Pathogenesis of Gonococcal infection

• Gonococcus is considered to be a strict human parasite.
• Various attempts were done to infect animals.
• But all had failed until recently when chimpanzees have been experimentally infected.
• Gonococcus is generally found only in cases of acute, chronic or asymptomatic infection.
• But not found in healthy carriers like meningococccus.
• The latter may account for 70-80% infections in women and 5-10% in males.
• The anterior urethra gets affected in men in the initial infection and in case of female urethra and cervix of uterus gets affected.
• The infection become chronic or lead to upper genital tract or systemic complications if not treated on time or left untreated.
• Sometimes asymptomatic infections might also lead to complicated infection.
• The urethral exudate consists of gonococcus on the surface of or within epithelial cells or extracellularly, within the proportion of polymorphonuclear leukocytes in acute urethritis.

a) In case of men

• Urethra gets infected which produces a suppurative inflammation with purulent discharge.
• The cocci are present in large numbers in the discharge at an early stage, but later are scanty.
• Prostrate, seminal vesicles and epididymis may also get infected and it may also invade to the periurethral tissue producing an inflammatory reaction, periurethral abscess and subsequent stricture.

b) In case of women

• The urethra and cervix uteri are infected but the vaginal mucosa is rarely infected and the discharge is often scanty.
• The infection spreads to the vestibular glands(bartholinitis), the endometrium (endometritis) and fallopian tubes (salpingitis) and even the peritoneal cavity gets invaded.

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c) Rectal infection

• It occurs in case of both men and female which might be acquired exogenously by passive male homosexuals.
• And in females, it usually spreads to the anus from the genital infection.

d) Other infections

• Primary gonorrheal infections may help in invading the blood.
• This may results in arthritis and tenosynovitis as complications.
• Occasionally, gonococcus has also been cultivated from the joint fluid in arthritis.
• The possibility of gonococcal arthritis might be due to allergic manifestation.
• Various recent reports are present related to septic gonococcal dermatitis, usually associated with arthritis, arthralgia and fever.
• Varying size of maculo-papules to vesticulo-pustules are present in scanty as skin lesions.
• They are mostly present on the extremities or around joints and are more common in females than in males.
• Oro-genital contact may lead to gonococcal infection of the pharynx.
• It is more common in homosexual men but is also present in female and less frequently in heterosexual men.
• Asymptomatic infection may be noticed which is associated with sore throat, pharyngitis or tonsillitis.
• A persistent vulvo-vaginitis may be produced in female infants and children with involvement of rectum sometimes.
• This infection may lead to outbreaks in paediatric wards and children’s institution.
• Vulvo-vaginitis cases are rare now and are associated with sexual offences.
• Gonococcal opthalmia may result in new born infants at birth from direct infection from mother having gonorrhoea.

References: 

i) https://pubmed.ncbi.nlm.nih.gov/31119614/

ii) https://www.wikidoc.org/index.php/Gonorrhea_pathophysiology

Pathogenesis of Gonococcal infection