Neisseria gonorrhea (STI) symptoms, pathophysiology, complications and treatment — Transcript

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1. 0:05Hello, in this video we're going to talk
2. 0:06about Neisseria gonorrhoeae.
3. 0:09Neisseria gonorrhoeae is a gram negative
4. 0:12diplococci which causes gonorrhea, a
5. 0:14sexually transmitted infection.
6. 0:17Which, if left untreated, can cause
7. 0:18serious complications such as septic
8. 0:21arthritis and pelvic inflammatory
9. 0:22disease.
10. 0:24Gonorrhea is the second most common
11. 0:26bacterial sexually transmitted infection
12. 0:28worldwide after chlamydia.
13. 0:31Rates of gonorrhea infection have been
14. 0:33increasing thanks to the emergence of
15. 0:36broad-spectrum antibiotic-resistant
16. 0:39organisms.
17. 0:42Let's talk about the life cycle of
18. 0:43Neisseria gonorrhoeae.
19. 0:45Neisseria gonorrhoeae is a gram negative
20. 0:48obligate fastidious diplococcus
21. 0:50bacteria.
22. 0:52Like all gram negative bacteria,
23. 0:54Neisseria gonorrhoeae possesses a cell
24. 0:56envelope which is composed of an inner
25. 1:00cytoplasmic membrane,
26. 1:02a middle layer of peptidoglycan, and an
27. 1:04outer membrane.
28. 1:06The outer membrane contains
29. 1:08lipooligosaccharides,
30. 1:11or LOS,
31. 1:12which is an endotoxin.
32. 1:17The outer membrane also contains the
33. 1:18phospholipid and a variety of proteins
34. 1:21that contribute to cell adherence,
35. 1:24tissue invasion, and resistance to host
36. 1:28defenses.
37. 1:30Neisseria gonorrhoeae has many dynamic
38. 1:33polymeric protein filaments called pili,
39. 1:37which allow the bacteria to adhere to
40. 1:40and move along surfaces of cells.
41. 1:47Neisseria gonorrhoeae is transmitted
42. 1:49sexually
43. 1:50either oral, genital, or anal routes.
44. 1:54Neisseria gonorrhoeae can also be
45. 1:55transmitted perinatally from mother to
46. 1:59infant.
47. 2:01Risk factors for Neisseria gonorrhoeae
48. 2:04and its infection
49. 2:07include age 20 to 29, having multiple
50. 2:11sexual partners, having unprotected sex,
51. 2:15having known partners with gonorrhea,
52. 2:17men who have sex with men,
53. 2:19current or prior history of sexual
54. 2:21transmitted infections.
55. 2:25Let's talk about the pathophysiology of
56. 2:26Neisseria gonorrhoeae and how it causes
57. 2:30all the complications associated with
58. 2:32it.
59. 2:34Firstly,
60. 2:36the acquisition of Neisseria gonorrhoeae
61. 2:38is through sexual contact mainly as we
62. 2:40have learned.
63. 2:42Neisseria gonorrhoeae infects primarily
64. 2:45columnar epithelial cells.
65. 2:48In this scenario, it is in the urethra
66. 2:52or the vaginal epithelium.
67. 3:00The pili of the Neisseria gonorrhoeae
68. 3:03attaches and adheres to the columnar
69. 3:05epithelial cells. Adherence to the cells
70. 3:08is also facilitated by opacity proteins
71. 3:11termed Opa proteins.
72. 3:14Neisseria gonorrhoeae have many virulent
73. 3:16factors, really things that help them
74. 3:19with their infection.
75. 3:21The gonococcal lipooligosaccharide,
76. 3:24the LOS, is an endotoxin and causes
77. 3:28ciliostasis
78. 3:29and sloughing of ciliated epithelial
79. 3:31cells, basically damaging the cells.
80. 3:35Lipooligosaccharide
81. 3:37also activates complement and immune
82. 3:39cells such as the macrophages
83. 3:42and neutrophils which also contributes
84. 3:44to the acute inflammatory response.
85. 3:48Neisseria gonorrhoeae have something
86. 3:50called IgA protease.
87. 3:54This enzyme inactivates the host
88. 3:56immunoglobulins, IgA, by cleaving the
89. 3:59molecule in the hinge region, allowing
90. 4:01the bacteria to pass this area without
91. 4:04any problems.
92. 4:07Neisseria gonorrhoea also has a capsule
93. 4:09which helps evade phagocytosis,
94. 4:11basically hide or not be phagocytosed by
95. 4:15the macrophages and neutrophils.
96. 4:18They also contain porin proteins termed
97. 4:21por proteins which help evade immune
98. 4:24system.
99. 4:26All these virulent factors help
100. 4:27essentially with Neisseria gonorrhoea
101. 4:30entering the cell.
102. 4:32They helps the bacteria with mucosal
103. 4:35invasion whilst evading the immune
104. 4:38system.
105. 4:40Mucosal invasion by Neisseria gonorrhoea
106. 4:43result in a local inflammatory response
107. 4:45that produces a purulent exudate.
108. 4:49Transmission can subsequently occur to
109. 4:51another patient with through sexual
110. 4:53contact.
111. 4:54Lipo-oligosaccharides
112. 4:57attaches to sperm cells
113. 5:00and likely leads to transmission from
114. 5:02males to uninfected sexual partners.
115. 5:07Neisseria gonorrhoea may ascend the
116. 5:10urogenital tract and cause
117. 5:13complications.
118. 5:15So, in men
119. 5:17Neisseria gonorrhoea causes urethritis,
120. 5:20epididymitis,
121. 5:23and prostatitis.
122. 5:26Symptoms in men occur in more than 90%
123. 5:29of infections.
124. 5:31And this will manifest as urogenital
125. 5:33gonorrhoea.
126. 5:34Males will describe dysuria with
127. 5:37urethritis, purulent urethral discharge,
128. 5:40yellow and green in color. They may also
129. 5:42complain of abdominal discomfort.
130. 5:52When Neisseria gonorrhoeae causes
131. 5:54infection in the urogenital tract in
132. 5:57females, they can cause acute
133. 5:59endometritis,
134. 6:01salpingitis, which is inflammation of
135. 6:03the fallopian tubes, and acute pelvic
136. 6:07inflammatory disease.
137. 6:10These conditions may lead to infertility
138. 6:12long-term, chronic pelvic pain, and
139. 6:15ectopic pregnancy.
140. 6:17Neisseria gonorrhoeae can also
141. 6:19disseminate from the fallopian tubes
142. 6:21through the peritoneum to the liver
143. 6:23capsule, resulting in something called
144. 6:25perihepatitis,
145. 6:27termed Fitz-Hugh-Curtis syndrome.
146. 6:31Symptoms of urogenital gonorrhea in
147. 6:33females
148. 6:34occur only in 50% of cases,
149. 6:38and many will not manifest the symptoms,
150. 6:40interestingly.
151. 6:42In females, symptoms include cervicitis,
152. 6:46which is inflammation and pain in the
153. 6:48cervix.
154. 6:49They also have purulent cervical
155. 6:51discharge, yellow and malodorous,
156. 6:55dysuria,
157. 6:56as well as abdominal pelvic pain.
158. 7:03Neisseria gonorrhoeae may invade the
159. 7:05lymphatics and blood vessels, as well.
160. 7:08And this can cause other complications,
161. 7:11including inguinal lymphadenopathy,
162. 7:14perineal, perianal, ischiorectal, and
163. 7:18periprostatic abscess, for example,
164. 7:22endocarditis,
165. 7:25as well as disseminated gonococcal
166. 7:27infection,
167. 7:29which is characterized by the classic
168. 7:31triad, hemorrhagic vesiculopustular
169. 7:34eruption, polyarthralgia,
170. 7:37and tenosynovitis.
171. 7:40Other complications can also occur in
172. 7:42the eyes. This typically occurs in
173. 7:44newborn babies as they are prone to eye
174. 7:47infection if their mother has a
175. 7:49gonorrhea infection.
176. 7:51Eye infection can cause permanent
177. 7:53blindness if not treated quickly.
178. 8:01Differential diagnosis of Neisseria
179. 8:03gonorrhoeae infections are really other
180. 8:04sexually transmitted pathogens including
181. 8:07Chlamydia trachomatis,
182. 8:09Trichomonas vaginalis, and Mycoplasma
183. 8:12genitalium.
184. 8:14Investigations and diagnosis is through
185. 8:18nucleic acid amplification test or NAT.
186. 8:23This test is done of a urine,
187. 8:27of the urethral or cervical discharge.
188. 8:33Bacterial cultures can also be done of
189. 8:36fluid from the cervix,
190. 8:38from the blood if it's there is
191. 8:41disseminated infection, of the pharynx
192. 8:43and joint.
193. 8:48Treatment of gonorrhea
194. 8:51is with ceftriaxone
195. 8:54and with the addition possibly of
196. 8:56azithromycin or doxycycline.
197. 9:00It's important to have no sexual contact
198. 9:02for 7 days after treatment is
199. 9:04administered.
200. 9:05There should be no sex with partners
201. 9:07from the last 2 months until the
202. 9:09partners have been tested and treated if
203. 9:11necessary.
204. 9:14So in summary, Neisseria gonorrhoeae is
205. 9:16a gram-negative diplococci which causes
206. 9:19gonorrhea, a sexually transmitted
207. 9:21infection that is common.
208. 9:23Neisseria gonorrhoeae have many virulent
209. 9:26factors including lipooligosaccharides,
210. 9:31IgA proteases, and a capsule.
211. 9:35They're able to evade the immune system
212. 9:37and cause
213. 9:39infection locally in the urogenital
214. 9:41tract or they can disseminate to the
215. 9:44liver
216. 9:45or to the joint
217. 9:47as well as causing
218. 9:49disseminated gonococcal infection with
219. 9:51the classic triad we talked about.
220. 9:54Treatment is with antibiotics such as
221. 9:56ceftriaxone and azithromycin.
222. 9:59Thank you for watching.