Neisseria gonorrhoeae ferments (carbohydrate) , but not maltose.
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A 31-year-old woman comes to the gynecology clinic because of pelvic pain. She has had 2-weeks of intermittent pain, worse on the right, and radiating to her groin which has worsened and is more consistent. She denies urinary symptoms including burning, blood, urgency, and frequency. She had two sexual partners in the past month with intermittent condom use. Examination shows a temperature of 37.4°C (99.4°F), with normal vitals otherwise. There is pain to palpation in the right and left lower quadrants without rebound. A speculum examination demonstrates purulent discharge from the cervical os. Which of the following would most likely be present upon microscopic examination of the discharge?
The word Neisseria came from Neisser Albert, a German physician who discovered it, while gonorrhea is from the Greek words “gonos” which means "seed", and “rhoe” which means "flow", meaning "flow of seed", an illustration referring to the penile purulent discharge, which was mistakenly thought to be semen in infected males.
Now, a little bit of microbe anatomy and physiology. N. gonorrhoeae is a gram-negative bacterium, because its cell wall has a thin peptidoglycan layer and so it doesn’t retain purple dye used during Gram staining.
Instead, like any other Gram-negative bacteria, N. gonorrhoeae stains pink with safranin dye.
N. gonorrhoeae typically live in pairs called diplococci, stacked side to side, so the pair looks like a coffee bean.
They are also non-motile, non-spore forming, and obligate aerobes, which means that they absolutely need oxygen to grow.
Finally, they’re catalase and oxidase positive - which means they produce both these enzymes.
N. gonorrhoeae grows on a special chocolate medium called Thayer-Martin agar, which mainly consists of sheep blood... err, yum?
Some antimicrobials, like vancomycin and nystatin are usually added to the Thayer-Martin agar, to inhibit the possible growth of undesired bacteria or fungi, and maximize the growth of Neisseria species.
However, other Neisseria species, like N. meningitidis, have the same properties.
So the maltose fermentation test is done to differentiate the two.
To check for this, a pure sample from the culture of the suspected bacteria, is transferred to a sterile tube containing phenol red-maltose broth, which is then incubated at 36 degrees Celsius for 24 hours.
But this bacteria has a ton of other virulence factors, which it uses to attack and destroy host cells, and also to evade the immune system.
First, N. gonorrhoeae has pili, these little thread-like extensions radiating from the bacterial surface.
The pili help N. gonorrhoeae attach to a host’s mucosa surface.
Also, they help bacteria get physically connected with each other, making what’s known as a conjugation pilus, which is a hollow tiny rod, through which bacteria can swap genetic information back and forth - including antibiotic resistance genes.
Interestingly, N. gonorrhoeae pili are made of antigenic proteins which can vary with every infection – what’s known as phase variation.
Ok, so normally, when a certain bacteria causes an infection, the immune system keeps memory of the bacterial antigens configuration.
So if the same bacteria infects again, the immune system remembers it and quickly makes specific antibodies against it.
Pili aside, other virulence factors of N. gonorrhoeae include toxins.
The very important one is IgA protease, a toxic protein that this bacterium uses to destroy Immunoglobulin A – IgA.
IgA is an immune system protein that’s normally found in the mucosa secretions, like those produced by the vagina or the cervix.
IgA helps with bacteria opsonization - meaning it tags the bacteria so that neutrophils can recognize and destroy them.
So IgA protease neutralizes the first line of mucosal defense!
However, not all IgA molecules get neutralized, so some N. gonorrhoeae bacteria are still opsonized, and end up getting attacked by neutrophils.
Inside the neutrophil, N. gonorrhoeae is wrapped in a phagosome, a bubble inside which reactive oxygen species, such as H2O2, are released to kill it.
However, N. gonorrhoeae releases catalase, which breaks down H2O2.
Unfortunately, this translates as a win for N. gonorrhoeae, which now takes over the neutrophil and uses its energetic resources to multiply.
The neutrophil eventually becomes too full, bursting open, and letting out a lot of bacteria in the bloodstream, which is known as gonococcemia.