NAME: Neisseria gonorrhoeae
SYNONYM OR CROSS REFERENCE: Gonococci, Gonorrhea Footnote 1.
CHARACTERISTICS: Neisseria gonorrhoeae belongs to the genus Neisseria within the family Neisseriaceae Footnote 2. It is a Gram-negative, non-spore forming, non-motile, encapsulated, and non acid-fast bacteria, which appear in kidney bean shape under the microscope Footnote 1. It requires an aerobic environment with added CO2 and enriched media such as chocolate agar for growth. It is oxidase positive and produces β-lactamase Footnote 1, Footnote 3. Small, smooth, and non-pigmented colonies are produced after 18-24 hours of incubation. There are 70 different strains of N. gonorrhoeae Footnote 3.
Genital gonorrhea: In males, N. gonorrhoeae causes mainly urethritis, characterized by purulent urethral/penile discharge and dysuria Footnote 1-Footnote 3. Rarely, the local infection can spread to other areas and cause epididymitis, prostatitis, and penile lymphangitis Footnote 1-Footnote 3. Patients with epididymitis present with scrotal edema and scrotal, inguinal, and flank pain Footnote 3. In females, cervicitis (infection of endocervix) is the main infection caused by N. gonorrhoeae, and is characterized by increased vaginal discharge, dysuria, abdominal pain, and menstrual abnormalities Footnote 1-Footnote 3. 70%-90% of the women may also have a concomitant urethral infection Footnote 2. Some individuals may be infected but asymptomatic Footnote 2.
Other local infections: N. gonorrhoeae may also cause pharyngeal (pharyngitis) and anorectal infections (proctitis) in both males and females Footnote 1-Footnote 3. Patients with pharyngitis present with sore throat, fever, and cervical lymphadenopathy, and those with proctitis present with anal discharge, rectal bleeding, anorectal pain, tenesmus, and constipation Footnote 3.
Pelvic Inflammatory disease (PID): PID is defined as inflammation of the upper female genital tract, specifically the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries, as well as the adjacent peritoneum and occurs in 10-40% of the young women with gonococcal infection Footnote 1-Footnote 4. The main symptoms of the disease include fever, lower abdominal pain, adnexal and cervical motion tenderness, and leukocytosis Footnote 1, Footnote 3. The most serious complications of the disease are reproductive tract problems such as tubo-ovarian abscess, Fitz-Hugh-Curtis syndrome (perihepatitis), and ectopic pregnancy Footnote 1, Footnote 3.
Disseminated Infections: Disseminated gonococcal infections occur due to the spread of the bacteria Footnote 1-Footnote 3. Patients with disseminated infection may present with dermatitis, arthritis, and rarely, meningitis or endocarditis.
Infections in Neonates: Gonococcal infections in neonates include gonococcal ophthalmia neonatorum, gonococcal scalp abscess, and disseminated infections such as septic arthritis, and meningitis Footnote 3, Footnote 5. Gonococcal ophthalmia neonatorum is usually a mild infection of the conjunctiva, characterized by mucopurulent eye discharge Footnote 5.
EPIDEMIOLOGY: Worldwide. Sixty-two million cases of gonorrhea have been estimated to occur annually worldwide, by the World Health Organization Footnote 6. The majority of the cases occur in developing countries. Infections due to gonococci are the second most common reportable or notifiable bacterial disease in the United States Footnote 3. The national rate of gonococcal infections was reported to be 115.6 cases per 100,000, in 2005 in the United States, with higher rates among African Americans as well as in rural areas of the southeastern United States. Incidence of gonococcal infections is highest in youth, with 40% of the infections occurring in females between 15 and 19 years of age. In Canada, 12,723 cases of gonorrhea were reported in 2008 Footnote 7.
HOST RANGE: It is an obligate human pathogen with no other known host Footnote 8.
INFECTIOUS DOSE: Unknown.
MODE OF TRANSMISSION: Gonorrhea is sexually transmitted Footnote 1, Footnote 8. Gonococcal ophthalmia neonatorum is acquired as a result of eye contamination during vaginal delivery Footnote 2. Transmission through fomites has been reported for purulent vulvovaginitis in prepubescent girls Footnote 1.
COMMUNICABILITY: Gonorrhea is sexually transmitted (exchange of bodily fluids) Footnote 3.
RESERVOIR: Humans Footnote 1.
DRUG SUSCEPTIBILITY/RESISTANCE: Susceptible to third generation cephalosporins, and spectinomycin Footnote 3, Footnote 5. N. gonorrhoeae is often resistant to penicillin and tetracycline Footnote 2, Footnote 9. In Canada, approximately 12 % of all the strains tested between 2000 and 2008 are resistant to quinolones such as ciprofloxacin, and ofloxacin Footnote 5, Footnote 9. Strains resistant to azithromycin and erythromycin have been reported in the United States Footnote 5 and Canada. N. gonorrhoeae strains resistant to oral third-generation cephalosporins (cefixime and ceftibuten) have been reported Footnote 10. Resistance has not been reported with injectable ceftriaxone.
SUSCEPTIBILITY TO DISINFECTANTS: N. gonorrhoeae is sensitive to most disinfectants Footnote 11. Disinfectants used against most vegetative bacteria include 1% sodium hypochlorite, 70% ethanol, phenolics, 2% glutaraldehyde, formaldehyde, and peracetic acid Footnote 12.
PHYSICAL INACTIVATION: N. gonorrhoeae is sensitive to desiccation Footnote 11. Most vegetative bacteria can also be inactivated by moist heat (121°C for 15 min- 30 min) and dry heat (160-170°C for 1-2 hours) Footnote 13.
SURVIVAL OUTSIDE HOST: Gonococci have survived for brief periods on a toilet seat Footnote 1, with reports of up to 2 hours Footnote 14. Gonococci have also survived for 3 hours on toilet paper, 17 hours on slides, and 24 hours on towels Footnote 14. Transmission by fomites is rare.
SURVEILLANCE: Monitor for symptoms. Culturing of discharge can be done on chocolate agar or Thayer-Matin agar Footnote 1-Footnote 3, Footnote 6, Footnote 15, Footnote 16. Other methods include polymerase-chain reaction (PCR) to detect bacterial DNA from endocervical or urethreal sites or urine Footnote 1, Footnote 3, Footnote 5, Footnote 6, Footnote 8; direct examination of samples using Gram staining Footnote 3, and serological tests, including enzyme-linked immunosorbent assays (ELISA) or direct fluorescence antigen testing Footnote 6, Footnote 15.
Note: All diagnostic methods are not necessarily available in all countries.
FIRST AID/TREATMENT: Although treatment of gonococcal infections depends upon the site and type of infection, most infections are treated with third generation cephalosporins such as Ceftriaxone or Cefixime Footnote 3, Footnote 5, Footnote 17. Other drugs that can be used to treat gonococcal infections include spectinomycin and azithromycinFootnote 3. Penicillin is not recommended for therapy due to antimicrobial resistance. Fluoroquinolones should not be used in areas where the prevalence of GC quinolone resistance is greater than 3-5%.
PROPHYLAXIS: In neonates, prophylaxis for gonococcal ophthalmia neonatorum is done with 1% solution of AgNO3, 1% tetracycline ointment, or 0.5% erythromycin ophthalmic ointment, instilled into the eyes of every neonate within 1 hour after birth Footnote 5.
LABORATORY-ACQUIRED INFECTIONS: Five reported cases of laboratory acquired infection Footnote 18. One case was a cutaneous infection, 4 were gonococcal conjunctivitis.
SOURCES/SPECIMENS: Conjuctiva, blood, joint fluid, endocervix, urethra, skin lesions, endometrium, fallopian tubes, rectum, pharynx Footnote 2.
PRIMARY HAZARDS: Accidental parenteral inoculation and direct or indirect contact of mucous membranes with infectious material Footnote 19.
SPECIAL HAZARDS: None.
RISK GROUP CLASSIFICATION: Risk Group 2 Footnote 20.
CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.
PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes Footnote 21.
OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities Footnote 21.
SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up.
DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism by autoclave, chemical disinfection, gamma irradiation, or incineration before disposing.
STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled.
REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.
UPDATED: September 2011
PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada
Although the information, opinions and recommendations contained in this Pathogen Safety Data sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.
Public Health Agency of Canada, 2011