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]

Pathophysiology

Gonorrhea is a sexually transmitted disease (STD) that is caused by Neisseria gonorrhea. Neisseria gonorrhea is gram-negative intracellular diplococcus, oxidase-positive, utilizes glucose, but not sucrose, maltose, or lactose. It can infectmucus-secreting epithelial cells both in men and women.

Transmission

The recognized routes of transmission of the Neisseria gonorrhoeae include:

• Male to female via semen. The transmission rate is estimated to be 50%-70% per episode of vaginal intercourse
• Female vagina to male urethra. The transmission rate is estimated to be 20% per episode of vaginal intercourse and increases to 60%-80% after 4 or more exposures.
• Rectal intercourse
• Fellatio and less commonly cunnilingus can result in pharyngeal gonorrhea
• Perinatal transmission

Virulence factors

The recognized virulence factors of the Neisseria gonorrhoeae include:

• The main pathogenicity of the Neisseria gonorrhea obtains from the surface pili
  • Attachment on the surface of the urethra, fallopian tubes and endocervix
  • Preventing phagocytosis by neutrophils
• Opa proteins is a surface proteins that helps gonococcus binds to receptors on immune cells
  • Prevent an Immune response
  • Unable immunological memory against gonorrhea
• Lipooligosaccharides (LOS)
• Producing IgA protease
  • Hydrolyze secretory IgA, which can prevent the attachment to the mucosa

In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva.

Associated Conditions

HIVinfection

Gonorrhea is associated with increased susceptibility to the transmission of HIV infection. It is thought, gonorrhea infections can result in the increase HIV shedding in individuals.