NEISSERIA GONORRHOEAE

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Neisseria gonorrhoeae

SYNONYM OR CROSS REFERENCE: Gonococci, Gonorrhea ⁽¹⁾.

CHARACTERISTICS: Neisseria gonorrhoeae belongs to the genus Neisseria within the family Neisseriaceae ⁽²⁾. It is a Gram-negative, non-spore forming, non-motile, encapsulated, and non acid-fast bacteria, which appear in kidney bean shape under the microscope ⁽¹⁾. It requires an aerobic environment with added CO₂ and enriched media such as chocolate agar for growth. It is oxidase positive and produces β-lactamase ^{(1, 3)}. Small, smooth, and non-pigmented colonies are produced after 18-24 hours of incubation. There are 70 different strains of N. gonorrhoeae ⁽³⁾.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Neisseria gonorrhoeae has a wide range of clinical manifestations ^{(1, 2)}.

Genital gonorrhea: In males, N. gonorrhoeae causes mainly urethritis, characterized by purulent urethral/penile discharge and dysuria ^(1-3). Rarely, the local infection can spread to other areas and cause epididymitis, prostatitis, and penile lymphangitis ^(1-3). Patients with epididymitis present with scrotal edema and scrotal, inguinal, and flank pain ⁽³⁾. In females, cervicitis (infection of endocervix) is the main infection caused by N. gonorrhoeae, and is characterized by increased vaginal discharge, dysuria, abdominal pain, and menstrual abnormalities ^(1-3). 70%-90% of the women may also have a concomitant urethral infection ⁽²⁾. Some individuals may be infected but asymptomatic ⁽²⁾.

Other local infections: N. gonorrhoeae may also cause pharyngeal (pharyngitis) and anorectal infections (proctitis) in both males and females ^(1-3). Patients with pharyngitis present with sore throat, fever, and cervical lymphadenopathy, and those with proctitis present with anal discharge, rectal bleeding, anorectal pain, tenesmus, and constipation ⁽³⁾.

Pelvic Inflammatory disease (PID): PID is defined as inflammation of the upper female genital tract, specifically the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries, as well as the adjacent peritoneum and occurs in 10-40% of the young women with gonococcal infection ^(1-4). The main symptoms of the disease include fever, lower abdominal pain, adnexal and cervical motion tenderness, and leukocytosis ^{(1, 3)}. The most serious complications of the disease are reproductive tract problems such as tubo-ovarian abscess, Fitz-Hugh-Curtis syndrome (perihepatitis), and ectopic pregnancy ^{(1, 3)}.

Disseminated Infections: Disseminated gonococcal infections occur due to the spread of the bacteria ^(1-3). Patients with disseminated infection may present with dermatitis, arthritis, and rarely, meningitis or endocarditis.

Infections in Neonates: Gonococcal infections in neonates include gonococcal ophthalmia neonatorum, gonococcal scalp abscess, and disseminated infections such as septic arthritis, and meningitis ^{(3, 5)}. Gonococcal ophthalmia neonatorum is usually a mild infection of the conjunctiva, characterized by mucopurulent eye discharge ⁽⁵⁾.

EPIDEMIOLOGY: Worldwide. Sixty-two million cases of gonorrhea have been estimated to occur annually worldwide, by the World Health Organization ⁽⁶⁾. The majority of the cases occur in developing countries. Infections due to gonococci are the second most common reportable or notifiable bacterial disease in the United States ⁽³⁾. The national rate of gonococcal infections was reported to be 115.6 cases per 100,000, in 2005 in the United States, with higher rates among African Americans as well as in rural areas of the southeastern United States. Incidence of gonococcal infections is highest in youth, with 40% of the infections occurring in females between 15 and 19 years of age. In Canada, 12,723 cases of gonorrhea were reported in 2008 ^(7).

HOST RANGE: It is an obligate human pathogen with no other known host ⁽⁸⁾.

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: Gonorrhea is sexually transmitted ^{(1, 8)}. Gonococcal ophthalmia neonatorum is acquired as a result of eye contamination during vaginal delivery ⁽²⁾. Transmission through fomites has been reported for purulent vulvovaginitis in prepubescent girls ⁽¹⁾.

INCUBATION PERIOD: 2-7 days in males and 8-10 days in females ^{(2, 3)}; 2-5 days for gonococcal opthalmia neonatorum ⁽⁵⁾.

COMMUNICABILITY: Gonorrhea is sexually transmitted (exchange of bodily fluids) ⁽³⁾.

SECTION III - DISSEMINATION

RESERVOIR: Humans ⁽¹⁾.

ZOONOSIS: None.

VECTOR: None.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY/RESISTANCE: Susceptible to third generation cephalosporins, and spectinomycin ^{(3, 5)}. N. gonorrhoeae is often resistant to penicillin and tetracycline ^{(2, 9)}. In Canada, approximately 12 % of all the strains tested between 2000 and 2008 are resistant to quinolones such as ciprofloxacin, and ofloxacin ^{(5, 9)}. Strains resistant to azithromycin and erythromycin have been reported in the United States ⁽⁵⁾ and Canada. N. gonorrhoeae strains resistant to oral third-generation cephalosporins (cefixime and ceftibuten) have been reported ⁽¹⁰⁾. Resistance has not been reported with injectable ceftriaxone.

SUSCEPTIBILITY TO DISINFECTANTS: N. gonorrhoeae is sensitive to most disinfectants ⁽¹¹⁾. Disinfectants used against most vegetative bacteria include 1% sodium hypochlorite, 70% ethanol, phenolics, 2% glutaraldehyde, formaldehyde, and peracetic acid ⁽¹²⁾.

PHYSICAL INACTIVATION: N. gonorrhoeae is sensitive to desiccation ⁽¹¹⁾. Most vegetative bacteria can also be inactivated by moist heat (121°C for 15 min- 30 min) and dry heat (160-170°C for 1-2 hours) ⁽¹³⁾.

SURVIVAL OUTSIDE HOST: Gonococci have survived for brief periods on a toilet seat ⁽¹⁾, with reports of up to 2 hours ⁽¹⁴⁾. Gonococci have also survived for 3 hours on toilet paper, 17 hours on slides, and 24 hours on towels ⁽¹⁴⁾. Transmission by fomites is rare.

SECTION V - FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Culturing of discharge can be done on chocolate agar or Thayer-Matin agar ^{(1-3, 6, 15, 16)}. Other methods include polymerase-chain reaction (PCR) to detect bacterial DNA from endocervical or urethreal sites or urine ^{(1, 3, 5, 6, 8)}; direct examination of samples using Gram staining ⁽³⁾, and serological tests, including enzyme-linked immunosorbent assays (ELISA) or direct fluorescence antigen testing ^{(6, 15)}.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Although treatment of gonococcal infections depends upon the site and type of infection, most infections are treated with third generation cephalosporins such as Ceftriaxone or Cefixime ^{(3, 5, 17)}. Other drugs that can be used to treat gonococcal infections include spectinomycin and azithromycin⁽³⁾. Penicillin is not recommended for therapy due to antimicrobial resistance. Fluoroquinolones should not be used in areas where the prevalence of GC quinolone resistance is greater than 3-5%.

IMMUNIZATION: None.

PROPHYLAXIS: In neonates, prophylaxis for gonococcal ophthalmia neonatorum is done with 1% solution of AgNO₃, 1% tetracycline ointment, or 0.5% erythromycin ophthalmic ointment, instilled into the eyes of every neonate within 1 hour after birth ⁽⁵⁾.

SECTION VI - LABORATORY HAZARD

LABORATORY-ACQUIRED INFECTIONS: Five reported cases of laboratory acquired infection ⁽¹⁸⁾. One case was a cutaneous infection, 4 were gonococcal conjunctivitis.

SOURCES/SPECIMENS: Conjuctiva, blood, joint fluid, endocervix, urethra, skin lesions, endometrium, fallopian tubes, rectum, pharynx ⁽²⁾.

PRIMARY HAZARDS: Accidental parenteral inoculation and direct or indirect contact of mucous membranes with infectious material ⁽¹⁹⁾.

SPECIAL HAZARDS: None.

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 ⁽²⁰⁾.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes ⁽²¹⁾.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities ⁽²¹⁾.

SECTION VIII - HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism by autoclave, chemical disinfection, gamma irradiation, or incineration before disposing.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: September 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada

Although the information, opinions and recommendations contained in this Pathogen Safety Data sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©

Public Health Agency of Canada, 2011

Canada

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