{"id":191,"date":"2015-10-14T17:00:52","date_gmt":"2015-10-14T09:00:52","guid":{"rendered":"https:\/\/www.shimclinic.com\/blog\/?p=191"},"modified":"2015-10-14T17:07:02","modified_gmt":"2015-10-14T09:07:02","slug":"is-it-a-rash-is-it-a-stain-no-its-a-superbug-neisseria-gonorrhoeae","status":"publish","type":"post","link":"https:\/\/www.shimclinic.com\/blog\/is-it-a-rash-is-it-a-stain-no-its-a-superbug-neisseria-gonorrhoeae\/","title":{"rendered":"Is it a rash? Is it a stain? No its a superbug: Neisseria gonorrhoeae"},"content":{"rendered":"

Gonorrhoea<\/a> is one of the oldest known STDs<\/a> with evidence suggesting it was present in the human population as far back as ancient Greece and Egypt.\u00a0 It is a gram negative (has two cell walls with a small periplasmic space between) bacteria and consists of two ball-shaped cells joined by a septum thus is called diplococci (di = two, cocci = ball-shaped).<\/p>\n

How It All Began<\/h2>\n

Gonococci are a human obligate pathogen, all of the Neisseria spp.<\/em> are only found in humans, and it started out as a harmless member of the community of bacteria that colonise the back of the throat.\u00a0 Biologists believe that over time the bacteria Neisseria meningitidis<\/em> (meningococcal) picked up virulence genes from bacteria passing through and transformed from normal flora (good bacteria) into a dangerous pathogen.\u00a0 At some time in the distance past a strain of N. meningitidis <\/em>got to the genital region and found it to its liking.<\/p>\n

The strain ditched most of the virulence factors required for survival in the harsh regions of the throat and bloodstream and settled down to become a subspecies N. gonorrhoeae<\/em>.\u00a0 While still able to cause the rare infection in other parts of the body, notably the throat and eyes (eye infection with N. gonorrhoeae<\/em>\u00a0 is often seen in abused children) it is found now almost exclusively as an STD and those opportunistic infections in other areas of the body are often caused by sexual contact.<\/p>\n

The Damage<\/h2>\n

gonorrhoeae<\/em> can colonise either the urethra or vagina. Symptomatic infection can cause itching, stinging pain on urination, a smelly discharge and in severe cases can form a biofilm that clogs the urethra causing difficulty in urination. More dangerous is that <\/span>N. gonorrhoeae<\/em> has retained the ability it had when it was normal flora to <\/span>cause asymptomatic infection.<\/span><\/p>\n

Asymptomatic gonorrhoea is still infectious and is able to hang around for years, possibly causing infections in multiple partners.\u00a0 In women, it is particularly damaging.\u00a0 While the woman infected does not sense the infection, her immune system does.\u00a0 It mounts a response, but due to the location of the bacteria is generally unsuccessful.\u00a0 The continuous mild inflammation eventually results in scarring of reproductive organs.\u00a0 This may cause Pelvic Inflammatory Disease (PID) which is chronic low-grade pelvic pain from the scarring and often results in reduced or loss of fertility.\u00a0 In men it can, in rare cases, cause scarring in the tubes that lead from the testes to the urethra resulting in chronic pain and\/or infertility.<\/p>\n

Fighting The Growing Resistance<\/h2>\n

The urogenital area colonised by gonococci, like the brain preferred by its cousin meningococcal, is known as an immunoprivileged site.\u00a0 Despite what that sounds like, it means the immune system finds it very hard to access.\u00a0 There are physical barriers that prevent white blood cells and other immune cells access to the site.\u00a0\u00a0 The body is often unable to clear the infection without medical assistance.<\/p>\n

When gonorrhoea was able to be cured with a single dose of penicillin this was not too much of an issue provided treatment was sought.\u00a0 N. gonorrhoeae <\/em>however is a genetic whore.\u00a0 Any piece of DNA it encounters it will take up into the cell, line it up with its own DNA to see if there is a match in the sequence.\u00a0 If there is sufficient sequence homology (sameness) then the bacteria will swap the pieces of DNA.\u00a0 It uses this method to pick up any useful DNA in the surrounding area.\u00a0 Bacteria lyse when dead and release their DNA and so if there are any resistance genes in the surrounding bacteria the gonococci will find it. \u00a0(Fortunately and for reasons unknown as there are comparable numbers of bacteria in the throat as the genital regions, meningococcal has not done this despite having the same ability, so can still be treated with benzyl-penicillin).<\/p>\n

Currently there are strains of N. gonorrhoeae<\/em> resistant to penicillin, tetracycline, and fluoroquinolone.\u00a0 The last effective drug are the antibiotics in the cephalosporin group and already superbug N. gonorrhoeae<\/em> have emerged in Europe and Japan which are resistant to this last line of defence.<\/p>\n

Hope For The Future<\/h2>\n

There is hope.\u00a0 Superbugs don\u2019t last. Antibiotic resistance genes are not cheap. They take energy to maintain and are lost as easily as they are obtained.\u00a0 Often the resistance is due to mutation in a protein that is less effective in the resistant state.\u00a0 N. gonorrhoeae <\/em>that are not maintaining four different resistance genes have more efficient cell processes and in the absence of antibiotics can outcompete the superbugs.\u00a0 Given time, they will push the resistant strains out.\u00a0 It is estimated that it takes 60 years for a resistant population to become susceptible to penicillin once the drug is removed and it is likely that a similar time frame exists for the other antibiotics. The antibiotics will start to work again eventually if we stop using them.<\/p>\n

This does not help those infected in the short term. It will likely take a century for the resistance to die down. In the meantime, it may be that the only way to avoid a chronic gonococcal infection is to not get it in the first place. Always use protection if you are unsure of your partner\u2019s condition. Get regular screenings and talk to your doctor if you have any doubts.<\/p>\n","protected":false},"excerpt":{"rendered":"

Gonorrhoea is one of the oldest known STDs with evidence suggesting it was present in the human population as far back as ancient Greece and Egypt.\u00a0 It is a gram negative (has two cell walls with a small periplasmic space between) bacteria and consists of two ball-shaped cells joined by a septum thus is called… Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":194,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[21,17],"class_list":["post-191","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-things-you-should-know","tag-gonorrhoea","tag-std"],"_links":{"self":[{"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/posts\/191","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/comments?post=191"}],"version-history":[{"count":4,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/posts\/191\/revisions"}],"predecessor-version":[{"id":196,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/posts\/191\/revisions\/196"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/media\/194"}],"wp:attachment":[{"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/media?parent=191"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/categories?post=191"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.shimclinic.com\/blog\/wp-json\/wp\/v2\/tags?post=191"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}