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Chapter 9 : Complications and Long-Term Sequelae of Infections by Neisseria gonorrhoeae
Category: Clinical Microbiology
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The species Neisseria gonorrhoeae in the genus Neisseria belongs to the family Neisseriaceae, which consists mostly of gram-negative cocci that divide in two planes at right angles to each other. Gonococci can be detected in Gram-and methylene blue-stained smears of body secretions, in which characteristic “coffee bean” diplococci can be seen. Gonococci may also be detected in the rectum in patients with gonococcal proctitis; in eye secretions in cases of gonococcal conjunctivitis, including in newborns with ophthalmia neonatorum; in the oropharynx of patients with gonococcal pharyngitis; and in skin blisters in cases of disseminated gonococcal infections (DGI) (i.e., gonococcal septicemia). The chapter first focuses on epidemiology of gonorrhea. Next, it concentrates on long-term sequelae of gonorrhea, and specified complications. Gonococcal endometritis is usually regarded as part of an ascending infection reaching the fallopian tubes leading to salpingitis. Since it is difficult to distinguish between these entities clinically, the term pelvic inflammatory disease (PID) is used to cover both conditions. Serological studies have demonstrated that gonococci, chlamydia, and mycoplasma organisms are independently associated with tubal factor infertility (TFI). Both gonococci and chlamydia organisms can cause a profound destruction of the tubal epithelium. Ectopic or extrauterine pregnancy may be long-term sequela of gonococcal salpingitis. Urethral stricture is also one of the long-term sequelae of gonorrhea. Finally, the chapter focuses on primary and secondary interventions to reduce complications and sequelae of gonorrhea.
Microimmunofluorescent (MIF) and indirect hemagglutination (IHA) antibodies to Neisseria gonorrhoeae in males and females attending a venereal disease clinic in Greenland.
Influence of cell-free culture filtrates of N. gonorrhoeae (A) and purified gonococcal endotoxin (B) on mucociliary wave activity in tissue cell culture of human fallopian tube epithelium.
Electron micrograph showing gonococci and gonococcal endotoxin blebs, which can be seen as indistinct structures outside the epithelial cells. The endotoxin, in turn, influences the host cells to produce pseudopodia. There is a repelling force between gonococci and host cells, which are both negatively charged. The tip of a cell pseudopodium and the tip of a gonococcal pilus represent a minimal contact surface with a minimum of physical repelling force, which will facilitate the initial phase of an intracellular uptake of gonococci.