Neisseria gonorrhoeae :Diagnosis and Treatment

Neisseria gonorrhoeae :Diagnosis and Treatment

Q. 1

Which of the following is not true about Neisseria gonorrhoeae ‑

 A It is an exclusive human pathogen
 B Some strains may cause disseminated disease
 C Acute urethritis is the most common manifestation in males
 D All strains are highly sensitive to penicillin
Q. 1

Which of the following is not true about Neisseria gonorrhoeae ‑

 A It is an exclusive human pathogen
 B Some strains may cause disseminated disease
 C Acute urethritis is the most common manifestation in males
 D All strains are highly sensitive to penicillin
Ans. D

Explanation:

All strains are highly sensitive to penicillin [Ref : Anantnarayan 8th/e p. 227-228; Harrison 17th/e p. 916-918; Jawetz 23″1/e p. 300]

  • Gonorrhoea is a gram negative organism.
  • The genus Neisseria contains two important human pathogens

N. gonorrhoea

– N. meningitides

  • Neisseria gonorrhoea causes gonorrhoea and Neisseria meningitides causes meningitis.
  • Neisseria gonorrhoea infections have a high prevalence and low mortality where as N. meningitides infections have low prevalence and high mortality.
  • Many Neisseria species are a part of normal flora in humans and animals.
  • Neisseria meningitides .frequently occurs in a carrier state in the absence of any disease.
  • However, Neisseria Gonorrhoea is an “obligate pathogen” and is never part of the normal human flora under any circumstances.

Gonococci is exclusive to humans

  • Gonorrhoea is an exclusive human disease, there being no natural infection in animals.
  • The only source of infection is a human carrier or less often a patient. In women gonococcus usually cause asymptomatic infection wheras in men the infection is usually symptomatic.

Clinical features of Gonococcal infection:-

  • Neisseria Gonorrhoea infection is acquired by sexual contacts and usually affects the mucous membrane of the urethra in males and endocervix and urethra in females.
  • They mainly affect the host’s columnar or cuboidal epithelium.

The vaginal mucosa is usually not affected in the adults because the stratified squamous epithelium is resistant to infection by the cocci and also because of the acid pH of vaginal secretions.

Clinical disease as a rule is less severe in females.

In women gonococcus usually cause “asymptomatic infection” the existence of asymptomatic carriage in women makes them a reservoir serving to perpetuate infection among their male contacts.

Gonococcal infection in men is usually “symptomatic”.
In men the disease starts as an acute urethritis.

PID

1f gonococcal infections

are asymptomatic or

unrecognized may

progress to P.1.D.

Fitz — Hugh Curtis syndrome

– Occurs due to direct

extension of the

organism through

fallopian tube to liver

Treatment of Gonorrhoea 😕

  • “Penicillin is ineffective in treatment of Gonorrhoea as most of the strains are resistant to penicillin because penicillinase producing N. gonorrhoea have spread widely”.

Neisseria Gonorrhoea has become resistant to numerous antibiotics because 😕

a)  It has got remarkable capacity to alter its antigenic structure.

b)  It can easily adopt to changes in microenvironment.

“Now the treatment of choice for gonococcal infection is ceftriaxone”.

  • “Quinolones” are the drug of choice for penicillin allergy.
  • In Patients who cannot tolerate both cephalosporin and quinolones, spectinomycin is the D.O.C.

Gonococcal infection: DOC

•  D.O.C.

-Ceftriaxonc

•  D.O.C. for penicillin allergey

-*Quinolones

•  If cannot tolerate both cephalosporins

and Quinolones

—4 Spectinomycin


Q. 2 Gonorrhea is assumed to be caused by gonococcus. Gonococcus can be identified by being:
 A By the growth on McConkey medium
 B By the fermentation of maltose
 C By the fermentation of glucose
 D Gram positive
Q. 2 Gonorrhea is assumed to be caused by gonococcus. Gonococcus can be identified by being:
 A By the growth on McConkey medium
 B By the fermentation of maltose
 C By the fermentation of glucose
 D Gram positive
Ans. C

Explanation:

By the fermentation of glucose


Q. 3

All are true about Neisseria gonorrhoeae except ‑

 A

Gram positive cocci

 B

Cause stricture of urethra

 C

Involves seminal vesicles and spreads to epididymis

 D

Drug of choice is ceftriaxone

Q. 3

All are true about Neisseria gonorrhoeae except ‑

 A

Gram positive cocci

 B

Cause stricture of urethra

 C

Involves seminal vesicles and spreads to epididymis

 D

Drug of choice is ceftriaxone

Ans. A

Explanation:

Ans. is ‘a’ i.e., Gram positive cocci 

  • Gonocci are gram negative diplococci.
  • Urethral stricture may occur as a complication of gonococcal urethritis.
  • Gonococci may extend to seminal vesicle and epididymis, along the urethra.
  • For uncomplicated gonorrhea, single dose of ceftriaxone is DOC.

Q. 4

The best site to obtain a swab in asymptomatic gonorrhea is –

 A

Endocervix

 B

Urethra

 C

Lateral vaginal wall

 D

Posterior fornix

Q. 4

The best site to obtain a swab in asymptomatic gonorrhea is –

 A

Endocervix

 B

Urethra

 C

Lateral vaginal wall

 D

Posterior fornix

Ans. A

Explanation:

Ans. is ‘a’ i.e., Endocervix 

No book has mentioned the best site to obtain a swab in asymptomatic gonorrhea. But we can make out our choice from the following statement of Ananthanarayan.

“Asymptomatic carriage of gonococci is rare in men and clinical disease as a rule is less severe in women, many of whom may carry gonococci in the cervix without symptoms”.

From above statement it is obvious that women with asymptomatic gonorrhea carry gonococci in cervix, while men usually do not have asymptomatic gonorrhea. So the best site to obtain a swab in asymptomatic gonorrhea should be endocervix.


Q. 5

Rx of penicillinase producing Neisseria gonorrhoeae is/are –

 A

Amoxycillin

 B

Ciprofloxacin

 C

Cefotaxime

 D

b and c

Q. 5

Rx of penicillinase producing Neisseria gonorrhoeae is/are –

 A

Amoxycillin

 B

Ciprofloxacin

 C

Cefotaxime

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e., Ciprofloxacin; ‘c’ i.e., Cefotaxime

Recommended Rx of Gonococcal infection (Penicillinase producing NG) :

Gonococcal infection of cervix, urethra, pharynx, rectum

                         First line – Ceftriaxone, ciprofloxacin, ofloxacin.

                         Alternatives – Spectinomycin, ceftizoxime, cefotetan.

o Gonococcal conjuctivitis and ophthalmia neonatorum – Ceftriaxone. o Disseminated gonoccal infection (Gonococcal arthritis)

                         Patient tolerant to P-lactam drugs – ceftriaxone, cefotaxime, ceftizoxim.

                         Patient allergic to P-lactam drugs – ciprofloxacin, ofloxacin, spectinomycin.

                         Continuation therapy – Ciprofloxacin, ofloxacin, levofloxacin.

o Gonococcal epididymitis – ceftriaxone followed by doxycycline.

DOC for gonorrhea is ceftriaxone


Q. 6

CDC recommended treatment for uncomplicated gonorrhea –

 A

Ceftriaxone

 B

Tetracycline

 C

Azithromycin

 D

Cootrimoxazole

Q. 6

CDC recommended treatment for uncomplicated gonorrhea –

 A

Ceftriaxone

 B

Tetracycline

 C

Azithromycin

 D

Cootrimoxazole

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ceftriaxone

For uncomplicated gonococcal infection ceftriaxone is DOC (along with azithromycin or doxycyclin to cover chlamydial infection).

  • For penicillin allergic patients quinolones are DOC.
  • Person who can not tolerate both cephalosporin and quinolones, spectinomycin is DOC.

Q. 7

Drug of choice for treating chylmydia with gonorrhea is ‑

 A

Ciprofloxacin

 B

Norfloxac in

 C

Nalidixic acid

 D

Doxycycline

Q. 7

Drug of choice for treating chylmydia with gonorrhea is ‑

 A

Ciprofloxacin

 B

Norfloxac in

 C

Nalidixic acid

 D

Doxycycline

Ans. D

Explanation:

Ans. is ‘d’ i.e., Doxycycline


Q. 8

Single dose treatment for gonorrhea ‑

 A

Azithromycin

 B

Tetracyline

 C

Ceftriaxone

 D

Erythromycin

Q. 8

Single dose treatment for gonorrhea ‑

 A

Azithromycin

 B

Tetracyline

 C

Ceftriaxone

 D

Erythromycin

Ans. C

Explanation:

Ans. is ‘c’ i.e., Ceftriaxone

  • For uncomplicated gonococcal infection, single dose of IM ceftriaxone is the drug of choice.
  • It is given along with azithromycin (single dose) or doxycyline (BD for 7 days) to cover chlamydial infection


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