Neisseria GonorrheaChlamydia Trachomatis

Group III

Chlamydia Trachomatis

Infection Suggestive Signs/Symptoms

Presumptive Diagnosisa 

Confirmatory Test of Choice

MenNGU, PGU Discharge, dysuria Gram's stain with >4

neutrophils per oil-immersion field; no gonococci

Urine or urethral NAAT for C. trachomatis 

Epididymitis Unilateral intrascrotal swelling, pain, tenderness; fever; NGU

Gram's stain with >4 neutrophils per oil-immersion field; no gonococci; urinalysis with pyuria

Urine or urethral NAAT for C. trachomatis 

WomenCervicitis Mucopurulent cervical

discharge, bleeding and edema of the zone of cervical ectopy

Cervical Gram's stain with 20 neutrophils per oil-immersion field in cervical mucus

Urine, cervical, or vaginal NAAT for C. trachomatis 

Salpingitis Lower abdominal pain, cervical motion tenderness, adnexal tenderness or masses

C. trachomatis always potentially present in salpingitis 

Urine, cervical, or vaginal NAAT for C. trachomatis 

Urethritis Dysuria and frequency without hematuria

MPC; sterile pyuria; negative routine urine culture

Urine or urethral NAAT for C. trachomatis 

Infection Suggestive Signs/Symptoms

Presumptive Diagnosisa 

Confirmatory Test of Choice

Adults of Either Sex Proctitis Rectal pain, discharge, tenesmus, bleeding; history of receptive anorectal intercourse

Negative gonococcal culture and Gram's stain; at least 1 neutrophil per oil-immersion field in rectal Gram's stain

Rectal NAAT for C. trachomatis or culture 

Reiter's syndrome NGU, arthritis, conjunctivitis, typical skin lesionsGram's stain with >4 neutrophils per oil-immersion field; lack of gonococci indicative of NGU

Urine or urethral NAAT for C. trachomatis 

LGV Regional adenopathy, primary lesion, proctitis, systemic symptoms

None Culture of LGV strain from node or rectum, occasionally from urethra or cervix; NAAT for C. trachomatis from these sites; LGV CF titer, 1:64; micro-IF titer, 1:512

Comparison between Neisseria Gonorrrhea

& Chlamydia Trachomatis

Comparison between N. Gonorrhea & C. Trachomatis

Neisseria Gonorrhea

Chlamydia Trachomatis

Reservoir • Humans only (no immunity to repeated infections)

• Humans• Morphologic Note: Gram (-)

but lacks peptidoglycan layer & muramic acid

Gram Stain Gram NegativeIncubation Period

3-5 days after exposure 7-21 days after exposure

Transmission

Sexual transmission • Direct personal contacta. Eyesb. Genitalsc. Lungs

Chlamydia Life Cycle

Gonorrhea Life Cycle

Comparison between N. Gonorrhea & C. Trachomatis

Neisseria Gonorrhea

Chlamydia Trachomatis

Pathogenesis/Virulence

attachment of the bacterium to nonciliated epithelial cells via pili (fimbriae) and the production of lipopolysaccharide endotoxin – produces IgA proteases which promote virulence. adherence to epithelial cellsAntigenic variationAntiphagocytic: binds bacteria tightly to host cell preventing phagocytosis•Outer membrane proteins: Protein I: porinProtein II (opacity protein) : presence asstd w/ dark, colonies- for adherenceToxins: Endotoxin- Lipopolysaccharide

• Resistant to lysozymes (since their wall lacks muramic acid)

• Prevents Phagosome: lysosome fusion

• Non-motile• No pili• No exotoxins

Comparison between N. Gonorrhea & C. Trachomatis

Neisseria Gonorrhea

Chlamydia Trachomatis

Clinical Manifestations

• Asymptomatic (but still infectious)

• Men: urethritis• Women: cervical gonorrhea

can progress to PIDComplications of PID• Sterility• Ectopic pregnancy• Abscess• Peritonitis• PerihepatitisBoth men and women:• Gonococcal bacteremia• Septic arthritis: gonococcal

arthritis is the most common cause of septic arthritis in sexually active individuals

• Neonates: Ophthalmia Neonatorium- conjunctivitis in newborn. Infection acquired through the infected birth canal; usually erupts w/in the 1st 5 days

Serotype A, B &C•Trachoma: causes scarring of the inside of the eyelid, resulting in redirection of the eyelashes onto the corneal surface. This results to corneal scarring and blindnessSerotypes D thru K•Inclusion conjunctivitis (ophthalmia neonatorium)•Infant pneumonia•Urethritis, cervicitis, PID (in women)•Non-gonococcal urethritis,epidymitis and prostatis (in men)Complications:•Sterility, ectopic pregnancy and chronic pain after PID•Reiters Syndrome: triad of conjunctivitis, urethritis and arthritis•Fitz-Hugh-Curtis Syndrome: PerahepatitisSerum L1, L2, L3•Lymphogranuloma Venereum

Comparison between N. Gonorrhea & C. TrachomatisNeisseria Gonorrhea Chlamydia Trachomatis

Treatment 1st line: 3rd gen Cephalosporin such as Ceftriaxone (+doxycycline 2 cover incubating C. Trachomatis & Syphilis)2nd Line ( but not effective in syphilis): fluoroquinolones,spectinomycinOphthalmia Neonatorium: Erythromycin eye drops immediately after birth, as prophylaxis against both N. Gonorrhea and C. Trachomatis conjunctivitis. Infants w/ Ophthalmia Neonatorium require systemic tx w/ ceftriaxone. Erythromycin syrup should also be provided 2 cover 4 possible concurrent Chlamydial disease (failure to treat Chlamydial conjunctivitis can lead 2 Chlamydial pneumonia)

Genital Eye infection:•Doxycycline (use for adults)•Erythromycin (for infants and pregnant women)•AzithromycinNote: Systemic treatment is needed for chlamydial eye infection especially for the infants who can develop chlamydial pneumonia after chlamydial conjuctivitis

Comparison between N. Gonorrhea & C. Trachomatis

Neisseria Gonorrhea

Chlamydia Trachomatis

Treatment Infants w/ Ophthalmia Neonatorium require systemic treatment w/ ceftriaxone. Erythromycin syrup should also be provided 2 cover 4 possible concurrent Chlamydial disease (failure to treat Chlamydial conjunctivitis can lead 2 Chlamydial pneumonia)

Microscopic View

N. Gonorrhea Gram-negative coffee bean-

shaped diplococci bacteria

Gram's stain of urethral discharge from a male patient with gonorrhea shows gram-negative intracellular monococci and diplococci. (From the Public Health Agency of Canada.)

C. Trachomatis- gram-negative bacteria that lack mechanisms for

the production of metabolic energy and cannot synthesize ATP

Urethritis

Neisseria Gonorrhea- yellowish discharge from the penis,

associated with painful, and sometimes frequent, urination

C. Trachomatis-Male patients may develop a white, cloudy or watery discharge from the tip of

the penis

Vaginosis

Neisseria Gonorrhea- vaginal discharge that may be thin &

watery or thick & yellow/greenChlamydia Trachomatis- Mild,

milky or yellow mucus-like vaginal discharge

Cervicitis

N. Gonorrhea- Infection of the lower genital tract occurs through direct inoculation of columnar epithelial cells of

mucous membranes in the cervix and the urethraC. Trachomatis- Chlamydial cervicitis

with ectopy, discharge, bleeding.

Eye Infection

N. Gonorrhea- baby's eyes are contaminated during passage through the birth canal from a

mother infected with either Neisseria gonorrhoeae

C. Trachomatis- infection due to Chlamydia (trachoma) can be

spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-

seeking flies