gonococcus

introduction

the gonococcus (Neisseria gonorrhoeae) is an obligate aerobe, bean-shaped diplococcus, fastidious, oxidase +ve Gram -ve coccoid discovered in 1879
it is transmitted by sexual contact and co-infections with other causes of sexually transmitted infections (STDs/STIs) is common
in 2018, WHO estimates that 78 million people worldwide are infected with gonorrhea each year, with almost 1 million new cases in USA each year
the European Centre for Disease Prevention and Control reported that in 2017, there were 75 cases of gonococcal disease per 100,000 people in the UK - 3x higher than the average rate in Europe (next highest rate is Ireland at 47 cases/100,000, then Iceland and Scandinavia and Malta), UK accounts for 55% of cases in Europe with 49,000 cases reported in Britons (10% are in France, 9% in Spain, 8% in Netherlands). Cases increased by 51% from 2013-2017 and is thought to be a signal of the prevalence sex without condoms, and almost half of cases were in gay men.
sexual contact may result in either:
- pelvic inflammatory disease (PID) with purulent cervical discharge (gonorrhoea) and 10% risk of infertility per episode
- pharyngitis via oral sex or via tongue kissing (French kissing)
- proctitis via anal sex
- urethritis with purulent urethral discharge (gonorrhoea or “the clap”)
- prostatitis
- epididymo-orchitis
- conjunctivitis
- 10% of cases are thought to be asymptomatic
neonates may develop conjunctivitis
disseminated infections can occur, resulting in endocarditis, meningitis or gonococcal dermatitis-arthritis syndrome.
- dermatitis-arthritis syndrome presents with arthralgia, tenosynovitis and painless non-pruritic (non-itchy) dermatitis.
antibiotic resistance
- 2018: 1st case of highly resistant strain to both ceftriaxone and azithromycin, requiring iv ertapenem - this case was acquired in South-East Asia