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Biology of Neisseria gonorrhoeae and the Clinical Picture of Infection

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Abstract

Neisseria gonorrhoeae is the causative bacterium of gonorrhoea, the second most common bacterial sexually transmitted infection (STI). It is an obligate human pathogen and colonises primarily the anogenital tract, and is extremely adept at evading the immune response and developing or acquiring resistance to therapeutic agents. This chapter describes the pathogenesis of the infection and how it manifests itself as a clinical presentation. The diagnostic tests of microscopy, isolation and identification are now being superseded by molecular approaches and this presents challenges for the surveillance of antimicrobial resistance.

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References

  1. Alcorn, T.M., Cohen, M.S.: Gonococcal pathogenesis: adaptation and immune evasion in the human host. Curr Opin Infect Dis 7, 310–316 (1994)

    Article  Google Scholar 

  2. Alexander, S.: The challenges of detecting gonorrhoea and chlamydia in rectal and pharyngeal sites: could we, should we, be doing more? Sex Transm Infect 85, 159–160 (2009)

    Article  PubMed  Google Scholar 

  3. Alexander, S., Ison, C.: Evaluation of commercial kits for the identification of Neisseria gonorrhoeae. J Med Microbiol 54, 827–831 (2005)

    Article  PubMed  Google Scholar 

  4. Alexander, S., Ison, C., Parry, J., et al.: Self-taken pharyngeal and rectal swabs are appropriate for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in asymptomatic men who have sex with men. Sex. Transm. Infect. 84, 488–492 (2008)

    Article  PubMed  CAS  Google Scholar 

  5. Alexander, S., Martin, I.M., Fenton, K., et al.: The prevalence of proline iminopeptidase negative Neisseria gonorrhoeae throughout England and Wales. Sex. Transm. Infect. 82, 280–282 (2006)

    Article  PubMed  CAS  Google Scholar 

  6. Ashford, W.A., Golash, R.G., Hemming, V.G.: Penicillinase-producing Neisseria gonorrhoeae. Lancet 2, 657–658 (1976)

    Article  PubMed  CAS  Google Scholar 

  7. Ashford, W.A., Potts, D.W., Adams, H.J., et al.: Spectinomycin-resistant penicillinase-producing Neisseria gonorrhoeae. Lancet 2, 1035–1037 (1981)

    Article  PubMed  CAS  Google Scholar 

  8. Belland, R.J., Morrison, S.G., Ison, C., et al.: Neisseria gonorrhoeae acquires mutations in analogous regions of gyrA and parC in fluoroquinolone-resistant isolates. Mol. Microbiol. 14, 371–380 (1994)

    Article  PubMed  CAS  Google Scholar 

  9. CDC: Trends in Reportable Sexually Transmitted Diseases in the United States, 2006 – National Surveillance Data for Chlamydia, Gonorrhea and Syphilis, pp. 1–7. Centers for Disease Control and Prevention (2007)

    Google Scholar 

  10. Chen, M.I., Ghani, A.C., Edmunds, J.: Mind the gap: the role of time between sex with two consecutive partners on the transmission dynamics of gonorrhea. Sex. Transm. Dis. 35, 435–444 (2008)

    Article  PubMed  Google Scholar 

  11. Chisholm, S.A., Neal, T.J., Alawattegama, A.B., et al.: Emergence of high-level azithromycin resistance in Neisseria gonorrhoeae in England and Wales. J. Antimicrob. Chemother. 64, 353–358 (2009)

    Article  PubMed  CAS  Google Scholar 

  12. Cook, R.L., Hutchison, S.L., Ostergaard, L., et al.: Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann. Intern. Med. 142, 914–925 (2005)

    PubMed  Google Scholar 

  13. Cousin Jr., S.L., Whittington, W.L., Roberts, M.C.: Acquired macrolide resistance genes and the 1 bp deletion in the mtrR promoter in Neisseria gonorrhoeae. J. Antimicrob. Chemother. 51, 131–133 (2003)

    Article  PubMed  CAS  Google Scholar 

  14. Delpech, V., Martin, I.M., Hughes, G., et al.: Epidemiology and clinical presentation of gonorrhoea in England and Wales: findings from the gonococcal resistance to antimicrobials surveillance programme 2001–2006. Sex. Transm. Infect. 85, 317–321 (2009)

    Article  PubMed  CAS  Google Scholar 

  15. Dillon, J.R.: National microbiological surveillance of the susceptibility of gonococccal isolates to antimicrobial agents. Can. J. Infect. Dis. 3, 202–206 (1992)

    Google Scholar 

  16. Easmon, C.S., Ison, C.A., Bellinger, C.M., et al.: Emergence of resistance after spectinomycin treatment for gonorrhoea due to beta-lactamase producing strain of Neisseria gonorrhoeae. Br. Med. J. (Clin. Res. Ed.) 284, 1604–1605 (1982)

    Article  CAS  Google Scholar 

  17. Fenton, K.A., Lowndes, C.M.: Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex. Transm. Infect. 80, 255–263 (2004)

    Article  PubMed  CAS  Google Scholar 

  18. Galarza, P.G., Alcala, B., Salcedo, C., et al.: Emergence of high level azithromycin-resistant Neisseria gonorrhoeae strain isolated in Argentina. Sex. Transm. Dis. 36, 787–788 (2009)

    Article  PubMed  CAS  Google Scholar 

  19. GRASP Steering Group: The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Year 2008 Report. Health Protection Agency, London (2009)

    Google Scholar 

  20. Hauck, C.R., Meyer, T.F.: ‘Small’ talk: Opa proteins as mediators of Neisseria-host-cell communication. Curr. Opin. Microbiol. 6, 43–49 (2003)

    Article  PubMed  CAS  Google Scholar 

  21. Hughes, G., Brady, A.R., Catchpole, M.A., et al.: Characteristics of those who repeatedly acquire sexually transmitted infections: a retrospective cohort study of attendees at three urban sexually transmitted disease clinics in England. Sex. Transm. Dis. 28, 379–386 (2001)

    Article  PubMed  CAS  Google Scholar 

  22. Ison, C., Martin, D.: Gonorrhea. Atlas of Sexually Transmitted Diseases and AIDS, pp. 109–139 (2003)

    Google Scholar 

  23. Ison, C.A., Martin, I.M., Lowndes, C.M., et al.: Comparability of laboratory diagnosis and antimicrobial susceptibility testing of Neisseria gonorrhoeae from reference laboratories in Western Europe. J. Antimicrob. Chemother. 58, 580–586 (2006)

    Article  PubMed  CAS  Google Scholar 

  24. Kallstrom, H., Liszewski, M.K., Atkinson, J.P., et al.: Membrane cofactor protein (MCP or CD46) is a cellular pilus receptor for pathogenic Neisseria. Mol. Microbiol. 25, 639–647 (1997)

    Article  PubMed  CAS  Google Scholar 

  25. Knapp, J.S., Fox, K.K., Trees, D.L., et al.: Fluoroquinolone resistance in Neisseria gonorrhoeae. Emerg. Infect. Dis. 3, 33–39 (1997)

    Article  PubMed  CAS  Google Scholar 

  26. Knapp, J.S., Johnson, S.R., Zenilman, J.M., et al.: High-level tetracycline resistance resulting from TetM in strains of Neisseria spp., Kingella denitrificans, and Eikenella corrodens. Antimicrob. Agents Chemother. 32, 765–767 (1988)

    PubMed  CAS  Google Scholar 

  27. LaMontagne, D.S., Fenton, K.A., Pimenta, J.M., et al.: Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England. Int. J. STD AIDS 16, 323–327 (2005)

    Article  PubMed  CAS  Google Scholar 

  28. Lavelle, S.J., Jones, K.E., Mallinson, H., et al.: Finding, confirming, and managing gonorrhoea in a population screened for chlamydia using the Gen-Probe Aptima Combo2 assay. Sex. Transm. Infect. 82, 221–224 (2006)

    Article  PubMed  CAS  Google Scholar 

  29. Luna, V.A., Cousin Jr., S., Whittington, W.L., et al.: Identification of the conjugative mef gene in clinical Acinetobacter junii and Neisseria gonorrhoeae isolates. Antimicrob. Agents Chemother. 44, 2503–2506 (2000)

    Article  PubMed  CAS  Google Scholar 

  30. Massari, P., Ram, S., Macleod, H., et al.: The role of porins in neisserial pathogenesis and immunity. Trends Microbiol. 11, 87–93 (2003)

    Article  PubMed  CAS  Google Scholar 

  31. Merz, A.J., So, M.: Interactions of pathogenic neisseriae with epithelial cell membranes. Annu. Rev. Cell Dev. Biol. 16, 423–457 (2000)

    Article  PubMed  CAS  Google Scholar 

  32. Morse, S.A., Johnson, S.R., Biddle, J.W., et al.: High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant. Antimicrob. Agents Chemother. 30, 664–670 (1986)

    PubMed  CAS  Google Scholar 

  33. Naumann, M., Rudel, T., Meyer, T.F.: Host cell interactions and signalling with Neisseria gonorrhoeae. Curr. Opin. Microbiol. 2, 62–70 (1999)

    Article  PubMed  CAS  Google Scholar 

  34. Ng, L.K., Martin, I., Liu, G., et al.: Mutation in 23S rRNA associated with macrolide resistance in Neisseria gonorrhoeae. Antimicrob. Agents Chemother. 46, 3020–3025 (2002)

    Article  PubMed  CAS  Google Scholar 

  35. Nicoll, A., Hughes, G., Donnelly, M., et al.: Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England. Sex. Transm. Infect. 77, 242–247 (2001)

    Article  PubMed  CAS  Google Scholar 

  36. Ota, K.V., Jamieson, F., Fisman, D.N., et al.: Prevalence of and risk factors for quinolone-resistant Neisseria gonorrhoeae infection in Ontario. CMAJ 180, 287–290 (2009)

    Article  PubMed  Google Scholar 

  37. Pagotto, F., Aman, A.T., Ng, L.K., et al.: Sequence analysis of the family of penicillinase-producing plasmids of Neisseria gonorrhoeae. Plasmid 43, 24–34 (2000)

    Article  PubMed  CAS  Google Scholar 

  38. Paine, T.C., Fenton, K.A., Herring, A., et al.: GRASP: a new national sentinel surveillance initiative for monitoring gonococcal antimicrobial resistance in England and Wales. Sex. Transm. Infect. 77, 398–401 (2001)

    Article  PubMed  CAS  Google Scholar 

  39. Palmer, H.M., Mallinson, H., Wood, R.L., et al.: Evaluation of the specificities of five DNA amplification methods for the detection of Neisseria gonorrhoeae. J. Clin. Microbiol. 41, 835–837 (2003)

    Article  PubMed  CAS  Google Scholar 

  40. Palmer, H.M., Young, H., Winter, A., et al.: Emergence and spread of azithromycin-resistant Neisseria gonorrhoeae in Scotland. J. Antimicrob. Chemother. 62, 490–494 (2008)

    Article  PubMed  CAS  Google Scholar 

  41. Phillips, I.: Beta-lactamase-producing, penicillin-resistant gonococcus. Lancet 2, 656–657 (1976)

    Article  PubMed  CAS  Google Scholar 

  42. Rao, G.G., Bacon, L., Evans, J., et al.: Prevalence of Neisseria gonorrhoeae infection in young subjects attending community clinics in South London. Sex. Transm. Infect. 84, 117–121 (2008)

    Article  PubMed  Google Scholar 

  43. Roberts, M.C.: Plasmids of Neisseria gonorrhoeae and other Neisseria species. Clin. Microbiol. Rev. 2(suppl), S18–S23 (1989)

    PubMed  Google Scholar 

  44. Roberts, M.C., Chung, W.O., Roe, D., et al.: Erythromycin-resistant Neisseria gonorrhoeae and oral commensal Neisseria spp. carry known rRNA methylase genes. Antimicrob. Agents Chemother. 43, 1367–1372 (1999)

    PubMed  CAS  Google Scholar 

  45. Ropp, P.A., Hu, M., Olesky, M., et al.: Mutations in ponA, the gene encoding penicillin-binding protein 1, and a novel locus, penC, are required for high-level chromosomally mediated penicillin resistance in Neisseria gonorrhoeae. Antimicrob. Agents Chemother. 46, 769–777 (2002)

    Article  PubMed  CAS  Google Scholar 

  46. Rothenberg, R.B.: The geography of gonorrhea. Empirical demonstration of core group transmission. Am. J. Epidemiol. 117, 688–694 (1983)

    PubMed  CAS  Google Scholar 

  47. Rouquette-Loughlin, C.E., Balthazar, J.T., Shafer, M.: Characterization of the MacA-MacB efflux system in Neisseria gonorrhoeae. J. Antimicrob. Chemother. 56, 856–860 (2005)

    Article  PubMed  CAS  Google Scholar 

  48. Schwarcz, S.K., Zenilman, J.M., Schnell, D., et al.: National surveillance of antimicrobial resistance in Neisseria gonorrhoeae. The Gonococcal Isolate Surveillance Project. JAMA 264, 1413–1417 (1990)

    Article  PubMed  CAS  Google Scholar 

  49. Song, W., Ma, L., Chen, R., et al.: Role of lipooligosaccharide in Opa-independent invasion of Neisseria gonorrhoeae into human epithelial cells. J. Exp. Med. 191, 949–960 (2000)

    Article  PubMed  CAS  Google Scholar 

  50. Sparling, P.F., Sarubbi Jr., F.A., Blackman, E.: Inheritance of low-level resistance to penicillin, tetracycline, and chloramphenicol in Neisseria gonorrhoeae. J. Bacteriol. 124, 740–749 (1975)

    PubMed  CAS  Google Scholar 

  51. Stanley, B., Todd, A.: Testing for Neisseria gonorrhoeae by nucleic acid amplification testing of chlamydia samples using Roche Cobas Amplicor in a rural area in the north of England does not find more gonorrhoea in primary care. Sex. Transm. Infect. 81, 518 (2005)

    Article  PubMed  CAS  Google Scholar 

  52. Starnino, S., Stefanelli, P., Neisseria gonorrhoeae Italian Study Group: Azithromycin-resistant Neisseria gonorrhoeae strains recently isolated in Italy. J. Antimicrob. Chemother. 63, 1200–1204 (2009)

    Article  PubMed  CAS  Google Scholar 

  53. Australian Gonococcal Surveillance Programme, Tapsall, J.: Annual report of the Australian Gonococcal Surveillance Programme, 2008. Commun. Dis. Intell. 33, 268–274 (2009)

    PubMed  Google Scholar 

  54. Trees, D.L., Sandul, A.L., Neal, S.W., et al.: Molecular epidemiology of Neisseria gonorrhoeae exhibiting decreased susceptibility and resistance to ciprofloxacin in Hawaii, 1991–1999. Sex. Transm. Dis. 28, 309–314 (2001)

    Article  PubMed  CAS  Google Scholar 

  55. Trotter, C., Hughes, G., Ison, C.: Epidemiology in the Vaccine Era. Neisseria Molecular Mechanisms of Pathogenesis, pp. 227–243. (2010)

    Google Scholar 

  56. Unemo, M., Fasth, O., Fredlund, H., et al.: Phenotypic and genetic characterization of the 2008 WHO Neisseria gonorrhoeae reference strain panel intended for global quality assurance and quality control of gonococcal antimicrobial resistance surveillance for public health purposes. J. Antimicrob. Chemother. 63, 1142–1151 (2009)

    Article  PubMed  CAS  Google Scholar 

  57. Unemo, M., Palmer, H.M., Blackmore, T., et al.: Global transmission of prolyliminopeptidase-negative Neisseria gonorrhoeae strains: implications for changes in diagnostic strategies. Sex. Transm. Infect. 83, 47–51 (2007)

    Article  PubMed  CAS  Google Scholar 

  58. van de Laar, M.J., van Duynhoven, Y.T., Dessens, M., et al.: Surveillance of antibiotic resistance in Neisseria gonorrhoeae in The Netherlands, 1977–95. Genitourin. Med. 73, 510–517 (1997)

    PubMed  Google Scholar 

  59. Whiley, D.M., Garland, S.M., Harnett, G., et al.: Exploring ‘best practice’ for nucleic acid detection of Neisseria gonorrhoeae. Sex. Health 5, 17–23 (2008)

    Article  PubMed  Google Scholar 

  60. WHO: Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates WHO/HIV-AIDS/2001.02,WHO/CDS/CSR/EDC/2001.10, pp. 1–43. WHO, Geneva (2001)

    Google Scholar 

  61. WHO: Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2006. Commun. Dis. Intell. 32, 48–51 (2008)

    Google Scholar 

  62. Workowski, K.A., Berman, S.M., Douglas, JM, Jr.: Emerging antimicrobial resistance in Neisseria gonorrhoeae: urgent need to strengthen prevention strategies. Ann. Intern. Med. 148, 606–613 (2008)

    PubMed  Google Scholar 

  63. Yorke, J.A., Hethcote, H.W., Nold, A.: Dynamics and control of the transmission of gonorrhea. Sex. Transm. Dis. 5, 51–56 (1978)

    Article  PubMed  CAS  Google Scholar 

  64. Zarantonelli, L., Borthagaray, G., Lee, E.H., et al.: Decreased azithromycin susceptibility of Neisseria gonorrhoeae due to mtrR mutations. Antimicrob. Agents Chemother. 43, 2468–2472 (1999)

    PubMed  CAS  Google Scholar 

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Ison, C.A. (2011). Biology of Neisseria gonorrhoeae and the Clinical Picture of Infection. In: Gross, G., Tyring, S. (eds) Sexually Transmitted Infections and Sexually Transmitted Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-14663-3_6

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