or Proctitis
  • Preferred regimen : Ceftriaxone 25-50 mg/kg/day IM/IV in a single dose, not to exceed 125 mg
  • Children Who Weigh >45 kg and Who Have Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or Proctitis
  • Preferred regimen : Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
  • Alternative regimen: Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)
  • Children Who Weigh ≤45 kg and Who Have Bacteremia or Arthritis
  • Preferred regimen : Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM or IV q 24 h for 7 days
  • Children Who Weigh >45 kg and Who Have Bacteremia or Arthritis
  • Preferred regimen : Ceftriaxone 1 g IM /IV q 24 for 7 days

Prophylaxis

  • Neisseria gonorrhoeae
  • Ophthalmia Neonatorum
  • Preferred regimen : Erythromycin (0.5%) ophthalmic ointment in each eye in a single application at birth

References

  1. Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0838585299.
  2. http://picasaweb.google.com/mcmumbi/USMLEIIImages
  3. Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.