A venereal disease (disease spread through sexual contact), caused by Neisseria gonorrhea (Gonococci). Gonorrhea is an exclusive human disease, causing no natural infection in animals.
General characters of Gonococci:
The bacteria are typically kidney- shaped. It has certain structures called pili, which helps in the attachment of the bacteria onto the mucosal surfaces. They are aerobic in nature, grows best at 35- 360C. 5- 10% of carbon dioxide is essential for growth. Gonococci possess heterogeneous antigens. They can change the surface structures, once inside the body. But still, the organism is very delicate. They are easily killed by heat, drying and antiseptics.
Source of transmission:
The only source of infection is a human carrier. Asymptomatic women carriers may spread infection among the male contacts. Fomites do not play any role in disease transmission. The organism cannot survive outside the human body. The only way of transmission is through unsafe sex.
Pathogenicity:
1) The incubation period is about 2- 8 days.
2) The first step of infection is the attachment of the Gonococci, to the urethra or other mucosal surfaces by pili.
3) Attachment is very firm that even strong flow of urine cannot wash out the bacteria.
4) The intercellular space is penetrated through and reaches the sub epithelial connective tissue.
5) This occurs after 3rd day of infection.
In men,
1. Disease starts as an acute urethritis.
2. This often follows a discharge mixed with mucus and pus.
3. This will be high in gonococci.
4. The infection slowly extends to the prostate, seminal vesicles and epididymis.
5. The infection may spread to the neighboring tissues, causing swelling and discharge from the sinus.
6. This condition is termed as ‘watercan perineum’.
7. This leads to sterility in men.
In women,
1) Urethra and the cervix are initially infected.
2) The vaginal region is less affected, as the acidic pH and the epithelial cells are resistant to bacterial attack.
3) In case of pre- pubertal girls, the vulvus and the vagina may get inflamed.
4) The endometrium and the fallopian tubes may also be infected.
5) Pelvic inflammatory disease and salpingitis (inflammation of the fallopian tube) may lead to sterility.
In men and women;
1. Proctitis develops in both sexes, among those who practice anal sex.
2. Conjunctivitis by self inoculation with one’s own fingers.
3. Arthritis
4. Endocarditis
5. Rarely, meningitis
A non- venereal type of gonococcal ophthalmia (ophthalmia neonatorum) in the newborn occurs by direct infection during passage through the birth canal. This often causes bacterimia causing skin lesions on the hands, fore- arm, feet and legs. At times pain may result in knees, ankles and wrists. This is controlled by use of 1% silver nitrate into the eyes of the newborn babies.
Lab diagnosis:
1. Demonstration of bacteria in samples obtained from men can be effective.
2. In women, fluorescent antibody techniques prove to be more useful, as normal smears may contain normal vaginal flora.
3. Urethral discharge and cervical swabs are taken from women.
4. In men, ‘morning drop’ may be obtained after prostatic massage.
Control:
Detection of infection in the early stages, proper health education, prevention of unsafe sex, etc. can control the disease. Clinical disease and vaccination does not confer any immunity.
