Keywords: gonorrhea etiology and pathology

    Etiology

    The gonorrhea pathogens gonorrheal genus Neisseria. 1879, Neisser isolated gonorrheal gonorrheal called Neisseria meningitidis (Neisseria Gonorrhoeae). 1885 Bamm serum-free medium in the solidification culture Neisseria gonorrhoeae succeed.

    Neisseria gonorrhoeae morphology meningococcal similar, was circular, the garden egg-shaped or kidney-shaped, often arranged in pairs near the surface is flat or slightly concave, size is 0.6μm × 0.8 μm, Gram stain-negative, pink color. Methylene blue stained blue. Secretions of white blood cells of patients with acute gonococcal common chronic phase and more outside of the white blood cells. Weak, afraid gonococcal resistance to dry, like humidity, temperature 35 ~ 36 ℃, the growth medium containing 2.5% and 5% carbon dioxide environment. 1 to 2 hours’ can only survive in a completely dry environment can survive for 18-24 hours in a damp underwear, towels, bedding, only survive for 5 minutes at 50 ℃. Neisseria gonorrhoeae commonly used fungicide resistance is weak, 1:4000 silver nitrate seven minutes to kill, death carbolic acid 1% 3 minutes.

    Gonococcal outer membrane by lipopolysaccharide, outer membrane protein and pili composed of parasitic and pathogenic role.

    Fimbriae (Pili) consisting of polypeptides, antigenic, its terminal amino acid sequence, a relatively constant, while the middle and carboxyl terminal amino acid order often changed to determine the diversity of different strains of fimbrial antigen. Pilus adhesion of Neisseria gonorrhoeae, also inhibit leukocyte phagocytosis. Colonies cultured 20 hours, their cell surface with fimbriae, contagious. The pili also disappear colonies aging produce urethritis vaccination urethra.

    Neisseria gonorrhoeae outer membrane protein is at least three, wherein the protein I-based protein, accounting for 60% of the outer membrane proteins of different protein I of Neisseria gonorrhoeae the different antigen. The nature of the antigen is stable, it can also be used to made of monoclonal antibody serotyping of Neisseria gonorrhoeae. It is expressed in two forms ie PIA and PIB. It can be formed in the membrane pores. Water-soluble substances, and other substances have an important role in bacterial metabolism and certain antibiotics into the cell through the cell membrane. Protein II with Neisseria gonorrhoeae with human epithelial cells, leukocyte adhesion and cell adhesion-related thermal modification. Protein Ⅲ having reducing modification, also known Rmp, has a strong immunogenicity, there are cross-reactive with the same kind of other Neisseria, can block the bactericidal effect of the other antibodies. In recent years, also found that iron regulatory protein that Frp, iron receptor expression in iron deficiency.

    Lipopolysaccharide for Neisseria gonorrhoeae important surface structure of the gonococcal endotoxin caused submucosal and complement in vivo synergy inflammatory response, with gonococcal virulence, pathogenicity and immunity. Now identified six different antigenic gonococcal lipopolysaccharide.

    Pathogenesis

    Urine under normal circumstances should be sterile, the urine continuously flushing the urethra of the impregnated microorganism is difficult to settle in the urinary tract, and the for Neisseria gonorrhoeae easily in the urinary tract, the parasitic, mainly due to Neisseria gonorrhoeae pilus, such that the Neisseria gonorrhoeae simple columnar epithelial cells and transitional epithelial cells, such as the urethra, cervix, urethra, bladder mucosa sensitive, very easy to adhere to the above cell above. Neisseria gonorrhoeae soon killed in acidic urine (pH <5.5), and thus the bladder and kidneys can not easily be infected prostatic fluid containing spermine and zinc, it may be subject to gonococcal infection.

    Urethra and vagina hyperparasite group certain inhibitory effect on the growth of Neisseria gonorrhoeae. The presence of these bacteria to the body to provide some natural resistance. Mucosal surface there lactoferrin, iron is essential to the longevity and reproduction of Neisseria gonorrhoeae, such as the concentration of iron in the environment at low levels, Neisseria gonorrhoeae growth restriction. Neisseria gonorrhoeae different cell sensitivity, the most sensitive to the columnar epithelial cells of the anterior urethral mucosa. Thus anterior urethral most likely to be infected, the posterior urethra and bladder mucosa by transitional epithelium, Neisseria gonorrhoeae its sensitivity is less than the columnar cells, thus opportunities than before urethral gonococcal infection. The navicular fossa mucosa by stratified squamous cells composed of stratified squamous epithelial cells can not be easily gonococcal infection. Neisseria gonorrhoeae by means of pili and protein II and IgA enzymes break down quickly and urethra, cervical epithelial adhesion. Gonococcal outer membrane protein I go to the urinary tract epithelial membrane, Neisseria gonorrhoeae is, columnar epithelial cells that engulfs and then transferred to the submucosal extracellular, causing inflammation in the area by the synergistic effect of lipopolysaccharide, complement and IgM reaction. About 30 hours caused extensive edema of the mucous membrane adhesions and purulent discharge, stimulate local nerves cause pain when urination, the the urethral mucosa expansion adhesions. Due to the inflammatory response and mucosal erosion, shedding a typical urethral purulent secretions. Contraction due to inflammation of the urethral sphincter spasm, urinary frequency, urgency. The mucosa of the small blood vessels rupture at the same time there were ultimately unable to hematuria. Bacteria into the urethra gland and crypts can also invade the submucosa by the mucous layer, blocking the duct and the nest opening, causing localized abscess. In this process, the body of local and systemic antibody immune performance of the body of Neisseria gonorrhoeae in all aspects of the host defense against Neisseria gonorrhoeae immune rely mainly on IgG and IgM, and IgA can prevent infection from the mucosal surface. Male urethral discharge often suffering from gonococcal urethritis gonococcal infection antibody response shall mucosal antibody reaction. These antibodies in addition to IgA, IgG and IgM, serum antibody response, gonococcal infection, elevated serum IgG, IgM and IgA levels, IgA secretory antibody, into the blood from the mucosal surface of these antibodies on the serum antibody – complement-mediated bactericidal effect is very important, that they are caused by susceptible strains of the serum Neisseria gonorrhoeae bacteremia has a protective effect. The general inflammation does not spread throughout the body, if the medication is symptomatic, the full amount of local inflammation will gradually subside. Necrotic mucosal repair after the inflammation subsided, replaced by squamous epithelium or connective tissue. Serious or repeated infections, connective tissue fibrosis, can cause urethral stricture. If untreated, the urethra the gonococcal can enter or cervical spread upward, causing inflammation of the urogenital tract and nearby organs, such as the paraurethral pancreatitis, the bulbourethral pancreatitis, prostatitis, vesiculitis, epididymitis, endometritis and so on. In severe cases, can hematogenous spread to the whole body. Neisseria gonorrhoeae can also be prolonged latent in deep glandular tissue, become the chronic gonorrhea recurrent reason. The infected organ inflammation subsided connective tissue fibrosis can be caused by the vas deferens narrow fallopian tube obstruction secondary to ectopic pregnancy and male infertility.