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Neisseria gonorrhoeae - Wikipedia
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<li id="toc-Culture_and_identification" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Culture_and_identification"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Culture and identification</span> </div> </a> <ul id="toc-Culture_and_identification-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Metabolism" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Metabolism"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Metabolism</span> </div> </a> <button aria-controls="toc-Metabolism-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Metabolism subsection</span> </button> <ul id="toc-Metabolism-sublist" class="vector-toc-list"> <li id="toc-Carbon" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Carbon"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Carbon</span> </div> </a> <ul id="toc-Carbon-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Electron_Transport_Chain_and_Oxidative_Phosphorylation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Electron_Transport_Chain_and_Oxidative_Phosphorylation"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Electron Transport Chain and Oxidative Phosphorylation</span> </div> </a> <ul id="toc-Electron_Transport_Chain_and_Oxidative_Phosphorylation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Iron" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Iron"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Iron</span> </div> </a> <ul id="toc-Iron-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Surface_molecules" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surface_molecules"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Surface molecules</span> </div> </a> <ul id="toc-Surface_molecules-sublist" class="vector-toc-list"> <li id="toc-Opa_Proteins" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Opa_Proteins"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4.1</span> <span>Opa Proteins</span> </div> </a> <ul id="toc-Opa_Proteins-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Type_IV_Pili" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Type_IV_Pili"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4.2</span> <span>Type IV Pili</span> </div> </a> <ul id="toc-Type_IV_Pili-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Lipooligosaccharide" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Lipooligosaccharide"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4.3</span> <span>Lipooligosaccharide</span> </div> </a> <ul id="toc-Lipooligosaccharide-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Antigenic_variation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antigenic_variation"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Antigenic variation</span> </div> </a> <ul id="toc-Antigenic_variation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Phase_variation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Phase_variation"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.6</span> <span>Phase variation</span> </div> </a> <ul id="toc-Phase_variation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Survival_of_gonococci" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Survival_of_gonococci"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.7</span> <span>Survival of gonococci</span> </div> </a> <ul id="toc-Survival_of_gonococci-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Genome" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Genome"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Genome</span> </div> </a> <button aria-controls="toc-Genome-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Genome subsection</span> </button> <ul id="toc-Genome-sublist" class="vector-toc-list"> <li id="toc-Horizontal_gene_transfer" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Horizontal_gene_transfer"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Horizontal gene transfer</span> </div> </a> <ul id="toc-Horizontal_gene_transfer-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Disease" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Disease"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Disease</span> </div> </a> <button aria-controls="toc-Disease-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Disease subsection</span> </button> <ul id="toc-Disease-sublist" class="vector-toc-list"> <li id="toc-Symptoms" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Symptoms"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Symptoms</span> </div> </a> <ul id="toc-Symptoms-sublist" class="vector-toc-list"> <li id="toc-Male" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Male"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.1</span> <span>Male</span> </div> </a> <ul id="toc-Male-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Female" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Female"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.2</span> <span>Female</span> </div> </a> <ul id="toc-Female-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Neonates_(perinatal_infection)" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Neonates_(perinatal_infection)"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.3</span> <span>Neonates (perinatal infection)</span> </div> </a> <ul id="toc-Neonates_(perinatal_infection)-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Transmission" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transmission"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Transmission</span> </div> </a> <ul id="toc-Transmission-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Infection" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Infection"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Infection</span> </div> </a> <ul id="toc-Infection-sublist" class="vector-toc-list"> <li id="toc-Laboratory_diagnosis" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Laboratory_diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3.1</span> <span>Laboratory diagnosis</span> </div> </a> <ul id="toc-Laboratory_diagnosis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Prevention</span> </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> <li id="toc-Vaccine" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Vaccine"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4.1</span> <span>Vaccine</span> </div> </a> <ul id="toc-Vaccine-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.5</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Antibiotic_resistance" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Antibiotic_resistance"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.5.1</span> <span>Antibiotic resistance</span> </div> </a> <ul id="toc-Antibiotic_resistance-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Serum_resistance" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Serum_resistance"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.6</span> <span>Serum resistance</span> </div> </a> <ul id="toc-Serum_resistance-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>History</span> </div> </a> <button aria-controls="toc-History-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle History subsection</span> </button> <ul id="toc-History-sublist" class="vector-toc-list"> <li id="toc-Name_origin" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Name_origin"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Name origin</span> </div> </a> <ul id="toc-Name_origin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Discovery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Discovery"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Discovery</span> </div> </a> <ul id="toc-Discovery-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><i>Neisseria gonorrhoeae</i></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 34 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-34" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">34 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Gonokokkus" title="Gonokokkus – Afrikaans" lang="af" hreflang="af" data-title="Gonokokkus" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target"><span>Afrikaans</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%86%D9%8A%D8%B3%D8%B1%D9%8A%D8%A9_%D8%A8%D9%86%D9%8A%D8%A9" title="نيسرية بنية – Arabic" lang="ar" hreflang="ar" data-title="نيسرية بنية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Bulgarian" lang="bg" hreflang="bg" data-title="Neisseria gonorrhoeae" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Gonococ" title="Gonococ – Catalan" lang="ca" hreflang="ca" data-title="Gonococ" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Czech" lang="cs" hreflang="cs" data-title="Neisseria gonorrhoeae" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – German" lang="de" hreflang="de" data-title="Neisseria gonorrhoeae" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9D%CE%B1%CF%8A%CF%83%CF%83%CE%AD%CF%81%CE%B9%CE%B1_%CF%84%CE%B7%CF%82_%CE%B3%CE%BF%CE%BD%CF%8C%CF%81%CF%81%CE%BF%CE%B9%CE%B1%CF%82" title="Ναϊσσέρια της γονόρροιας – Greek" lang="el" hreflang="el" data-title="Ναϊσσέρια της γονόρροιας" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Spanish" lang="es" hreflang="es" data-title="Neisseria gonorrhoeae" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Basque" lang="eu" hreflang="eu" data-title="Neisseria gonorrhoeae" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%86%D8%A7%DB%8C%D8%B3%D8%B1%DB%8C%D8%A7_%DA%AF%D9%88%D9%86%D9%88%D8%B1%D9%87%E2%80%8C%D8%A2" title="نایسریا گونورهآ – Persian" lang="fa" hreflang="fa" data-title="نایسریا گونورهآ" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – French" lang="fr" hreflang="fr" data-title="Neisseria gonorrhoeae" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Galician" lang="gl" hreflang="gl" data-title="Neisseria gonorrhoeae" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%9E%84%EA%B7%A0" title="임균 – Korean" lang="ko" hreflang="ko" data-title="임균" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Indonesian" lang="id" hreflang="id" data-title="Neisseria gonorrhoeae" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Italian" lang="it" hreflang="it" data-title="Neisseria gonorrhoeae" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%92%E1%83%9D%E1%83%9C%E1%83%9D%E1%83%99%E1%83%9D%E1%83%99%E1%83%98" title="გონოკოკი – Georgian" lang="ka" hreflang="ka" data-title="გონოკოკი" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Gonokoks" title="Gonokoks – Latvian" lang="lv" hreflang="lv" data-title="Gonokoks" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Hungarian" lang="hu" hreflang="hu" data-title="Neisseria gonorrhoeae" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D9%86%D9%8A%D8%B3%D8%B1%D9%8A%D9%87_%D8%A8%D9%86%D9%8A%D9%87" title="نيسريه بنيه – Egyptian Arabic" lang="arz" hreflang="arz" data-title="نيسريه بنيه" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target"><span>مصرى</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Dutch" lang="nl" hreflang="nl" data-title="Neisseria gonorrhoeae" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%B7%8B%E8%8F%8C" title="淋菌 – Japanese" lang="ja" hreflang="ja" data-title="淋菌" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Neisseria gonorrhoeae" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Gonokokk" title="Gonokokk – Uzbek" lang="uz" hreflang="uz" data-title="Gonokokk" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Dwoinka_rze%C5%BC%C4%85czki" title="Dwoinka rzeżączki – Polish" lang="pl" hreflang="pl" data-title="Dwoinka rzeżączki" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Portuguese" lang="pt" hreflang="pt" data-title="Neisseria gonorrhoeae" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae – Romanian" lang="ro" hreflang="ro" data-title="Neisseria gonorrhoeae" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%93%D0%BE%D0%BD%D0%BE%D0%BA%D0%BE%D0%BA%D0%BA" title="Гонококк – Russian" lang="ru" hreflang="ru" data-title="Гонококк" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Gonokokki" title="Gonokokki – Finnish" lang="fi" hreflang="fi" data-title="Gonokokki" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Gonokocker" title="Gonokocker – Swedish" lang="sv" hreflang="sv" data-title="Gonokocker" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link 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Note distribution in neutrophils and presence of both intracellular and extracellular bacteria. (CDC)" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Gonococcal_urethritis_PHIL_4085_lores.jpg/220px-Gonococcal_urethritis_PHIL_4085_lores.jpg" decoding="async" width="220" height="145" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Gonococcal_urethritis_PHIL_4085_lores.jpg/330px-Gonococcal_urethritis_PHIL_4085_lores.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Gonococcal_urethritis_PHIL_4085_lores.jpg/440px-Gonococcal_urethritis_PHIL_4085_lores.jpg 2x" data-file-width="3604" data-file-height="2376" /></a></span> </td></tr> <tr> <td colspan="2" style="text-align: center; font-size: 88%"><a href="/wiki/Gram-stain" class="mw-redirect" title="Gram-stain">Gram-stain</a> of <a href="/wiki/Gonococcal_urethritis" class="mw-redirect" title="Gonococcal urethritis">gonococcal urethritis</a>. Note distribution in <a href="/wiki/Neutrophil" title="Neutrophil">neutrophils</a> and presence of both <a href="/wiki/Intracellular" class="mw-redirect" title="Intracellular">intracellular</a> and <a href="/wiki/Extracellular" class="mw-redirect" title="Extracellular">extracellular</a> bacteria. (<a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a>) </td></tr> <tr> <th colspan="2" style="color:inherit; min-width:15em; text-align: center; background-color: rgb(220,235,245)"><a href="/wiki/Taxonomy_(biology)" title="Taxonomy (biology)">Scientific classification</a> <span class="plainlinks taxobox-edit-taxonomy skin-invert" style="font-size:smaller; float:right; padding-right:0.4em; margin-left:-3em;"><span typeof="mw:File"><a href="/wiki/Template:Taxonomy/Neisseria" title="Edit this classification"><img alt="Edit this classification" src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/OOjs_UI_icon_edit-ltr.svg/15px-OOjs_UI_icon_edit-ltr.svg.png" decoding="async" width="15" height="15" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/OOjs_UI_icon_edit-ltr.svg/23px-OOjs_UI_icon_edit-ltr.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8a/OOjs_UI_icon_edit-ltr.svg/30px-OOjs_UI_icon_edit-ltr.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span> </th></tr> <tr> <td>Domain: </td> <td><a href="/wiki/Bacteria" title="Bacteria">Bacteria</a> </td></tr> <tr> <td>Phylum: </td> <td><a href="/wiki/Pseudomonadota" title="Pseudomonadota">Pseudomonadota</a> </td></tr> <tr> <td>Class: </td> <td><a href="/wiki/Betaproteobacteria" title="Betaproteobacteria">Betaproteobacteria</a> </td></tr> <tr> <td>Order: </td> <td><a href="/wiki/Neisseriaceae" title="Neisseriaceae">Neisseriales</a> </td></tr> <tr> <td>Family: </td> <td><a href="/wiki/Neisseriaceae" title="Neisseriaceae">Neisseriaceae</a> </td></tr> <tr> <td>Genus: </td> <td><a href="/wiki/Neisseria" title="Neisseria"><i>Neisseria</i></a> </td></tr> <tr> <td>Species: </td> <td><div style="display:inline" class="species"><i><b>N. gonorrhoeae</b></i></div> </td></tr> <tr> <th colspan="2" style="color:inherit; text-align: center; background-color: rgb(220,235,245)"><a href="/wiki/Binomial_nomenclature" title="Binomial nomenclature">Binomial name</a> </th></tr> <tr> <td colspan="2" style="text-align: center"><b><span class="binomial"><span style="font-weight:normal;"></span><i>Neisseria gonorrhoeae</i></span></b><br /><div style="font-size: 85%;">(<a href="/wiki/Friedrich_Wilhelm_Zopf" title="Friedrich Wilhelm Zopf">Zopf</a> 1885) <a href="/wiki/Vittore_Benedetto_Antonio_Trevisan_de_Saint-L%C3%A9on" title="Vittore Benedetto Antonio Trevisan de Saint-Léon">Trevisan</a> 1885<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></div> </td></tr> <tr> <th colspan="2" style="color:inherit; text-align: center; background-color: rgb(220,235,245)"><a href="/wiki/Synonym_(taxonomy)" title="Synonym (taxonomy)">Synonyms</a> </th></tr> <tr> <td colspan="2" style="text-align: left"> <ul><li><i>Micrococcus</i> der Gonorrhoe <small><a href="/wiki/Albert_Ludwig_Sigesmund_Neisser" title="Albert Ludwig Sigesmund Neisser">Neisser</a> 1879</small><sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li> <li><i>Gonococcus neisseri</i> <small><a href="/wiki/Arvid_Lindau" title="Arvid Lindau">Lindau</a> 1898</small></li></ul> </td></tr> </tbody></table><style data-mw-deduplicate="TemplateStyles:r1238732961">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox.biota tr{background:transparent!important}html.skin-theme-clientpref-night .mw-parser-output .infobox.biota img{background:transparent}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox.biota tr{background:transparent!important}html.skin-theme-clientpref-os .mw-parser-output .infobox.biota img{background:white}}.mw-parser-output .infobox.biota .taxobox-edit-taxonomy img{background:transparent!important}body.skin-vector .mw-parser-output table.biota.infobox{margin-top:0.5em}body.skin--responsive .mw-parser-output table.biota.infobox tr.taxonrow td{padding:2px 10px}</style> <p><i><b>Neisseria gonorrhoeae</b></i>, also known as <i><b>gonococcus</b></i> (singular) or <i><b>gonococci</b></i> (plural), is a species of <a href="/wiki/Gram-negative" class="mw-redirect" title="Gram-negative">Gram-negative</a> <a href="/wiki/Diplococci" class="mw-redirect" title="Diplococci">diplococci</a> <a href="/wiki/Bacteria" title="Bacteria">bacteria</a> first isolated by <a href="/wiki/Albert_Ludwig_Sigesmund_Neisser" title="Albert Ludwig Sigesmund Neisser">Albert Neisser</a> in 1879.<sup id="cite_ref-O'Donnell_2009_3-0" class="reference"><a href="#cite_note-O'Donnell_2009-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> An obligate human pathogen, it primarily colonizes the mucosal lining of the urogenital tract; however, it is also capable of adhering to the mucosa of the nose,<sup id="cite_ref-pmid37558089_4-0" class="reference"><a href="#cite_note-pmid37558089-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> pharynx, rectum, and <a href="/wiki/Conjunctiva" title="Conjunctiva">conjunctiva</a>.<sup id="cite_ref-pmid37711920_5-0" class="reference"><a href="#cite_note-pmid37711920-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> It causes the <a href="/wiki/Sexually_transmitted_infection" title="Sexually transmitted infection">sexually transmitted</a> genitourinary infection <a href="/wiki/Gonorrhea" title="Gonorrhea">gonorrhea</a><sup id="cite_ref-Sherris_6-0" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> as well as other forms of gonococcal disease including disseminated gonococcemia, <a href="/wiki/Septic_arthritis" title="Septic arthritis">septic arthritis</a>, and gonococcal ophthalmia neonatorum. </p><p><i>N. gonorrhoeae</i> is <a href="/wiki/Oxidase_test" title="Oxidase test">oxidase</a> positive and a <a href="/wiki/Microaerophile" title="Microaerophile">microaerophile</a> that is capable of surviving <a href="/wiki/Phagocyte" title="Phagocyte">phagocytosis</a> and growing inside <a href="/wiki/Neutrophil" title="Neutrophil">neutrophils</a>.<sup id="cite_ref-Sherris_6-1" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Microbiological_culture" title="Microbiological culture">Culturing</a> it requires carbon dioxide supplementation and enriched agar (<a href="/wiki/Chocolate_agar" title="Chocolate agar">chocolate agar</a>) with various antibiotics (<a href="/wiki/Thayer%E2%80%93Martin_agar" title="Thayer–Martin agar">Thayer–Martin</a>). It exhibits <a href="/wiki/Antigenic_variation" title="Antigenic variation">antigenic variation</a> through <a href="/wiki/Genetic_recombination" title="Genetic recombination">genetic recombination</a> of its <a href="/wiki/Pilus" title="Pilus">pili</a> and surface proteins that interact with the <a href="/wiki/Immune_system" title="Immune system">immune system</a>.<sup id="cite_ref-O'Donnell_2009_3-1" class="reference"><a href="#cite_note-O'Donnell_2009-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>Sexual transmission is through vaginal, anal, or oral sex.<sup id="cite_ref-www.cdc.gov_2017_7-0" class="reference"><a href="#cite_note-www.cdc.gov_2017-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Sexual transmission may be prevented through the use of barrier protection.<sup id="cite_ref-CDC_8-0" class="reference"><a href="#cite_note-CDC-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Perinatal transmission may occur during childbirth, though it is preventable through antibiotic treatment of the mother before birth and application of antibiotic eye gel on the eyes of the newborn.<sup id="cite_ref-CDC_8-1" class="reference"><a href="#cite_note-CDC-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Gonococcal infections do not result in protective immunity; therefore, individuals may be infected multiple times. Reinfection is possible due to <i>N. gonorrhoeae's</i> ability to evade the immune system by varying its surface proteins.<sup id="cite_ref-Hill_2016_9-0" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Asymptomatic infection is common in both males and females.<sup id="cite_ref-CDC_8-2" class="reference"><a href="#cite_note-CDC-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Untreated infection may spread to the rest of the body (disseminated gonorrhea infection), especially the joints (septic arthritis). Untreated infection in women may cause <a href="/wiki/Pelvic_inflammatory_disease" title="Pelvic inflammatory disease">pelvic inflammatory disease</a> and possible infertility due to the resulting scarring.<sup id="cite_ref-Lev13th2_11-0" class="reference"><a href="#cite_note-Lev13th2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Gonorrhoea is diagnosed through <a href="/wiki/Microbiological_culture" title="Microbiological culture">cultures</a>, <a href="/wiki/Gram_stain" title="Gram stain">Gram staining</a>, or <a href="/wiki/Nucleic_acid_test" title="Nucleic acid test">nucleic acid tests</a> (i.e. <a href="/wiki/Polymerase_chain_reaction" title="Polymerase chain reaction">polymerase chain reaction</a>) of urine samples, urethral swabs, or cervical swabs.<sup id="cite_ref-Ng_2005_12-0" class="reference"><a href="#cite_note-Ng_2005-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gonococcal_Infections_2018_13-0" class="reference"><a href="#cite_note-Gonococcal_Infections_2018-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Chlamydia_infection" class="mw-redirect" title="Chlamydia infection">Chlamydia</a> co-testing and testing for other STIs is recommended due to high rates of co-infection.<sup id="cite_ref-Humana_Press_2012_14-0" class="reference"><a href="#cite_note-Humana_Press_2012-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Antibiotic_resistance_in_gonorrhea" title="Antibiotic resistance in gonorrhea">Antibiotic resistance in <i>N. gonorrhoeae</i></a> is a growing public health concern, especially given its propensity to develop resistance easily.<sup id="cite_ref-Quillin_2018_15-0" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> This ability of <i>N. gonorrhoeae</i> to rapidly adapt to novel antimicrobial treatments has been seen several times since the 1930s, making numerous treatment plans obsolete. Some strains have exhibited resistance to the current ceftriaxone treatments.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Microbiology">Microbiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=1" title="Edit section: Microbiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Neisseria_gonorrhoeae_with_pus_cells.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Neisseria_gonorrhoeae_with_pus_cells.jpg/220px-Neisseria_gonorrhoeae_with_pus_cells.jpg" decoding="async" width="220" height="330" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Neisseria_gonorrhoeae_with_pus_cells.jpg/330px-Neisseria_gonorrhoeae_with_pus_cells.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Neisseria_gonorrhoeae_with_pus_cells.jpg/440px-Neisseria_gonorrhoeae_with_pus_cells.jpg 2x" data-file-width="1080" data-file-height="1620" /></a><figcaption>A Gram stain of a urethral exudate showing typical intracellular Gram-negative diplococci, which is diagnostic for gonococcal urethritis<sup id="cite_ref-pmid33929174_17-0" class="reference"><a href="#cite_note-pmid33929174-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p><i><a href="/wiki/Neisseria" title="Neisseria">Neisseria</a></i> species are <a href="/wiki/Fastidious" class="mw-redirect" title="Fastidious">fastidious</a>, Gram-negative cocci (though some species are rod-shaped and occur in pairs or short chains) that require nutrient supplementation to grow in laboratory cultures.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> They are facultative intracellular pathogens, meaning they are able to persist and colonize within host cells but can also multiply outside the host cellular environment.<sup id="cite_ref-Green_2022_19-0" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Yeshanew_2018_21-0" class="reference"><a href="#cite_note-Yeshanew_2018-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> They typically appear in pairs (diplococci), resembling the shape of coffee beans.<sup id="cite_ref-Yeshanew_2018_21-1" class="reference"><a href="#cite_note-Yeshanew_2018-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Members of this genus do not form endospores and are nonmotile, with the exception of pathogenic species, which capable of moving using <a href="/wiki/Twitching_motility" title="Twitching motility">twitching motility</a>;<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> most are also <a href="/wiki/Obligate_aerobe" title="Obligate aerobe">obligate aerobes</a>.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Of the 17 species that colonize humans, only two are pathogenic: <i>N. gonorrhoeae,</i> which causes gonorrhea, and <i><a href="/wiki/Neisseria_meningitidis" title="Neisseria meningitidis">N. meningitidis</a></i>, a leading cause of <a href="/wiki/Bacterial_meningitis" class="mw-redirect" title="Bacterial meningitis">bacterial meningitis</a>.<sup id="cite_ref-pmid32534649_25-0" class="reference"><a href="#cite_note-pmid32534649-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Culture_and_identification">Culture and identification</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=2" title="Edit section: Culture and identification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Neisseria_gonorrhoeae_01.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f5/Neisseria_gonorrhoeae_01.png/220px-Neisseria_gonorrhoeae_01.png" decoding="async" width="220" height="151" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f5/Neisseria_gonorrhoeae_01.png/330px-Neisseria_gonorrhoeae_01.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f5/Neisseria_gonorrhoeae_01.png/440px-Neisseria_gonorrhoeae_01.png 2x" data-file-width="681" data-file-height="467" /></a><figcaption>Thayer–Martin agar is selective for growth of <i>Neisseria</i> species. Further testing (oxidase, carbohydrate use and pcr) can be used to differentiate <i>N. gonorrhoeae</i> from <i>N. meningitidis.q</i></figcaption></figure> <p><i>N. gonorrhoeae</i> can be isolated on <a href="/wiki/Thayer%E2%80%93Martin_agar" title="Thayer–Martin agar">Thayer–Martin agar</a> (or VPN) agar in an atmosphere enriched with 3-7% carbon dioxide.<sup id="cite_ref-Ng_2005_12-1" class="reference"><a href="#cite_note-Ng_2005-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Thayer–Martin agar is a chocolate <a href="/wiki/Agar_plate" title="Agar plate">agar plate</a> (heated blood agar) containing nutrients and <a href="/wiki/Antibiotic" title="Antibiotic">antimicrobials</a> (<a href="/wiki/Vancomycin" title="Vancomycin">vancomycin</a>, <a href="/wiki/Colistin" title="Colistin">colistin</a>, <a href="/wiki/Nystatin" title="Nystatin">nystatin</a>, and <a href="/wiki/Trimethoprim" title="Trimethoprim">trimethoprim</a>). This agar preparation facilitates the growth of <i>Neisseria</i> species while inhibiting the growth of contaminating bacteria and fungi. Martin Lewis and <a href="/wiki/New_York_City_agar" title="New York City agar">New York City agar</a> are other types of selective chocolate agar commonly used for <i>Neisseria</i> growth.<sup id="cite_ref-Ng_2005_12-2" class="reference"><a href="#cite_note-Ng_2005-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> <i>N. gonorrhoeae</i> is <a href="/wiki/Oxidase_test" title="Oxidase test">oxidase</a> positive (possessing cytochrome c oxidase) and <a href="/wiki/Catalase" title="Catalase">catalase</a> positive (able to convert hydrogen peroxide to oxygen).<sup id="cite_ref-Ng_2005_12-3" class="reference"><a href="#cite_note-Ng_2005-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> When incubated with the carbohydrates lactose, <a href="/wiki/Maltose" title="Maltose">maltose</a>, <a href="/wiki/Sucrose" title="Sucrose">sucrose</a>, and <a href="/wiki/Glucose" title="Glucose">glucose</a>, <i>N. gonorrhoeae</i> will oxidize only the glucose.<sup id="cite_ref-Ng_2005_12-4" class="reference"><a href="#cite_note-Ng_2005-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Metabolism">Metabolism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=3" title="Edit section: Metabolism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Carbon">Carbon</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=4" title="Edit section: Carbon"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Unlike other <i>Neisseria</i> species that can also metabolize maltose, <i>N. gonorrhoeae</i> is capable of using only glucose, pyruvate, and lactate as central carbon sources, and glucose is catabolized via both the <a href="/wiki/Entner%E2%80%93Doudoroff_pathway" title="Entner–Doudoroff pathway">Entner-Doudoroff</a> (ED) and <a href="/wiki/Pentose_phosphate_pathway" title="Pentose phosphate pathway">pentose phosphate</a> (PP) pathways,and the ED pathway is the primary oxidative method.<sup id="cite_ref-Green_2022_19-1" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Morse_1980_27-0" class="reference"><a href="#cite_note-Morse_1980-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Use of these pathways is necessary as <i>N. gonorrhoeae</i> is incapable of glucose catabolism via the <a href="/wiki/Embden-Meyerhof-Parnas_pathway" class="mw-redirect" title="Embden-Meyerhof-Parnas pathway">Embden-Meyerhof-Parnas</a> (EMP) pathway due its lack of the phosphofructokinase (PFK) gene; however, the fructose 1,6-bisphosphatase enzyme is present to allow for <a href="/wiki/Gluconeogenesis" title="Gluconeogenesis">gluconeogenesis</a> to occur.<sup id="cite_ref-Green_2022_19-2" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Glucose is first metabolized through the ED pathway to produce pyruvate and glyceraldehyde 3-phosphate, the latter of which can then further metabolized by enzymes of the EMP pathway to yield another molecule of pyruvate.<sup id="cite_ref-Morse_1974_28-0" class="reference"><a href="#cite_note-Morse_1974-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> The resultant pyruvate molecules are then converted into <a href="/wiki/Acetyl-CoA" title="Acetyl-CoA">acetyl-CoA</a>, which can then be incorporated as a substrate for the <a href="/wiki/Citric_acid_cycle" title="Citric acid cycle">citric acid cycle</a> (CAC) to yield high-energy electron carriers that will be used by the <a href="/wiki/Electron_transport_chain" title="Electron transport chain">electron transport chain</a> (ETC) for ATP production; however, the CAC is largely used for generating biosynthetic precursors rather than for catabolic purposes.<sup id="cite_ref-Green_2022_19-3" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hebeler_1976_29-0" class="reference"><a href="#cite_note-Hebeler_1976-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> This is due in part to inhibited expression of several CAC enzymes in the presence of glucose, pyruvate, or lactate. These enzymes, namely <a href="/wiki/Citrate_synthase" title="Citrate synthase">citrate synthase</a>, <a href="/wiki/Aconitase" title="Aconitase">aconitase</a>, and <a href="/wiki/Isocitrate_dehydrogenase" title="Isocitrate dehydrogenase">isocitrate dehydrogenase</a>, are needed for the incorporation of acetate. Instead, a partial CAC has been observed, where α-ketoglutarate is formed by <a href="/wiki/Glutamate_dehydrogenase" title="Glutamate dehydrogenase">glutamate dehydrogenase</a> or transamination of oxaloacetate and glutamate by <a href="/wiki/Aspartate_transaminase" title="Aspartate transaminase">aspartate aminotransferase</a> (yielding aspartate and α-ketoglutarate).<sup id="cite_ref-Morse_1980_27-1" class="reference"><a href="#cite_note-Morse_1980-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hebeler_1976_29-1" class="reference"><a href="#cite_note-Hebeler_1976-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> The CAC then continues from there to yield oxaloacetate, which is an important precursor molecule for a number of biosynthetic pathways.<sup id="cite_ref-Hebeler_1976_29-2" class="reference"><a href="#cite_note-Hebeler_1976-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Another differentiating aspect of the gonococcal CAC is the lack of malate dehydrogenase, which is instead replaced by a membrane-bound malate:quinone-oxidoreductase that operates independently of NAD<sup>+</sup> by directly transferring electrons to ubiquinone.<sup id="cite_ref-Green_2022_19-4" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Conversely, acetyl-CoA that does not enter the CAC but enters the <a href="/wiki/Phosphate_acetyltransferase" title="Phosphate acetyltransferase">phosphotransacetylase</a>-<a href="/wiki/Acetate_kinase" title="Acetate kinase">acetate kinase</a> (PTA-AckA) pathway, where it can be converted into acetate by phosphorylation (to form acetyl phosphate and release coenzyme A) and dephosphorylation to form ATP.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> While this acetate can enter the CAC for further oxidation, this does not occur so long as other carbon sources such as glucose or lactate are present, in which case it is excreted from the cell or incorporated for lipid synthesis.<sup id="cite_ref-Morse_1974_28-1" class="reference"><a href="#cite_note-Morse_1974-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> <i>N. gonorrhoeae</i> lack the <a href="/wiki/Glyoxylate_cycle" title="Glyoxylate cycle">glyoxylate shunt</a>, preventing them from using acetate to form CAC intermediates to replenish the cycle.<sup id="cite_ref-Morse_1974_28-2" class="reference"><a href="#cite_note-Morse_1974-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Morse_1980_27-2" class="reference"><a href="#cite_note-Morse_1980-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>A significant portion of the glyceraldehyde 3-phosphate formed in gonococci is recycled via the gluconeogenic pathway to reform glucose 6-phosphate, as well as the intermediate fructose 6-phosphate. Both of these can then be used for pentose synthesis in the PP pathway via the oxidative and non-oxidative pathways, respectively, for subsequent nucleotide formation as well as energy production.<sup id="cite_ref-Morse_1980_27-3" class="reference"><a href="#cite_note-Morse_1980-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p><i>N. gonorrhoeae</i>, like other pathogenic members of the genus <i>Neisseria</i>, are <a href="/wiki/Capnophile" title="Capnophile">capnophiles</a>, meaning they require higher-than-normal concentrations of carbon dioxide (CO<sub>2</sub>) to grow , either in the form of CO<sub>2</sub> or bicarbonate (HCO<sub>3</sub><sup>-</sup>) depending on the bacterial strain. This requirement must be met exogenously during the lag and stationary growth phases, though it appears to be met through high metabolic CO<sub>2</sub> productions in the exponential phase. Assimilation of this CO<sub>2</sub> in <i>Neisseria</i> species is done by <a href="/wiki/Carbonic_anhydrase" title="Carbonic anhydrase">carbonic anhydrase</a> and phosphoenolpyruvate enzymes in the periplasmic space and the cytoplasm, respectively.<sup id="cite_ref-Morse_1980_27-4" class="reference"><a href="#cite_note-Morse_1980-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>Lactate catabolism is also of particular importance for gonococci, both for pathogenicity and for growth.<sup id="cite_ref-Green_2022_19-5" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> External lactate is transported in to the cell via lactate permease (LctP).<sup id="cite_ref-Green_2022_19-6" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> The <i>N. gonorrhoeae</i> genome encodes for three <a href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">lactate dehydrogenase</a> (LDH) enzymes for that allow for metabolism of both <i>L</i>-lactate and <i>D</i>-lactate: a cytoplasmic <a href="/wiki/Nicotinamide_adenine_dinucleotide" title="Nicotinamide adenine dinucleotide">NAD<sup>+</sup></a>-dependent <i>D</i>-lactate dehydrogenase (LdhA), which is responsible for and two membrane-bound LDHs, one specific to <i>L</i>-lactate (LldD) and the other specific to <i>D</i>-lactate (LdhD).<sup id="cite_ref-Green_2022_19-7" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Atack_2014_32-0" class="reference"><a href="#cite_note-Atack_2014-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> The membrane-bound LDHs have been determined to be <a href="/wiki/Flavoprotein" title="Flavoprotein">flavoprotein</a>-containing respiratory enzymes that directly oxidize lactate to reduce <a href="/wiki/Coenzyme_Q10" title="Coenzyme Q10">ubiquinone</a>. While these enzymes do not directly pump protons (H<sup>+</sup> ions) into the periplasmic space, it is proposed that the reduction of ubiquinone by these enzymes is capable of feeding into the larger ETC.<sup id="cite_ref-Atack_2014_32-1" class="reference"><a href="#cite_note-Atack_2014-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Electron_Transport_Chain_and_Oxidative_Phosphorylation">Electron Transport Chain and Oxidative Phosphorylation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=5" title="Edit section: Electron Transport Chain and Oxidative Phosphorylation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As an obligate human pathogen and a facultative anaerobic capnophile, <i>Neisseria gonorrhoeae</i> typically colonize mucosal surfaces in microaerobic environments, such as those in the genitourinary tract.<sup id="cite_ref-Green_2022_19-8" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Growth in areas where oxygen concentrations are limited requires a terminal oxidase with a high affinity for oxygen; in gonococci, oxygen reduction is performed by a <i>ccb<sub>3</sub></i> -type cytochrome oxidase. In addition to aerobic respiration, gonococci can also perform anaerobic respiration via the reduction of nitrite (NO<sub>2</sub>) to nitric oxide (NO) as well as reduction of NO to nitrous oxide (N<sub>2</sub>O).<sup id="cite_ref-Green_2022_19-9" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Li_2010_33-0" class="reference"><a href="#cite_note-Li_2010-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p><p>There are several enzymes that contribute electrons to the intramembranous ubiquinone pool, the first step in the ETC. These include the membrane bound LDHs (LldD and LdhD), <a href="/wiki/Respiratory_complex_I" title="Respiratory complex I">NADH:ubiquinone oxidoreductase</a> (aka NADH dehydrogenase; Nuo complex I), Na<sup>+</sup>-translocating NADH dehydrogenase (Nqr), <a href="/wiki/Succinate_dehydrogenase" title="Succinate dehydrogenase">succinate dehydrogenase</a> (SDH), and the membrane-bound NAD<sup>+</sup>-independent malate:quinone-oxidoreductase (MqR).<sup id="cite_ref-Green_2022_19-10" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Following the initial transfer of electrons to ubiquinone, proposed schematics for the organization of the gonococcal ETC suggest the electrons can be further passed down the chain by reduction of the <a href="/wiki/Coenzyme_Q_%E2%80%93_cytochrome_c_reductase" title="Coenzyme Q – cytochrome c reductase">cytochrome <i>bc<sub>1</sub></i> complex</a> or can be directly transferred to NO as a terminal electron acceptor by <a href="/wiki/Nitric-oxide_reductase" title="Nitric-oxide reductase">NO reductase</a> (NorB).<sup id="cite_ref-Green_2022_19-11" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Aspholm_2010_34-0" class="reference"><a href="#cite_note-Aspholm_2010-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> In the case of the former, electrons can then be passed from the <i>bc<sub>1</sub></i> complex along two alternative pathways via the reduction of either cytochrome <i>c<sub>4</sub></i> or <i>c<sub>5</sub></i>. Both of these cytochromes transfer electrons to the terminal cytochrome <i>ccb<sub>3</sub></i> oxidase for the reduction of O<sub>2</sub> to form H<sub>2</sub>O under aerobic conditions.<sup id="cite_ref-Green_2022_19-12" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Li_2010_33-1" class="reference"><a href="#cite_note-Li_2010-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p><p>Gonococci are also reduce NO<sub>2</sub> via an inducible outer membrane-attached copper-containing <a href="/wiki/Nitrite_reductase" title="Nitrite reductase">nitrite reductase</a> (AniA, a member of the NirK protein family) under anaerobic conditions, though this process has also been noted in microaerobic conditions as a means of supplementing growth.<sup id="cite_ref-Aspholm_2010_34-1" class="reference"><a href="#cite_note-Aspholm_2010-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> This leads to the formation of NO that is subsequently reduced to N<sub>2</sub>O in a partial denitrification pathway.<sup id="cite_ref-Green_2022_19-13" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Li_2010_33-2" class="reference"><a href="#cite_note-Li_2010-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Aspholm_2010_34-2" class="reference"><a href="#cite_note-Aspholm_2010-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> The <i>ccb<sub>3</sub></i> oxidase of <i>N. gonorrhoeae</i>, dissimilarly to other members of the <i>Neisseria</i> genus, is a tri-heme protein that can transfer electrons not only to O<sub>2</sub> (conserved across <i>Neisseria</i> species) but also to AniA for NO<sub>2</sub> reduction. This is in addition to the typical process of receiving electrons transferred from cytochrome <i>c<sub>5</sub></i>.<sup id="cite_ref-Aspholm_2010_34-3" class="reference"><a href="#cite_note-Aspholm_2010-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p><p>The general purpose of the ETC is the formation of the electrochemical gradient of hydrogen ions (H<sup>+</sup> or protons), resulting from concentration differences across the plasma membrane, needed to power ATP production in a process known as <a href="/wiki/Oxidative_phosphorylation" title="Oxidative phosphorylation">oxidative phosphorylation</a>.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> In gonococci, movement of protons into the periplasmic space is accomplished by the Nuo complex I, the cytochrome <i>bc<sub>1</sub></i> complex, and cytochrome <i>ccb<sub>3</sub></i>.<sup id="cite_ref-Green_2022_19-14" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Aspholm_2010_34-4" class="reference"><a href="#cite_note-Aspholm_2010-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> Subsequently, ATP synthesis is performed by the <a href="/wiki/ATP_synthase" title="ATP synthase">F<sub>1</sub>F<sub>0</sub> ATP synthase</a>, a two-part protein complex present in gonococci as well as numerous other species across phylogenetic domains.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> This complex couples proton translocation back into the cytoplasm along its gradient with mechanical rotation to generate ATP.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Iron">Iron</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=6" title="Edit section: Iron"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The general purpose of the ETC is the formation of the electrochemical gradient of hydrogen ions (H<sup>+</sup> or protons), resulting from concentration differences across the plasma membrane, needed to power ATP production in a process known as <a href="/wiki/Oxidative_phosphorylation" title="Oxidative phosphorylation">oxidative phosphorylation</a>.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> In gonococci, movement of protons into the periplasmic space is accomplished by the Nuo complex I, the cytochrome <i>bc<sub>1</sub></i> complex, and cytochrome <i>ccb<sub>3</sub></i>.<sup id="cite_ref-Green_2022_19-15" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Aspholm_2010_34-5" class="reference"><a href="#cite_note-Aspholm_2010-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Subsequently, ATP synthesis is performed by the <a href="/wiki/ATP_synthase" title="ATP synthase">F<sub>1</sub>F<sub>0</sub> ATP synthase</a>, a two-part protein complex present in gonococci as well as numerous other species across phylogenetic domains.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> This complex couples proton translocation back into the cytoplasm along its gradient with mechanical rotation to generate ATP.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p><p>To acquire the necessary iron, gonococci produce TonB-dependent transporters (TDTs) on the surface of their outer membrane that are able to directly extract iron, along with other metals, from their respective carrier proteins. Some of these include transferrin binding proteins A (TbpA) and B (TbpB), lactoferrin-binding proteins A (LbpA) and B (LbpB), and hemoglobin/hemoglobin-haptoglobin binding proteins HpuB and HpuA.<sup id="cite_ref-Green_2022_19-16" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Stoudenmire_2022_44-0" class="reference"><a href="#cite_note-Stoudenmire_2022-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> In addition to these proteins, gonococci are also capable of using <a href="/wiki/Siderophore" title="Siderophore">siderophores</a>, or compounds that are capable of chelating iron in the environment, that are produced by other bacteria; however, gonococcal cells are incapable of synthesizing siderophores themselves. These xenosiderophores are taken up by the TDT FetA through the outer membrane and then brought into the cell by the <i>fetBCDEF</i> transporter system.<sup id="cite_ref-Green_2022_19-17" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Stoudenmire_2022_44-1" class="reference"><a href="#cite_note-Stoudenmire_2022-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>Along with the sequestration defence that can be further upregulated by host inflammation, humans also produce <a href="/wiki/Siderocalin" title="Siderocalin">siderocalins</a> that are able to chelate siderophores to as a further method of inhibiting pathogenic bacterial growth. These are sometimes ineffective against <i>N. gonorrhoeae</i>, which is able to colonize intracellularly, particularly in phagocytic cells such as <a href="/wiki/Macrophage" title="Macrophage">macrophages</a> and neutrophils. Increases in host intracellular iron also down regulates some of the intracellular pathogen-killing mechanisms; coincidentally, pathogenic <i>Neisseria</i> are able to alter several host cell mechanisms that ultimately allow the pathogen to take most of the available iron away from the host immune cell.<sup id="cite_ref-Stoudenmire_2022_44-2" class="reference"><a href="#cite_note-Stoudenmire_2022-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surface_molecules">Surface molecules</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=7" title="Edit section: Surface molecules"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>On its surface, <i>N. gonorrhoeae</i> bears hair-like <a href="/wiki/Pilus" title="Pilus">pili</a>, surface proteins with various functions, and sugars called <a href="/wiki/Lipopolysaccharide" title="Lipopolysaccharide">lipooligosaccharide</a>. The pili mediate adherence, movement, and DNA exchange. The opacity-associated (Opa) proteins interact with the immune system, as do the <a href="/wiki/Porin_(protein)" title="Porin (protein)">porins</a>. Lipooligosaccharide is an <a href="/wiki/Endotoxin" class="mw-redirect" title="Endotoxin">endotoxin</a> that provokes an immune response. All of these are <a href="/wiki/Antigen" title="Antigen">antigenic</a> and exhibit <a href="/wiki/Antigenic_variation" title="Antigenic variation">antigenic variation</a>. The pili, Opa proteins, porins, and even the lipooligosaccharide have mechanisms to inhibit the immune response, making asymptomatic infection possible.<sup id="cite_ref-Edwards_2004_45-0" class="reference"><a href="#cite_note-Edwards_2004-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Opa_Proteins">Opa Proteins</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=8" title="Edit section: Opa Proteins"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Phase-variable opacity-associated (Opa) adhesin proteins are used by <i>N. gonorrhoeae</i> as part of evading immune response in a host cell. At least 12 Opa proteins are known and the many variations of surface proteins make recognizing <i>N. gonorrhoeae</i> and mounting a defense by immune cells more difficult.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Opa proteins are in the outer membrane and facilitate a response when the bacteria interacts with a variety of host cells. These proteins bind to various epithelial cells, and allow <i>N. gonorrhoeae</i> to increase the length of infection as well as increase the amount of invasion into other host cells.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Type_IV_Pili">Type IV Pili</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=9" title="Edit section: Type IV Pili"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Type_IV_Pilus_Twitching_Motility_Steps.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Type_IV_Pilus_Twitching_Motility_Steps.svg/511px-Type_IV_Pilus_Twitching_Motility_Steps.svg.png" decoding="async" width="511" height="270" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Type_IV_Pilus_Twitching_Motility_Steps.svg/767px-Type_IV_Pilus_Twitching_Motility_Steps.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Type_IV_Pilus_Twitching_Motility_Steps.svg/1022px-Type_IV_Pilus_Twitching_Motility_Steps.svg.png 2x" data-file-width="737" data-file-height="390" /></a><figcaption><i>Neisseria gonorrhoeae</i> use their type IV pili as a motility structure. These are the steps for the type IV pilus twitching motility mechanism.</figcaption></figure> <p>Dynamic <a href="/wiki/Polymer" title="Polymer">polymeric</a> protein filaments called <a href="/wiki/Type_IV_pilus" class="mw-redirect" title="Type IV pilus">type IV pili</a> allow <i>N. gonorrhoeae</i> to do many bacterial processes including adhesion to surfaces, transformation competence, twitching motility, and immune response evasions.<sup id="cite_ref-Green_2022_19-18" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> To enter the host the bacteria uses the pili to adhere to and penetrate mucosal surfaces. The pili are a pivotal <a href="/wiki/Virulence_factor" title="Virulence factor">virulence factor</a> for <i>N. gonorrhoeae</i>; without them, the bacterium is unable to promote colonization.<sup id="cite_ref-Hu_2020_48-0" class="reference"><a href="#cite_note-Hu_2020-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> For motility, individual bacteria use their pili in a manner that resembles a grappling hook: first, they are extended from the cell surface and attach to a <a href="/wiki/Substrate_(biology)" title="Substrate (biology)">substrate</a>. Subsequent pilus retraction drags the cell forward. The resulting movement is referred to as twitching motility. <i>N. gonorrhoeae</i> is able to pull 100,000 times its own weight,<sup id="cite_ref-Merz_2000_49-0" class="reference"><a href="#cite_note-Merz_2000-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> and the pili used to do so are amongst the strongest biological motors known to date, exerting one <a href="/wiki/Newton_(unit)" title="Newton (unit)">nanonewton</a>.<sup id="cite_ref-Merz_2000_49-1" class="reference"><a href="#cite_note-Merz_2000-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> The PilF and PilT <a href="/wiki/ATPase" title="ATPase">ATPase</a> proteins are responsible for powering the extension and retraction of the type IV pilus, respectively. The adhesive functions of the gonococcal pilus play a role in <a href="/wiki/Microcolony" title="Microcolony">microcolony</a> aggregation and <a href="/wiki/Biofilm" title="Biofilm">biofilm</a> formation. These pili are also used to avoid immune responses from the cell they are invading by having their type IV pili antigenically vary. The main pilus filament is replaced by variable DNA sequences very frequently.<sup id="cite_ref-Green_2022_19-19" class="reference"><a href="#cite_note-Green_2022-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> By doing this process rapidly, they are able to create a diversity of pili on their surface and evade the host cell's immune response.<sup id="cite_ref-Hu_2020_48-1" class="reference"><a href="#cite_note-Hu_2020-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Lipooligosaccharide">Lipooligosaccharide</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=10" title="Edit section: Lipooligosaccharide"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Lipooligosaccharide is a low-weight version of lipopolysaccharide present on the surfaces of most other Gram-negative bacteria. It is a sugar (saccharide) side chain attached to lipid A (thus "lipo-") in the outer membrane coating the cell wall of the bacteria. The root "oligo" refers to the fact that it is a few sugars shorter than the typical lipopolysaccharide.<sup id="cite_ref-Sherris_6-2" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> As an endotoxin, it provokes inflammation. The shedding of lipooligosaccharide by the bacteria are sometimes responsible for issues associated with pelvic inflammatory disease.<sup id="cite_ref-Sherris_6-3" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Although it functions primarily as an endotoxin, lipooligosaccharide may disguise itself with host <a href="/wiki/Sialic_acid" title="Sialic acid">sialic acid</a> and block initiation of the <a href="/wiki/Complement_system" title="Complement system">complement cascade</a>.<sup id="cite_ref-Sherris_6-4" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Antigenic_variation">Antigenic variation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=11" title="Edit section: Antigenic variation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i>N. gonorrhoeae</i> evades the immune system through a process called <a href="/wiki/Antigenic_variation" title="Antigenic variation">antigenic variation</a>.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> This process allows <i>N. gonorrhoeae</i> to recombine its genes and alter the <a href="/wiki/Antigenic_determinants" class="mw-redirect" title="Antigenic determinants">antigenic determinants</a> that adorn its surface,<sup id="cite_ref-Sherris_6-5" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> such as the Type IV pili.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Simply stated, the chemical composition of molecules are changed due to changes at the genetic level.<sup id="cite_ref-Hill_2016_9-1" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> <i>N. gonorrhoeae</i> is able to vary the composition of its pili and lipooligosaccharide. Of these, the pili exhibit the most antigenic variation due to chromosomal rearrangement.<sup id="cite_ref-Lev13th2_11-1" class="reference"><a href="#cite_note-Lev13th2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Sherris_6-6" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The <i>pilS</i> gene is an example of this ability to rearrange, as its combination with the <i>pilE</i> gene is estimated to produce over 100 variants of the PilE protein.<sup id="cite_ref-Hill_2016_9-2" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> These changes allow for adjustment to local environmental differences at the site of infection, evasion of recognition by targeted antibodies, and inhibit the formation of an effective vaccine.<sup id="cite_ref-Hill_2016_9-3" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>In addition to gene rearrangement, it is also <a href="/wiki/Natural_competence" title="Natural competence">naturally competent</a>, meaning it can acquire extracellular DNA from the environment via its type IV pilus, specifically proteins PilQ and PilT.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> These processes allow <i>N. gonorrhoeae</i> to acquire and spread new genes, disguise itself with different surface proteins, and prevent the development of <a href="/wiki/Immunological_memory" title="Immunological memory">immunological memory</a> – an ability which has contributed to antibiotic resistance and impeded vaccine development.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Phase_variation">Phase variation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=12" title="Edit section: Phase variation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Phase_variation" title="Phase variation">Phase variation</a> is similar to antigenic variation, but instead of changes at the genetic level altering the composition of molecules, these genetic changes result in the activation or deactivation of a gene.<sup id="cite_ref-Hill_2016_9-4" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Phase variation most often arises from a <a href="/wiki/Frameshift_mutation" title="Frameshift mutation">frameshift</a> in the expressed gene.<sup id="cite_ref-Hill_2016_9-5" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The Opa proteins of <i>N. gonorrhoeae</i> rely strictly on phase variation.<sup id="cite_ref-Hill_2016_9-6" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Every time the bacteria replicate, they may switch multiple Opa proteins on or off through <a href="/wiki/Slipped_strand_mispairing" title="Slipped strand mispairing">slipped-strand mispairing</a>. That is, the bacteria introduce frameshift mutations that bring genes in or out of frame. The result is that different Opa genes are translated every time.<sup id="cite_ref-Sherris_6-7" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Pili are varied by antigenic variation, but also phase variation.<sup id="cite_ref-Hill_2016_9-7" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Frameshifts occur in both the <i>pilE</i> and <i>pilC</i> genes, effectively turning off the expression of pili in situations when they are not needed, such as during intracellular colonization as opposed to extracellular mucosal cell surface adhesion.<sup id="cite_ref-Hill_2016_9-8" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Survival_of_gonococci">Survival of gonococci</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=13" title="Edit section: Survival of gonococci"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>After gonococci invade and <a href="/wiki/Transcytosis" title="Transcytosis">transcytose</a> the host epithelial cells, they land in the submucosa, where neutrophils promptly consume them.<sup id="cite_ref-Sherris_6-8" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The pili and Opa proteins on the surface may interfere with phagocytosis,<sup id="cite_ref-Lev13th2_11-2" class="reference"><a href="#cite_note-Lev13th2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> but most gonococci end up in neutrophils. The exudates from infected individuals contain many neutrophils with ingested gonococci. Neutrophils release an oxidative burst of <a href="/wiki/Reactive_oxygen_species" title="Reactive oxygen species">reactive oxygen species</a> in their phagosomes to kill the gonococci.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> However, a significant fraction of the gonococci can resist killing through the action of their <a href="/wiki/Catalase" title="Catalase">catalase</a><sup id="cite_ref-Sherris_6-9" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> which breaks down reactive oxygen species and is able to reproduce within the neutrophil phagosomes.<sup id="cite_ref-pmid30627130_55-0" class="reference"><a href="#cite_note-pmid30627130-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p><p>The bacterial RecA protein, which mediates repair of DNA damage, plays an important role in gonococcal survival.<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> <i>N. gonorrhoeae</i> may replace DNA damaged in neutrophil phagosomes with DNA from neighboring gonococci.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> The process in which recipient gonococci integrate DNA from neighboring gonococci into their genome is called transformation.<sup id="cite_ref-pmid27825443_58-0" class="reference"><a href="#cite_note-pmid27825443-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/en/thumb/d/d7/Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg/220px-Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg" decoding="async" width="220" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/d/d7/Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg/330px-Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/d/d7/Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg/440px-Neisseria_gonorrhoeae_Growth_on_New_York_City_Agar_Plate.jpg 2x" data-file-width="1608" data-file-height="1584" /></a><figcaption>The growth of <i>N. gonorrhoeae</i> colonies on New York City agar, a specialized and selective medium for gonococci</figcaption></figure> <div class="mw-heading mw-heading2"><h2 id="Genome">Genome</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=14" title="Edit section: Genome"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The genomes of several strains of <i>N</i>. <i>gonorrhoeae </i>have been sequenced. Most of them are about 2.1 Mb in size and encode 2,100 to 2,600 proteins (although most seem to be in the lower range).<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> For instance, strain NCCP11945 consists of one circular chromosome (2,232,025 bp) encoding 2,662 predicted <a href="/wiki/Open_reading_frame" title="Open reading frame">open reading frames</a> (ORFs) and one <a href="/wiki/Plasmid" title="Plasmid">plasmid</a> (4,153 bp) encoding 12 predicted ORFs. The estimated coding density over the entire genome is 87%, and the average G+C content is 52.4%, values that are similar to those of strain FA1090. The NCCP11945 genome encodes 54 tRNAs and four copies of 16S-23S-5S rRNA operons.<sup id="cite_ref-Chung2008_60-0" class="reference"><a href="#cite_note-Chung2008-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Horizontal_gene_transfer">Horizontal gene transfer</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=15" title="Edit section: Horizontal gene transfer"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Horizontal_gene_transfer" title="Horizontal gene transfer">Horizontal gene transfer</a>, also termed lateral gene transfer, is the sharing of genetic information amongst living organisms.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> This transmission of information is a driving force of antibiotic resistance in <i>N. gonorrhoeae</i>.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> <sup id="cite_ref-Spencer-Smith_2016_63-0" class="reference"><a href="#cite_note-Spencer-Smith_2016-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> Studies have identified that <i>N. gonorrhoeae</i> has obtained methods of antimicrobial resistance by way of horizontal gene transfer from other <i>Neisseria</i> species including <i>N.</i> <i>lactamica</i>, <i>N. macacae</i>, and <i>N. mucosa.</i> <sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p><p>Transformation in <i>N. gonorrhoeae</i> is performed by the type IV pilus, where the DNA is bound and brought into the cell, followed by processing and homologous recombination.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p><p>Found in some genomes of <i>Neisseria gonorrhoeae</i>, the gonococcal genetic island (GGI), a <a href="/wiki/Genomic_island" title="Genomic island">genomic island</a> (GI) specific to gonococci, has been identified as a mobile genetic element that is horizontally acquired.<sup id="cite_ref-Cehovin_2017_66-0" class="reference"><a href="#cite_note-Cehovin_2017-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> <sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> GGI is involved with antimicrobial resistance, transmission of genetic information, and iron acquisition.<sup id="cite_ref-Cehovin_2017_66-1" class="reference"><a href="#cite_note-Cehovin_2017-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> The genes within the gonococcal genetic island encode for the infamous <a href="/wiki/Type_IV_secretion_system" title="Type IV secretion system">type IV secretion system</a> (T4SS), which is responsible for DNA secretion and is essential for biofilm formation. <sup id="cite_ref-Cehovin_2017_66-2" class="reference"><a href="#cite_note-Cehovin_2017-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> </p><p>In 2011, researchers at Northwestern University found evidence of a human DNA fragment in a <i>N. gonorrhoeae</i> genome, the first example of horizontal gene transfer from humans to a bacterial pathogen.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-anderson2011_70-0" class="reference"><a href="#cite_note-anderson2011-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Disease">Disease</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=16" title="Edit section: Disease"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Gonorrhoea" class="mw-redirect" title="Gonorrhoea">Gonorrhoea</a></div> <div class="mw-heading mw-heading3"><h3 id="Symptoms">Symptoms</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=17" title="Edit section: Symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Symptoms of infection with <i>N. gonorrhoeae</i> differ depending on the site of infection and many infections are asymptomatic independent of sex.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Edwards_2004_45-1" class="reference"><a href="#cite_note-Edwards_2004-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-www.cdc.gov_2017_7-1" class="reference"><a href="#cite_note-www.cdc.gov_2017-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Depending on the route of transmission, <i>N. gonorrhoeae</i> may cause infection of the throat (<a href="/wiki/Pharyngitis" title="Pharyngitis">pharyngitis</a>) or infection of the anus/rectum (<a href="/wiki/Proctitis" title="Proctitis">proctitis</a>).<sup id="cite_ref-Sherris2_72-0" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lev13th2_11-3" class="reference"><a href="#cite_note-Lev13th2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Disseminated gonococcal infections can occur when <i>N. gonorrhoeae</i> enters the bloodstream, often spreading to the joints and causing a rash (dermatitis-arthritis syndrome).<sup id="cite_ref-Sherris2_72-1" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Dermatitis-arthritis syndrome results in joint pain (<a href="/wiki/Septic_arthritis" title="Septic arthritis">arthritis</a>), tendon inflammation (<a href="/wiki/Tenosynovitis" title="Tenosynovitis">tenosynovitis</a>), and painless non-<a href="/wiki/Pruritic" class="mw-redirect" title="Pruritic">pruritic</a> (non-itchy) <a href="/wiki/Dermatitis" title="Dermatitis">dermatitis</a>.<sup id="cite_ref-Lev13th2_11-4" class="reference"><a href="#cite_note-Lev13th2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Disseminated infection and pelvic inflammatory disease in women tend to begin after <a href="/wiki/Menstruation" title="Menstruation">menses</a> due to reflux during menses, facilitating spread.<sup id="cite_ref-Sherris2_72-2" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> In rare cases, disseminated infection may cause infection of the meninges of the brain and spinal cord (<a href="/wiki/Meningitis" title="Meningitis">meningitis</a>) or infection of the heart valves (<a href="/wiki/Endocarditis" title="Endocarditis">endocarditis</a>).<sup id="cite_ref-Sherris2_72-3" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-www.cdc.gov_73-0" class="reference"><a href="#cite_note-www.cdc.gov-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Male">Male</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=18" title="Edit section: Male"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In symptomatic men, the primary symptom of genitourinary infection is urethritis – burning with urination (<a href="/wiki/Dysuria" title="Dysuria">dysuria</a>), increased urge to urinate, and a <a href="/wiki/Pus" title="Pus">pus</a>-like (purulent) discharge from the penis. The discharge may be foul smelling.<sup id="cite_ref-Sherris2_72-4" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> If untreated, scarring of the <a href="/wiki/Urethra" title="Urethra">urethra</a> may result in difficulty urinating. Infection may spread from the urethra in the penis to nearby structures, including the testicles (<a href="/wiki/Epididymitis" title="Epididymitis">epididymitis</a>/<a href="/wiki/Orchitis" title="Orchitis">orchitis</a>), or to the prostate (<a href="/wiki/Prostatitis" title="Prostatitis">prostatitis</a>).<sup id="cite_ref-Sherris2_72-5" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lev13th2_11-5" class="reference"><a href="#cite_note-Lev13th2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Female">Female</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=19" title="Edit section: Female"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_(Gram_stain).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/04/Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_%28Gram_stain%29.jpg/220px-Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_%28Gram_stain%29.jpg" decoding="async" width="220" height="171" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/04/Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_%28Gram_stain%29.jpg/330px-Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_%28Gram_stain%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/04/Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_%28Gram_stain%29.jpg/440px-Neisseria_gonorrhoeae_and_pus_cells_in_a_vaginal_swab_%28Gram_stain%29.jpg 2x" data-file-width="875" data-file-height="681" /></a><figcaption>Gram stain of a vaginal swab showing gonococci (in pairs - arrow) inside polymorphonuclear granulocytes</figcaption></figure> <p>In symptomatic women, the primary symptoms of genitourinary infection are increased vaginal discharge, burning with urination (<a href="/wiki/Dysuria" title="Dysuria">dysuria</a>), increased urge to urinate, pain with intercourse, or menstrual abnormalities. <a href="/wiki/Pelvic_inflammatory_disease" title="Pelvic inflammatory disease">Pelvic inflammatory disease</a> results if <i>N. gonorrhoeae</i> ascends into the pelvic <a href="/wiki/Peritoneum" title="Peritoneum">peritoneum</a> (via the <a href="/wiki/Cervix" title="Cervix">cervix</a>, <a href="/wiki/Endometrium" title="Endometrium">endometrium</a>, and <a href="/wiki/Fallopian_tubes" class="mw-redirect" title="Fallopian tubes">fallopian tubes</a>). The resulting inflammation and scarring of the fallopian tubes can lead to infertility and increased risk of ectopic pregnancy.<sup id="cite_ref-Sherris2_72-6" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Pelvic inflammatory disease develops in 10 to 20% of the females infected with <i>N. gonorrhoeae</i>.<sup id="cite_ref-Sherris2_72-7" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Neonates_(perinatal_infection)"><span id="Neonates_.28perinatal_infection.29"></span>Neonates (perinatal infection)</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=20" title="Edit section: Neonates (perinatal infection)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <a href="/wiki/Perinatal_infection" class="mw-redirect" title="Perinatal infection">perinatal infection</a>, the primary manifestation is infection of the eye (neonatal conjunctivitis or <a href="/wiki/Neonatal_conjunctivitis" title="Neonatal conjunctivitis">ophthalmia neonatorum</a>) when the newborn is exposed to <i>N. gonorrhoeae</i> in the birth canal. The eye infection can lead to corneal scarring or perforation, ultimately resulting in blindness. If the newborn is exposed during birth, conjunctivitis occurs within 2–5 days after birth and is severe.<sup id="cite_ref-Sherris2_72-8" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-www.cdc.gov_73-1" class="reference"><a href="#cite_note-www.cdc.gov-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> Gonococcal ophthalmia neonatorum, once common in newborns, is prevented by the application of <a href="/wiki/Erythromycin" title="Erythromycin">erythromycin</a> (antibiotic) gel to the eyes of babies at birth as a public health measure. Silver nitrate is no longer used in the United States.<sup id="cite_ref-www.cdc.gov_73-2" class="reference"><a href="#cite_note-www.cdc.gov-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Sherris2_72-9" class="reference"><a href="#cite_note-Sherris2-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transmission">Transmission</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=21" title="Edit section: Transmission"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i>N. gonorrhoeae</i> is most often transmitted through vaginal, oral, or anal sex; nonsexual transmission is unlikely in adult infection.<sup id="cite_ref-www.cdc.gov_2017_7-2" class="reference"><a href="#cite_note-www.cdc.gov_2017-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> It can also be transmitted to a newborn during passage through the birth canal if the mother has an untreated genitourinary infection. Given the high rate of asymptomatic infection, it is recommended that pregnant women be tested for gonococcal infection prior to birth.<sup id="cite_ref-www.cdc.gov_2017_7-3" class="reference"><a href="#cite_note-www.cdc.gov_2017-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Communal baths, shared towels or fabrics, rectal thermometers, and improper hand hygiene by caregivers have been identified as potential means of transmission in pediatric settings.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> </p><p>Traditionally, the bacterium was thought to move attached to spermatozoa, but this hypothesis did not explain female to male transmission of the disease. A recent study suggests that rather than "surf" on wiggling <a href="/wiki/Sperm" title="Sperm">sperm</a>, <i>N. gonorrhoeae</i> bacteria use pili to anchor onto proteins in the sperm and move through coital liquid.<sup id="cite_ref-Anderson2014_76-0" class="reference"><a href="#cite_note-Anderson2014-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Infection">Infection</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=22" title="Edit section: Infection"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Successful transmission is followed by adherence to the <a href="/wiki/Epithelium" title="Epithelium">epithelial cells</a> found at the infected mucosal site by the bacterium's <a href="/wiki/Pilus" title="Pilus">type IV pili</a>. The pili's ability to attach and subsequently retract pulls <i>N. gonorrhoeae</i> towards the epithelial membrane at the surface of the mucosal cell.<sup id="cite_ref-Quillin_2018_15-1" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Post attachment, <i>N. gonorrhoeae</i> replicates its genome and divides to form <a href="/wiki/Microcolony" title="Microcolony">microcolonies</a>.<sup id="cite_ref-Quillin_2018_15-2" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Gonococcal infection is sometimes aided by the membrane cofactor protein, CD46, as it has been known to act as a receptor for gonococcal pilus.<sup id="cite_ref-Edwards_2004_45-2" class="reference"><a href="#cite_note-Edwards_2004-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Additionally, interaction with pili has been shown to cause cytoskeletal rearrangement of the host cell, further demonstrating that gonococcal pili engagement disrupts the response of the host cell and increases the likelihood of successful infection.<sup id="cite_ref-Edwards_2004_45-3" class="reference"><a href="#cite_note-Edwards_2004-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> During growth and colonization, <i>N. gonorrhoeae</i> stimulates the release of <a href="/wiki/Pro-inflammatory" class="mw-redirect" title="Pro-inflammatory">pro-inflammatory</a> <a href="/wiki/Cytokine" title="Cytokine">cytokines</a> and <a href="/wiki/Chemokine" title="Chemokine">chemokines</a> from host immune cells that result in the recruitment of <a href="/wiki/Neutrophil" title="Neutrophil">neutrophils</a> to the area.<sup id="cite_ref-Hill_2016_9-9" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> These <a href="/wiki/Phagocyte" title="Phagocyte">phagocytic cells</a> typically take in foreign pathogens and destroy them, however, <i>N. gonorrhoeae'</i>s ability to manipulate the host cell response allows the pathogen to survive within these immune cells and evade elimination.<sup id="cite_ref-Hill_2016_9-10" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Laboratory_diagnosis">Laboratory diagnosis</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=23" title="Edit section: Laboratory diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The primary detection methods for <i>Neisseria gonorrhoeae</i> are <a href="/wiki/Nucleic_acid_test" title="Nucleic acid test">nucleic acid amplification tests</a>, which are the most sensitive techniques available.<sup id="cite_ref-Meyer_2020_77-0" class="reference"><a href="#cite_note-Meyer_2020-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-78" class="reference"><a href="#cite_note-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> Other methods of detection include microscopy and culture.<sup id="cite_ref-Meyer_2020_77-1" class="reference"><a href="#cite_note-Meyer_2020-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Prevention">Prevention</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=24" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Transmission is reduced by using latex barriers (e.g. <a href="/wiki/Condom" title="Condom">condoms</a> or <a href="/wiki/Dental_dam" title="Dental dam">dental dams</a>) during sex and by limiting sexual partners.<sup id="cite_ref-CDC_8-3" class="reference"><a href="#cite_note-CDC-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Condoms and dental dams should be used during oral and anal sex as well. Spermicides, vaginal foams, and douches are not effective methods for transmission prevention.<sup id="cite_ref-Sherris_6-10" class="reference"><a href="#cite_note-Sherris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Vaccine">Vaccine</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=25" title="Edit section: Vaccine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A vaccine against <i>N. gonorrhoeae</i> is becoming more necessary due to the growing incidence of cases, increasing <a href="/wiki/Antimicrobial_resistance" title="Antimicrobial resistance">antimicrobial resistance</a>, and its impact on reproductive health.<sup id="cite_ref-www.cdc.gov_2_79-0" class="reference"><a href="#cite_note-www.cdc.gov_2-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> There are problems that have hampered vaccine development including: the absence of immunity post-infection, exclusively human hosts, and <a href="/wiki/Antigenic_variation" title="Antigenic variation">antigenic</a> and <a href="/wiki/Phase_variation" title="Phase variation">phase variation</a> of potential vaccine targets.<sup id="cite_ref-Williams_2024_80-0" class="reference"><a href="#cite_note-Williams_2024-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> Currently, there are several <i>N. gonorrhoeae</i> vaccines in development including an outer membrane vesicle vaccine.<sup id="cite_ref-Williams_2024_80-1" class="reference"><a href="#cite_note-Williams_2024-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> This includes the NGoXIM, the native OMV, and Bexsero/4CMenB vaccine candidates, which are all in the late clinical stages of development.<sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup> The creation of a vaccine for <i>N. gonorrhoeae</i> has several potential public health impacts. In one estimate, a vaccine for the heterosexual population given before sexual activity occurs showed that prevalence of <i>N. gonorrhoeae</i> could be reduced by up to 90% after 20 years.<sup id="cite_ref-Williams_2024_80-2" class="reference"><a href="#cite_note-Williams_2024-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Treatment">Treatment</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=26" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Currently, the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> recommends a single dose of the injectable <a href="/wiki/Cephalosporin" title="Cephalosporin">cephalosporin</a>, <a href="/wiki/Ceftriaxone" title="Ceftriaxone">ceftriaxone</a>, as the first line of defense against gonococcal infections.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> Individuals weighing less than 150 kg are typically prescribed a ceftriaxone concentration of 500 mg, while individuals who weigh over 150 kg are typically prescribed a dose of 1 g. Although ceftriaxone is not the only cephalosporin that has been effective at treating gonorrhoeae, it is the most advantageous.<sup id="cite_ref-www.cdc.gov_2_79-1" class="reference"><a href="#cite_note-www.cdc.gov_2-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> In the event of a cephalosporin allergy, the CDC recommends a dual treatment of <a href="/wiki/Gentamicin" title="Gentamicin">gentamicin</a> and <a href="/wiki/Azithromycin" title="Azithromycin">azithromycin</a>. Each drug should be administered as a single dose, with the gentamicin entering intramuscularly at a concentration of 240 mg, along with 2 g of azithromycin taken orally.<sup id="cite_ref-www.cdc.gov_2_79-2" class="reference"><a href="#cite_note-www.cdc.gov_2-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> If an individual is not allergic to cephalosporins but ceftriaxone is unavailable, an alternative treatment is a single dose of 800 mg cefixime consumed orally.<sup id="cite_ref-www.cdc.gov_2_79-3" class="reference"><a href="#cite_note-www.cdc.gov_2-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> In all of these cases, combination therapy and co-treatment for chlamydia is recommended, as simultaneous infections are common.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Antibiotic_resistance">Antibiotic resistance</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=27" title="Edit section: Antibiotic resistance"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Antibiotic_resistance_in_gonorrhea" title="Antibiotic resistance in gonorrhea">Antibiotic resistance in gonorrhea</a> was first identified in the 1940s. Gonorrhea was treated with penicillin, but doses had to be progressively increased to remain effective. By the 1970s, penicillin-and tetracycline-resistant gonorrhea emerged in the Pacific Basin. These resistant strains then spread to Hawaii, California, the rest of the United States, Australia and Europe. Fluoroquinolones were the next line of defense, but soon resistance to this antibiotic emerged, as well. Since 2007, standard treatment has been third-generation cephalosporins, such as ceftriaxone, which are considered to be our "last line of defense".<sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-blog.advocatesaz.org_85-0" class="reference"><a href="#cite_note-blog.advocatesaz.org-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup> Recently, a high-level ceftriaxone-resistant strain of gonorrhea called H041 was discovered in Japan. Lab tests found it to be resistant to high concentrations of ceftriaxone, as well as most of the other antibiotics tested. Within <i>N. gonorrhoeae</i>, genes exist that confer resistance to every single antibiotic used to cure gonorrhea, but thus far they do not coexist within a single gonococcus. However, because of <i>N. gonorrhoeae</i><span class="nowrap" style="padding-left:0.1em;">'</span>s high affinity for horizontal gene transfer, antibiotic-resistant gonorrhea is seen as an emerging public health threat.<sup id="cite_ref-blog.advocatesaz.org_85-1" class="reference"><a href="#cite_note-blog.advocatesaz.org-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup> </p><p>Prior to 2007, <a href="/wiki/Fluoroquinolone" class="mw-redirect" title="Fluoroquinolone">fluoroquinolones</a> were a common treatment recommendation for gonorrhoeae. The CDC stopped suggesting these systemic bacterial agents once a resistant strain of <i>N. gonorrhoeae</i> emerged in the United States. The removal of fluoroquinolones as a potential treatment left <a href="/wiki/Cephalosporin" title="Cephalosporin">cephalosporins</a> as the only viable antimicrobial option for gonorrhea treatment. Wary of further gonococcal resistance, the CDC's recommendations shifted in 2010 to a dual therapy strategy--cephalosporin with either <a href="/wiki/Azithromycin" title="Azithromycin">azithromycin</a> or <a href="/wiki/Doxycycline" title="Doxycycline">doxycycline</a>. Despite these efforts, resistant <i>N. gonorrhoeae</i> had been reported in five continents by 2011, further limiting treatment options and recommendations. Antimicrobial resistance is not universal and <i>N. gonorrhoeae</i> strains in the United States continue to respond to a combination regimen of <a href="/wiki/Ceftriaxone" title="Ceftriaxone">ceftriaxone</a> and azithromycin.<sup id="cite_ref-pmid35015033_86-0" class="reference"><a href="#cite_note-pmid35015033-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Serum_resistance">Serum resistance</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=28" title="Edit section: Serum resistance"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As a Gram negative bacterium, <i>N. gonorrhoeae</i> requires defense mechanisms to protect itself against the <a href="/wiki/Complement_system" title="Complement system">complement system</a> (or complement cascade), whose components are found with human <a href="/wiki/Serum_(blood)" title="Serum (blood)">serum</a>.<sup id="cite_ref-Edwards_2004_45-4" class="reference"><a href="#cite_note-Edwards_2004-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> There are three different pathways that activate this system however, they all result in the activation of complement protein 3 (C3).<sup id="cite_ref-Janeway_Jr_2001_87-0" class="reference"><a href="#cite_note-Janeway_Jr_2001-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup> A cleaved portion of this protein, <a href="/wiki/C3b" title="C3b">C3b</a>, is deposited on pathogenic surfaces and results in <a href="/wiki/Opsonin" title="Opsonin">opsonization</a> as well as the downstream activation of the <a href="/wiki/Complement_membrane_attack_complex" title="Complement membrane attack complex">membrane attack complex</a>.<sup id="cite_ref-Janeway_Jr_2001_87-1" class="reference"><a href="#cite_note-Janeway_Jr_2001-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup> <i>N. gonorrhoeae</i> has several mechanisms to avoid this action.<sup id="cite_ref-Quillin_2018_15-3" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> As a whole, these mechanisms are referred to as serum resistance.<sup id="cite_ref-Quillin_2018_15-4" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=29" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Name_origin">Name origin</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=30" title="Edit section: Name origin"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i>Neisseria gonorrhoeae</i> is named for Albert Neisser, who isolated it as the causative agent of the disease gonorrhea in 1878.<sup id="cite_ref-Quillin_2018_15-5" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-O'Donnell_2009_3-2" class="reference"><a href="#cite_note-O'Donnell_2009-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Galen (130 AD) coined the term "gonorrhea" from the Greek <i>gonos</i> which means "seed" and <i>rhoe</i> which means "flow".<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">[</span>88<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hill_2016_9-11" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Thus, gonorrhea means "flow of seed", a description referring to the white penile discharge, assumed to be semen, seen in male infection.<sup id="cite_ref-Quillin_2018_15-6" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Discovery">Discovery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=31" title="Edit section: Discovery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 1878, Albert Neisser isolated and visualized <i>N. gonorrhoeae</i> diplococci in samples of pus from 35 men and women with the classic symptoms of genitourinary infection with gonorrhea – two of whom also had infections of the eyes.<sup id="cite_ref-Hill_2016_9-12" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> In 1882, Leistikow and Loeffler were able to grow the organism in culture.<sup id="cite_ref-Quillin_2018_15-7" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Then in 1883, Max Bockhart proved conclusively that the bacterium isolated by Albert Neisser was the causative agent of the disease known as gonorrhea by inoculating the penis of a healthy man with the bacteria.<sup id="cite_ref-Hill_2016_9-13" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The man developed the classic symptoms of gonorrhea days after, satisfying the last of <a href="/wiki/Koch%27s_postulates" title="Koch's postulates">Koch's postulates</a>. Until this point, researchers debated whether syphilis and gonorrhea were manifestations of the same disease or two distinct entities.<sup id="cite_ref-Singal_89-0" class="reference"><a href="#cite_note-Singal-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hill_2016_9-14" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> One such 18th-century researcher, John Hunter, tried to settle the debate in 1767<sup id="cite_ref-Hill_2016_9-15" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> by inoculating a man with pus taken from a patient with gonorrhea. He erroneously concluded that syphilis and gonorrhea were indeed the same disease when the man developed the copper-colored rash that is classic for syphilis.<sup id="cite_ref-Janeway_Jr_2001_87-2" class="reference"><a href="#cite_note-Janeway_Jr_2001-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Singal_89-1" class="reference"><a href="#cite_note-Singal-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup> Although many sources repeat that Hunter inoculated himself,<sup id="cite_ref-Janeway_Jr_2001_87-3" class="reference"><a href="#cite_note-Janeway_Jr_2001-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Quillin_2018_15-8" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> others have argued that it was in fact another man.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">[</span>90<span class="cite-bracket">]</span></a></sup> After Hunter's experiment other scientists sought to disprove his conclusions by inoculating other male physicians, medical students,<sup id="cite_ref-Quillin_2018_15-9" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> and incarcerated men with gonorrheal pus, who all developed the burning and discharge of gonorrhea. One researcher, Ricord, took the initiative to perform 667 inoculations of gonorrheal pus on patients of a mental hospital, with zero cases of syphilis.<sup id="cite_ref-Hill_2016_9-16" class="reference"><a href="#cite_note-Hill_2016-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Quillin_2018_15-10" class="reference"><a href="#cite_note-Quillin_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Notably, the advent of penicillin in the 1940s made effective treatments for gonorrhea available.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91"><span class="cite-bracket">[</span>91<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=32" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><i><a href="/wiki/Neisseria_meningitidis" title="Neisseria meningitidis">Neisseria meningitidis</a></i></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=33" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFEuzébyParte" class="citation web cs1">Euzéby JP, Parte AC. <a rel="nofollow" class="external text" href="https://lpsn.dsmz.de/genus/neisseria">"Genus <i>Neisseria</i>"</a>. <i>List of Prokaryotic Names with Standing in Nomenclature (LPSN)</i><span class="reference-accessdate">. Retrieved <span class="nowrap">7 July</span> 2017</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=List+of+Prokaryotic+Names+with+Standing+in+Nomenclature+%28LPSN%29&rft.atitle=Genus+Neisseria&rft.aulast=Euz%C3%A9by&rft.aufirst=JP&rft.au=Parte%2C+AC&rft_id=https%3A%2F%2Flpsn.dsmz.de%2Fgenus%2Fneisseria&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeisseria+gonorrhoeae" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNeisser1879" class="citation journal cs1 cs1-prop-foreign-lang-source">Neisser A (1879). <a rel="nofollow" class="external text" href="https://archive.org/stream/centralblattfrd25unkngoog#page/n503/mode/1up">"Ueber eine der Gonorrhoe eigentümliche Micrococusform"</a> [About a micrococus form peculiar to gonorrhea]. <i>Centralblatt für die medizinischen Wissenschaften</i> (in German). <b>17</b> (28): 497–500.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Centralblatt+f%C3%BCr+die+medizinischen+Wissenschaften&rft.atitle=Ueber+eine+der+Gonorrhoe+eigent%C3%BCmliche+Micrococusform&rft.volume=17&rft.issue=28&rft.pages=497-500&rft.date=1879&rft.aulast=Neisser&rft.aufirst=A&rft_id=https%3A%2F%2Farchive.org%2Fstream%2Fcentralblattfrd25unkngoog%23page%2Fn503%2Fmode%2F1up&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeisseria+gonorrhoeae" class="Z3988"></span></span> </li> <li id="cite_note-O'Donnell_2009-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-O'Donnell_2009_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-O'Donnell_2009_3-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-O'Donnell_2009_3-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFO'DonnellGelone2009" class="citation book cs1">O'Donnell JA, Gelone SP (2009). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=JNlRYSC9gScC&q=Galen+coined+the+term+gonorrhea&pg=PA43">"Bacterial Cause of PID: Gonorrhoeae"</a>. <i>Pelvic Inflammatory Disease</i>. Infobase Publishing. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4381-0159-0" title="Special:BookSources/978-1-4381-0159-0"><bdi>978-1-4381-0159-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Bacterial+Cause+of+PID%3A+Gonorrhoeae&rft.btitle=Pelvic+Inflammatory+Disease&rft.pub=Infobase+Publishing&rft.date=2009&rft.isbn=978-1-4381-0159-0&rft.aulast=O%27Donnell&rft.aufirst=JA&rft.au=Gelone%2C+SP&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DJNlRYSC9gScC%26q%3DGalen%2Bcoined%2Bthe%2Bterm%2Bgonorrhea%26pg%3DPA43&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeisseria+gonorrhoeae" class="Z3988"></span></span> </li> <li id="cite_note-pmid37558089-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid37558089_4-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFInabaAizawaKataokaSaitoh2023" class="citation journal cs1">Inaba S, Aizawa Y, Kataoka S, Saitoh A (December 2023). 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(February 2015)">page needed</span></a></i>]</sup></span> </li> <li id="cite_note-www.cdc.gov_2017-7"><span class="mw-cite-backlink">^ <a href="#cite_ref-www.cdc.gov_2017_7-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-www.cdc.gov_2017_7-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-www.cdc.gov_2017_7-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-www.cdc.gov_2017_7-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm">"Detailed STD Facts - Gonorrhea"</a>. <i>www.cdc.gov</i>. 26 September 2017<span class="reference-accessdate">. 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title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Skin+and+Sexually+Transmitted+Diseases&rft.atitle=Gonorrhea%3A+Historical+outlook&rft.volume=2&rft.issue=2&rft.pages=110-114&rft.date=2020-10-15&rft_id=info%3Adoi%2F10.25259%2FJSSTD_4_2020&rft.issn=2582-3175&rft.aulast=Jose&rft.aufirst=Predesh+Parasseril&rft.au=Vivekanandan%2C+Vatsan&rft.au=Sobhanakumari%2C+Kunjumani&rft_id=https%3A%2F%2Fjsstd.org%2Fgonorrhea-historical-outlook%2F%23%3A~%3Atext%3DPenicillin%2520became%2520the%2520mainstay%2520of%2Ca%2520cure%2520rate%2520of%252098%2525.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeisseria+gonorrhoeae" class="Z3988"></span></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Neisseria_gonorrhoeae&action=edit&section=34" title="Edit section: External 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<i><b><a href="https://iw.toolforge.org/scholia/topic/Q131129" class="extiw" title="toolforge:scholia/topic/Q131129">Neisseria gonorrhoeae</a></b></i>.</div></div> </div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTodar" class="citation web cs1">Todar K. <a rel="nofollow" class="external text" href="http://www.textbookofbacteriology.net/neisseria.html">"Pathogenic Neisseriae: Gonorrhea, Neonatal Ophthalmia and Meningococcal Meningitis"</a>. <i>Todar's Online Textbook of Bacteriology</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Todar%27s+Online+Textbook+of+Bacteriology&rft.atitle=Pathogenic+Neisseriae%3A+Gonorrhea%2C+Neonatal+Ophthalmia+and+Meningococcal+Meningitis&rft.aulast=Todar&rft.aufirst=K&rft_id=http%3A%2F%2Fwww.textbookofbacteriology.net%2Fneisseria.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeisseria+gonorrhoeae" class="Z3988"></span></li> <li><i><a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/218059-overview">Gonorrhea</a></i> at <a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=485">"<i>Neisseria gonorrhoeae</i>"</a>. <i>NCBI Taxonomy Browser</i>. 485.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NCBI+Taxonomy+Browser&rft.atitle=Neisseria+gonorrhoeae&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2FTaxonomy%2FBrowser%2Fwwwtax.cgi%3Fmode%3DInfo%26id%3D485&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeisseria+gonorrhoeae" class="Z3988"></span></li></ul> </div> <ul><li><a rel="nofollow" class="external text" href="http://bacdive.dsmz.de/index.php?search=10470&submit=Search">Type strain of <i>Neisseria gonorrhoeae</i> at Bac<i>Dive</i> – the Bacterial Diversity Metadatabase</a></li></ul> <div class="navbox-styles"><style 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id="Diseases_of_the_skin_and_appendages_by_morphology" style="font-size:114%;margin:0 4em">Diseases of the skin and appendages by morphology</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Growths</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidermis" title="Epidermis">Epidermal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Wart" title="Wart">Wart</a></li> <li><a href="/wiki/Callus" title="Callus">Callus</a></li> <li><a href="/wiki/Seborrheic_keratosis" title="Seborrheic keratosis">Seborrheic keratosis</a></li> <li><a href="/wiki/Skin_tag" title="Skin tag">Acrochordon</a></li> <li><a href="/wiki/Molluscum_contagiosum" title="Molluscum contagiosum">Molluscum contagiosum</a></li> <li><a href="/wiki/Actinic_keratosis" title="Actinic keratosis">Actinic keratosis</a></li> <li><a href="/wiki/Squamous-cell_carcinoma" title="Squamous-cell carcinoma">Squamous-cell carcinoma</a></li> <li><a href="/wiki/Basal-cell_carcinoma" title="Basal-cell carcinoma">Basal-cell carcinoma</a></li> <li><a href="/wiki/Merkel-cell_carcinoma" title="Merkel-cell carcinoma">Merkel-cell carcinoma</a></li> <li><a href="/wiki/Nevus_sebaceous" title="Nevus sebaceous">Nevus sebaceous</a></li> <li><a href="/wiki/Trichoepithelioma" title="Trichoepithelioma">Trichoepithelioma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pigmented</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Freckle" title="Freckle">Freckles</a></li> <li><a href="/wiki/Lentigo" title="Lentigo">Lentigo</a></li> <li><a href="/wiki/Melasma" title="Melasma">Melasma</a></li> <li><a href="/wiki/Nevus" title="Nevus">Nevus</a></li> <li><a href="/wiki/Melanoma" title="Melanoma">Melanoma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dermis" title="Dermis">Dermal</a> and<br />subcutaneous</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Epidermoid_cyst" title="Epidermoid cyst">Epidermal inclusion cyst</a></li> <li><a href="/wiki/Hemangioma" title="Hemangioma">Hemangioma</a></li> <li><a href="/wiki/Benign_fibrous_histiocytoma" class="mw-redirect" title="Benign fibrous histiocytoma">Dermatofibroma (benign fibrous histiocytoma)</a></li> <li><a href="/wiki/Keloid" title="Keloid">Keloid</a></li> <li><a href="/wiki/Lipoma" title="Lipoma">Lipoma</a></li> <li><a href="/wiki/Neurofibroma" title="Neurofibroma">Neurofibroma</a></li> <li><a href="/wiki/Xanthoma" title="Xanthoma">Xanthoma</a></li> <li><a href="/wiki/Kaposi%27s_sarcoma" title="Kaposi's sarcoma">Kaposi's sarcoma</a></li> <li><a href="/wiki/Infantile_digital_fibromatosis" title="Infantile digital fibromatosis">Infantile digital fibromatosis</a></li> <li><a href="/wiki/Granular_cell_tumor" title="Granular cell tumor">Granular cell tumor</a></li> <li><a href="/wiki/Leiomyoma" title="Leiomyoma">Leiomyoma</a></li> <li><a href="/wiki/Lymphangioma_circumscriptum" title="Lymphangioma circumscriptum">Lymphangioma circumscriptum</a></li> <li><a href="/wiki/Myxoid_cyst" title="Myxoid cyst">Myxoid cyst</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Rash" title="Rash">Rashes</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">With<br /> epidermal<br /> involvement</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Eczematous</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Contact_dermatitis" title="Contact dermatitis">Contact dermatitis</a></li> <li><a href="/wiki/Atopic_dermatitis" title="Atopic dermatitis">Atopic dermatitis</a></li> <li><a href="/wiki/Seborrhoeic_dermatitis" title="Seborrhoeic dermatitis">Seborrheic dermatitis</a></li> <li><a href="/wiki/Stasis_dermatitis" title="Stasis dermatitis">Stasis dermatitis</a></li> <li><a href="/wiki/Lichen_simplex_chronicus" title="Lichen simplex chronicus">Lichen simplex chronicus</a></li> <li><a href="/wiki/Darier%27s_disease" title="Darier's disease">Darier's disease</a></li> <li><a href="/wiki/Glucagonoma_syndrome" class="mw-redirect" title="Glucagonoma syndrome">Glucagonoma syndrome</a></li> <li><a href="/wiki/Langerhans_cell_histiocytosis" title="Langerhans cell histiocytosis">Langerhans cell histiocytosis</a></li> <li><a href="/wiki/Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosus</a></li> <li><a href="/wiki/Pemphigus" title="Pemphigus">Pemphigus foliaceus</a></li> <li><a href="/wiki/Wiskott%E2%80%93Aldrich_syndrome" title="Wiskott–Aldrich syndrome">Wiskott–Aldrich syndrome</a></li> <li><a href="/wiki/Zinc_deficiency" title="Zinc deficiency">Zinc deficiency</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Scale_(dermatology)" class="mw-redirect" title="Scale (dermatology)">Scaling</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Psoriasis" title="Psoriasis">Psoriasis</a></li> <li>Tinea (<a href="/wiki/Tinea_corporis" title="Tinea corporis">Corporis</a></li> <li><a href="/wiki/Tinea_cruris" title="Tinea cruris">Cruris</a></li> <li><a href="/wiki/Athlete%27s_foot" title="Athlete's foot">Pedis</a></li> <li><a href="/wiki/Tinea_manuum" title="Tinea manuum">Manuum</a></li> <li><a href="/wiki/Tinea_faciei" title="Tinea faciei">Faciei</a>)</li> <li><a href="/wiki/Pityriasis_rosea" title="Pityriasis rosea">Pityriasis rosea</a></li> <li><a href="/wiki/Syphilis" title="Syphilis">Secondary syphilis</a></li> <li><a href="/wiki/Mycosis_fungoides" title="Mycosis fungoides">Mycosis fungoides</a></li> <li><a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li> <li><a href="/wiki/Pityriasis_rubra_pilaris" title="Pityriasis rubra pilaris">Pityriasis rubra pilaris</a></li> <li><a href="/wiki/Parapsoriasis" title="Parapsoriasis">Parapsoriasis</a></li> <li><a href="/wiki/Ichthyosis" title="Ichthyosis">Ichthyosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blister" title="Blister">Blistering</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Herpes" title="Herpes">Herpes simplex</a></li> <li><a href="/wiki/Herpes_zoster" class="mw-redirect" title="Herpes zoster">Herpes zoster</a></li> <li><a href="/wiki/Chickenpox" title="Chickenpox">Varicella</a></li> <li><a href="/wiki/Impetigo" title="Impetigo">Bullous impetigo</a></li> <li><a href="/wiki/Contact_dermatitis" title="Contact dermatitis">Acute contact dermatitis</a></li> <li><a href="/wiki/Pemphigus_vulgaris" title="Pemphigus vulgaris">Pemphigus vulgaris</a></li> <li><a href="/wiki/Bullous_pemphigoid" title="Bullous pemphigoid">Bullous pemphigoid</a></li> <li><a href="/wiki/Dermatitis_herpetiformis" title="Dermatitis herpetiformis">Dermatitis herpetiformis</a></li> <li><a href="/wiki/Porphyria_cutanea_tarda" title="Porphyria cutanea tarda">Porphyria cutanea tarda</a></li> <li><a href="/wiki/Epidermolysis_bullosa_simplex" title="Epidermolysis bullosa simplex">Epidermolysis bullosa simplex</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Papule" title="Papule">Papular</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Scabies" title="Scabies">Scabies</a></li> <li><a href="/wiki/Insect_bites_and_stings" class="mw-redirect" title="Insect bites and stings">Insect bite reactions</a></li> <li><a href="/wiki/Lichen_planus" title="Lichen planus">Lichen planus</a></li> <li><a href="/wiki/Miliaria" title="Miliaria">Miliaria</a></li> <li><a href="/wiki/Keratosis_pilaris" title="Keratosis pilaris">Keratosis pilaris</a></li> <li><a href="/wiki/Lichen_spinulosus" title="Lichen spinulosus">Lichen spinulosus</a></li> <li><a href="/wiki/Transient_acantholytic_dermatosis" title="Transient acantholytic dermatosis">Transient acantholytic dermatosis</a></li> <li><a href="/wiki/Lichen_nitidus" title="Lichen nitidus">Lichen nitidus</a></li> <li><a href="/wiki/Pityriasis_lichenoides_et_varioliformis_acuta" title="Pityriasis lichenoides et varioliformis acuta">Pityriasis lichenoides et varioliformis acuta</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pustule" class="mw-redirect" title="Pustule">Pustular</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acne_vulgaris" class="mw-redirect" title="Acne vulgaris">Acne vulgaris</a></li> <li><a href="/wiki/Rosacea" title="Rosacea">Rosacea</a></li> <li><a href="/wiki/Folliculitis" title="Folliculitis">Folliculitis</a></li> <li><a href="/wiki/Impetigo" title="Impetigo">Impetigo</a></li> <li><a href="/wiki/Candidiasis" title="Candidiasis">Candidiasis</a></li> <li><a class="mw-selflink selflink">Gonococcemia</a></li> <li><a href="/wiki/Dermatophyte" title="Dermatophyte">Dermatophyte</a></li> <li><a href="/wiki/Coccidioidomycosis" title="Coccidioidomycosis">Coccidioidomycosis</a></li> <li><a href="/wiki/Subcorneal_pustular_dermatosis" class="mw-redirect" title="Subcorneal pustular dermatosis">Subcorneal pustular dermatosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Hypopigmented</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tinea_versicolor" title="Tinea versicolor">Tinea versicolor</a></li> <li><a href="/wiki/Vitiligo" title="Vitiligo">Vitiligo</a></li> <li><a href="/wiki/Pityriasis_alba" title="Pityriasis alba">Pityriasis alba</a></li> <li><a href="/wiki/Postinflammatory_hyperpigmentation" title="Postinflammatory hyperpigmentation">Postinflammatory hyperpigmentation</a></li> <li><a href="/wiki/Tuberous_sclerosis" title="Tuberous sclerosis">Tuberous sclerosis</a></li> <li><a href="/wiki/Idiopathic_guttate_hypomelanosis" title="Idiopathic guttate hypomelanosis">Idiopathic guttate hypomelanosis</a></li> <li><a href="/wiki/Leprosy" title="Leprosy">Leprosy</a></li> <li><a href="/wiki/Mycosis_fungoides" title="Mycosis fungoides">Hypopigmented mycosis fungoides</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Without<br /> epidermal<br /> involvement</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Red" scope="row" class="navbox-group" style="width:1%">Red</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Blanchable<br /> <a href="/wiki/Erythema" title="Erythema">Erythema</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Generalized</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_eruption" title="Drug eruption">Drug eruptions</a></li> <li><a href="/wiki/Exanthem" title="Exanthem">Viral exanthems</a></li> <li><a href="/wiki/Erythema_toxicum_neonatorum" title="Erythema toxicum neonatorum">Toxic erythema</a></li> <li><a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Localized</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cellulitis" title="Cellulitis">Cellulitis</a></li> <li><a href="/wiki/Abscess" title="Abscess">Abscess</a></li> <li><a href="/wiki/Boil" title="Boil">Boil</a></li> <li><a href="/wiki/Erythema_nodosum" title="Erythema nodosum">Erythema nodosum</a></li> <li><a href="/wiki/Carcinoid_syndrome" title="Carcinoid syndrome">Carcinoid syndrome</a></li> <li><a href="/wiki/Fixed_drug_eruption" class="mw-redirect" title="Fixed drug eruption">Fixed drug eruption</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Specialized</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Urticaria" class="mw-redirect" title="Urticaria">Urticaria</a></li> <li>Erythema (<a href="/wiki/Erythema_multiforme" title="Erythema multiforme">Multiforme</a></li> <li><a href="/wiki/Erythema_chronicum_migrans" class="mw-redirect" title="Erythema chronicum migrans">Migrans</a></li> <li><a href="/wiki/Erythema_gyratum_repens" title="Erythema gyratum repens">Gyratum repens</a></li> <li><a href="/wiki/Erythema_annulare_centrifugum" title="Erythema annulare centrifugum">Annulare centrifugum</a></li> <li><a href="/wiki/Erythema_ab_igne" title="Erythema ab igne">Ab igne</a>)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonblanchable<br /> Purpura</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Macular</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Thrombocytopenic_purpura" title="Thrombocytopenic purpura">Thrombocytopenic purpura</a></li> <li><a href="/wiki/Solar_purpura" title="Solar purpura">Actinic/solar purpura</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Papular</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">Disseminated intravascular coagulation</a></li> <li><a href="/wiki/Vasculitis" title="Vasculitis">Vasculitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Indurated</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Scleroderma" title="Scleroderma">Scleroderma</a>/<a href="/wiki/Morphea" title="Morphea">morphea</a></li> <li><a href="/wiki/Granuloma_annulare" title="Granuloma annulare">Granuloma annulare</a></li> <li><a href="/wiki/Lichen_sclerosus" title="Lichen sclerosus">Lichen sclerosis et atrophicus</a></li> <li><a href="/wiki/Necrobiosis_lipoidica" title="Necrobiosis lipoidica">Necrobiosis lipoidica</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Miscellaneous<br /> disorders</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ulcer_(dermatology)" title="Ulcer (dermatology)">Ulcers</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li class="mw-empty-elt"></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Hair</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Telogen_effluvium" title="Telogen effluvium">Telogen effluvium</a></li> <li><a href="/wiki/Androgenic_alopecia" class="mw-redirect" title="Androgenic alopecia">Androgenic alopecia</a></li> <li><a href="/wiki/Alopecia_areata" title="Alopecia areata">Alopecia areata</a></li> <li><a href="/wiki/Systemic_lupus_erythematosus" class="mw-redirect" title="Systemic lupus erythematosus">Systemic lupus erythematosus</a></li> <li><a href="/wiki/Tinea_capitis" title="Tinea capitis">Tinea capitis</a></li> <li><a href="/wiki/Loose_anagen_syndrome" title="Loose anagen syndrome">Loose anagen syndrome</a></li> <li><a href="/wiki/Lichen_planopilaris" class="mw-redirect" title="Lichen planopilaris">Lichen planopilaris</a></li> <li><a href="/wiki/Folliculitis_decalvans" title="Folliculitis decalvans">Folliculitis decalvans</a></li> <li><a href="/wiki/Pseudofolliculitis_barbae" title="Pseudofolliculitis barbae">Acne keloidalis nuchae</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nail_(anatomy)" title="Nail (anatomy)">Nail</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Onychomycosis" title="Onychomycosis">Onychomycosis</a></li> <li><a href="/wiki/Psoriasis" title="Psoriasis">Psoriasis</a></li> <li><a href="/wiki/Paronychia" title="Paronychia">Paronychia</a></li> <li><a href="/wiki/Ingrown_nail" title="Ingrown nail">Ingrown nail</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mucous_membrane" title="Mucous membrane">Mucous<br /> membrane</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aphthous_stomatitis" title="Aphthous stomatitis">Aphthous stomatitis</a></li> <li><a href="/wiki/Oral_candidiasis" title="Oral candidiasis">Oral candidiasis</a></li> <li><a href="/wiki/Lichen_planus" title="Lichen planus">Lichen planus</a></li> <li><a href="/wiki/Leukoplakia" title="Leukoplakia">Leukoplakia</a></li> <li><a href="/wiki/Pemphigus" title="Pemphigus">Pemphigus vulgaris</a></li> <li><a href="/wiki/Mucous_membrane_pemphigoid" title="Mucous membrane pemphigoid">Mucous membrane pemphigoid</a></li> <li><a href="/wiki/Cicatricial_pemphigoid" class="mw-redirect" title="Cicatricial pemphigoid">Cicatricial pemphigoid</a></li> <li><a href="/wiki/Herpesviridae" title="Herpesviridae">Herpesvirus</a></li> <li><a href="/wiki/Coxsackievirus" title="Coxsackievirus">Coxsackievirus</a></li> <li><a href="/wiki/Syphilis" title="Syphilis">Syphilis</a></li> <li><a href="/wiki/Histoplasmosis" title="Histoplasmosis">Systemic histoplasmosis</a></li> <li><a href="/wiki/Squamous-cell_carcinoma" title="Squamous-cell carcinoma">Squamous-cell carcinoma</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pseudomonadota-associated_Gram-negative_bacterial_infections" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Gram-negative_proteobacterial_diseases" title="Template:Gram-negative proteobacterial diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Gram-negative_proteobacterial_diseases" title="Template talk:Gram-negative proteobacterial diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Gram-negative_proteobacterial_diseases" title="Special:EditPage/Template:Gram-negative proteobacterial diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pseudomonadota-associated_Gram-negative_bacterial_infections" style="font-size:114%;margin:0 4em"><a href="/wiki/Pseudomonadota" title="Pseudomonadota">Pseudomonadota</a>-associated <a href="/wiki/Gram-negative_bacterial_infection" class="mw-redirect" title="Gram-negative bacterial infection">Gram-negative bacterial infections</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alphaproteobacteria" title="Alphaproteobacteria">α</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Rickettsiales" title="Rickettsiales">Rickettsiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Rickettsiaceae" title="Rickettsiaceae">Rickettsiaceae</a>/<br />(<a href="/wiki/Rickettsiosis" title="Rickettsiosis">Rickettsioses</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Typhus" title="Typhus">Typhus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_typhi" title="Rickettsia typhi">Rickettsia typhi</a></i> <ul><li><a href="/wiki/Murine_typhus" title="Murine typhus">Murine typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_prowazekii" title="Rickettsia prowazekii">Rickettsia prowazekii</a></i> <ul><li><a href="/wiki/Epidemic_typhus" title="Epidemic typhus">Epidemic typhus</a>, <a href="/wiki/Brill%E2%80%93Zinsser_disease" title="Brill–Zinsser disease">Brill–Zinsser disease</a>, <a href="/wiki/Flying_squirrel_typhus" title="Flying squirrel typhus">Flying squirrel typhus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Spotted_fever" title="Spotted fever">Spotted<br />fever</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Tick-borne_disease" title="Tick-borne disease">Tick-borne</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_rickettsii" title="Rickettsia rickettsii">Rickettsia rickettsii</a></i> <ul><li><a href="/wiki/Rocky_Mountain_spotted_fever" title="Rocky Mountain spotted fever">Rocky Mountain spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_conorii" title="Rickettsia conorii">Rickettsia conorii</a></i> <ul><li><a href="/wiki/Boutonneuse_fever" title="Boutonneuse fever">Boutonneuse fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_japonica" title="Rickettsia japonica">Rickettsia japonica</a></i> <ul><li><a href="/wiki/Japanese_spotted_fever" title="Japanese spotted fever">Japanese spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_sibirica" title="Rickettsia sibirica">Rickettsia sibirica</a></i> <ul><li><a href="/wiki/North_Asian_tick_typhus" title="North Asian tick typhus">North Asian tick typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_australis" title="Rickettsia australis">Rickettsia australis</a></i> <ul><li><a href="/wiki/Queensland_tick_typhus" title="Queensland tick typhus">Queensland tick typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_honei" title="Rickettsia honei">Rickettsia honei</a></i> <ul><li><a href="/wiki/Flinders_Island_spotted_fever" title="Flinders Island spotted fever">Flinders Island spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_africae" title="Rickettsia africae">Rickettsia africae</a></i> <ul><li><a href="/wiki/African_tick_bite_fever" title="African tick bite fever">African tick bite fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_parkeri" title="Rickettsia parkeri">Rickettsia parkeri</a></i> <ul><li><a href="/wiki/American_tick_bite_fever" class="mw-redirect" title="American tick bite fever">American tick bite fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_aeschlimannii" class="mw-redirect" title="Rickettsia aeschlimannii">Rickettsia aeschlimannii</a></i> <ul><li><a href="/wiki/Rickettsia_aeschlimannii_infection" title="Rickettsia aeschlimannii infection"><i>Rickettsia aeschlimannii</i> infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Mite#Clinical_significance" title="Mite">Mite-borne</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_akari" title="Rickettsia akari">Rickettsia akari</a></i> <ul><li><a href="/wiki/Rickettsialpox" title="Rickettsialpox">Rickettsialpox</a></li></ul></li> <li><i><a href="/wiki/Orientia_tsutsugamushi" title="Orientia tsutsugamushi">Orientia tsutsugamushi</a></i> <ul><li><a href="/wiki/Scrub_typhus" title="Scrub typhus">Scrub typhus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Flea#Fleas_as_a_vector" title="Flea">Flea-borne</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_felis" title="Rickettsia felis">Rickettsia felis</a></i> <ul><li><a href="/wiki/Flea-borne_spotted_fever" title="Flea-borne spotted fever">Flea-borne spotted fever</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Anaplasmataceae" class="mw-redirect" title="Anaplasmataceae">Anaplasmataceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ehrlichiosis" title="Ehrlichiosis">Ehrlichiosis</a>: <i><a href="/wiki/Anaplasma_phagocytophilum" title="Anaplasma phagocytophilum">Anaplasma phagocytophilum</a></i> <ul><li><a href="/wiki/Human_granulocytic_anaplasmosis" title="Human granulocytic anaplasmosis">Human granulocytic anaplasmosis</a>, <a href="/wiki/Anaplasmosis" title="Anaplasmosis">Anaplasmosis</a></li></ul></li> <li><i><a href="/wiki/Ehrlichia_chaffeensis" title="Ehrlichia chaffeensis">Ehrlichia chaffeensis</a></i> <ul><li><a href="/wiki/Human_monocytotropic_ehrlichiosis" title="Human monocytotropic ehrlichiosis">Human monocytotropic ehrlichiosis</a></li></ul></li> <li><i><a href="/wiki/Ehrlichia_ewingii" title="Ehrlichia ewingii">Ehrlichia ewingii</a></i> <ul><li><a href="/wiki/Ehrlichiosis_ewingii_infection" title="Ehrlichiosis ewingii infection">Ehrlichiosis ewingii infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Hyphomicrobiales" title="Hyphomicrobiales">Hyphomicrobiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Brucellaceae" title="Brucellaceae">Brucellaceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Brucella_abortus" title="Brucella abortus">Brucella abortus</a></i> <ul><li><a href="/wiki/Brucellosis" title="Brucellosis">Brucellosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Bartonella" title="Bartonella">Bartonellaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bartonellosis" title="Bartonellosis">Bartonellosis</a>: <i><a href="/wiki/Bartonella_henselae" title="Bartonella henselae">Bartonella henselae</a></i> <ul><li><a href="/wiki/Cat-scratch_disease" title="Cat-scratch disease">Cat-scratch disease</a></li></ul></li> <li><i><a href="/wiki/Bartonella_quintana" title="Bartonella quintana">Bartonella quintana</a></i> <ul><li><a href="/wiki/Trench_fever" title="Trench fever">Trench fever</a></li></ul></li> <li>Either <i>B. henselae</i> or <i>B. quintana</i> <ul><li><a href="/wiki/Bacillary_angiomatosis" title="Bacillary angiomatosis">Bacillary angiomatosis</a></li></ul></li> <li><i><a href="/wiki/Bartonella_bacilliformis" title="Bartonella bacilliformis">Bartonella bacilliformis</a></i> <ul><li><a href="/wiki/Carrion%27s_disease" title="Carrion's disease">Carrion's disease</a>, <a href="/wiki/Verruga_peruana" class="mw-redirect" title="Verruga peruana">Verruga peruana</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Betaproteobacteria" title="Betaproteobacteria">β</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Neisseriaceae" title="Neisseriaceae">Neisseriales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Maltose" title="Maltose">M+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Neisseria_meningitidis" title="Neisseria meningitidis">Neisseria meningitidis/meningococcus</a></i> <ul><li><a href="/wiki/Meningococcal_disease" title="Meningococcal disease">Meningococcal disease</a>, <a href="/wiki/Waterhouse%E2%80%93Friderichsen_syndrome" title="Waterhouse–Friderichsen syndrome">Waterhouse–Friderichsen syndrome</a>, <a href="/wiki/Meningococcal_septicaemia" class="mw-redirect" title="Meningococcal septicaemia">Meningococcal septicaemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Maltose" title="Maltose">M−</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a class="mw-selflink selflink">Neisseria gonorrhoeae/gonococcus</a></i> <ul><li><a href="/wiki/Gonorrhea" title="Gonorrhea">Gonorrhea</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i>ungrouped:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Eikenella_corrodens" title="Eikenella corrodens">Eikenella corrodens</a></i>/<i><a href="/wiki/Kingella_kingae" title="Kingella kingae">Kingella kingae</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li> <li><i><a href="/wiki/Chromobacterium_violaceum" title="Chromobacterium violaceum">Chromobacterium violaceum</a></i> <ul><li><a href="/wiki/Chromobacteriosis_infection" title="Chromobacteriosis infection">Chromobacteriosis infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Burkholderiales" title="Burkholderiales">Burkholderiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Burkholderia_pseudomallei" title="Burkholderia pseudomallei">Burkholderia pseudomallei</a></i> <ul><li><a href="/wiki/Melioidosis" title="Melioidosis">Melioidosis</a></li></ul></li> <li><i><a href="/wiki/Burkholderia_mallei" title="Burkholderia mallei">Burkholderia mallei</a></i> <ul><li><a href="/wiki/Glanders" title="Glanders">Glanders</a></li></ul></li> <li><i><a href="/wiki/Burkholderia_cepacia_complex" title="Burkholderia cepacia complex">Burkholderia cepacia complex</a></i></li> <li><i><a href="/wiki/Bordetella_pertussis" title="Bordetella pertussis">Bordetella pertussis</a>/<a href="/wiki/Bordetella_parapertussis" title="Bordetella parapertussis">Bordetella parapertussis</a></i> <ul><li><a href="/wiki/Pertussis" class="mw-redirect" title="Pertussis">Pertussis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gammaproteobacteria" title="Gammaproteobacteria">γ</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Enterobacteriaceae" title="Enterobacteriaceae">Enterobacteriales</a><br />(<a href="/wiki/Oxidase_test#OX−" title="Oxidase test">OX−</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Lac+" title="MacConkey agar">Lac+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Klebsiella_pneumoniae" title="Klebsiella pneumoniae">Klebsiella pneumoniae</a></i> <ul><li><a href="/wiki/Rhinoscleroma" title="Rhinoscleroma">Rhinoscleroma</a>, <a href="/wiki/Pneumonia" title="Pneumonia">Pneumonia</a></li></ul></li> <li><i><a href="/wiki/Klebsiella_granulomatis" title="Klebsiella granulomatis">Klebsiella granulomatis</a></i> <ul><li><a href="/wiki/Granuloma_inguinale" title="Granuloma inguinale">Granuloma inguinale</a></li></ul></li> <li><i><a href="/wiki/Klebsiella_oxytoca" title="Klebsiella oxytoca">Klebsiella oxytoca</a></i></li></ul> <ul><li><i><a href="/wiki/Escherichia_coli" title="Escherichia coli">Escherichia coli</a></i>: <a href="/wiki/Enterotoxigenic_Escherichia_coli" title="Enterotoxigenic Escherichia coli">Enterotoxigenic</a></li> <li><a href="/wiki/Enteroinvasive_Escherichia_coli" title="Enteroinvasive Escherichia coli">Enteroinvasive</a></li> <li><a href="/wiki/Verotoxin-producing_Escherichia_coli" class="mw-redirect" title="Verotoxin-producing Escherichia coli">Enterohemorrhagic</a></li> <li><a href="/wiki/Escherichia_coli_O157:H7" title="Escherichia coli O157:H7">O157:H7</a></li> <li><a href="/wiki/Escherichia_coli_O104:H4" title="Escherichia coli O104:H4">O104:H4</a> <ul><li><a href="/wiki/Hemolytic-uremic_syndrome" class="mw-redirect" title="Hemolytic-uremic syndrome">Hemolytic-uremic syndrome</a></li></ul></li></ul> <ul><li><i><a href="/wiki/Enterobacter_aerogenes" class="mw-redirect" title="Enterobacter aerogenes">Enterobacter aerogenes</a>/<a href="/wiki/Enterobacter_cloacae" title="Enterobacter cloacae">Enterobacter cloacae</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Slow" title="MacConkey agar">Slow/weak</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Serratia_marcescens" title="Serratia marcescens">Serratia marcescens</a></i> <ul><li><a href="/wiki/Serratia_infection" class="mw-redirect" title="Serratia infection"><i>Serratia</i> infection</a></li></ul></li> <li><i><a href="/wiki/Citrobacter_koseri" title="Citrobacter koseri">Citrobacter koseri</a></i>/<i><a href="/wiki/Citrobacter_freundii" title="Citrobacter freundii">Citrobacter freundii</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Lac−" title="MacConkey agar">Lac−</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Bismuth_sulfite_agar" title="Bismuth sulfite agar">H2S+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Salmonella_enterica" title="Salmonella enterica">Salmonella enterica</a></i> <ul><li><a href="/wiki/Typhoid_fever" title="Typhoid fever">Typhoid fever</a>, <a href="/wiki/Paratyphoid_fever" title="Paratyphoid fever">Paratyphoid fever</a>, <a href="/wiki/Salmonellosis" title="Salmonellosis">Salmonellosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue">H2S−</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Shigella_dysenteriae" title="Shigella dysenteriae">Shigella dysenteriae</a>/<a href="/wiki/Shigella_sonnei" title="Shigella sonnei">sonnei</a>/<a href="/wiki/Shigella_flexneri" title="Shigella flexneri">flexneri</a>/<a href="/wiki/Shigella_boydii" title="Shigella boydii">boydii</a></i> <ul><li><a href="/wiki/Shigellosis" title="Shigellosis">Shigellosis</a>, <a href="/wiki/Bacillary_dysentery" title="Bacillary dysentery">Bacillary dysentery</a></li></ul></li> <li><i><a href="/wiki/Proteus_mirabilis" title="Proteus mirabilis">Proteus mirabilis</a></i>/<i><a href="/wiki/Proteus_vulgaris" title="Proteus vulgaris">Proteus vulgaris</a></i></li> <li><i><a href="/wiki/Yersinia_pestis" title="Yersinia pestis">Yersinia pestis</a></i> <ul><li><a href="/wiki/Plague_(disease)" title="Plague (disease)">Plague</a>/<a href="/wiki/Bubonic_plague" title="Bubonic plague">Bubonic plague</a></li></ul></li> <li><i><a href="/wiki/Yersinia_enterocolitica" title="Yersinia enterocolitica">Yersinia enterocolitica</a></i> <ul><li><a href="/wiki/Yersiniosis" title="Yersiniosis">Yersiniosis</a></li></ul></li> <li><i><a href="/wiki/Yersinia_pseudotuberculosis" title="Yersinia pseudotuberculosis">Yersinia pseudotuberculosis</a></i> <ul><li><a href="/wiki/Far_East_scarlet-like_fever" title="Far East scarlet-like fever">Far East scarlet-like fever</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Pasteurellaceae" title="Pasteurellaceae">Pasteurellales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Haemophilus" title="Haemophilus">Haemophilus</a>:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Haemophilus_influenzae" title="Haemophilus influenzae">H. influenzae</a></i> <ul><li><a href="/wiki/Haemophilus_meningitis" title="Haemophilus meningitis"><i>Haemophilus</i> meningitis</a></li> <li><a href="/wiki/Brazilian_purpuric_fever" title="Brazilian purpuric fever">Brazilian purpuric fever</a></li></ul></li> <li><i><a href="/wiki/Haemophilus_ducreyi" title="Haemophilus ducreyi">H. ducreyi</a></i> <ul><li><a href="/wiki/Chancroid" title="Chancroid">Chancroid</a></li></ul></li> <li><i><a href="/wiki/Haemophilus_parainfluenzae" title="Haemophilus parainfluenzae">H. parainfluenzae</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Pasteurella_multocida" title="Pasteurella multocida">Pasteurella multocida</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pasteurellosis" title="Pasteurellosis">Pasteurellosis</a></li> <li><i><a href="/wiki/Actinobacillus" title="Actinobacillus">Actinobacillus</a></i> <ul><li><a href="/wiki/Actinobacillosis" title="Actinobacillosis">Actinobacillosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Aggregatibacter_actinomycetemcomitans" title="Aggregatibacter actinomycetemcomitans">Aggregatibacter actinomycetemcomitans</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Legionellales" title="Legionellales">Legionellales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Legionella_pneumophila" title="Legionella pneumophila">Legionella pneumophila</a>/<a href="/wiki/Legionella_longbeachae" title="Legionella longbeachae">Legionella longbeachae</a></i> <ul><li><a href="/wiki/Legionnaires%27_disease" title="Legionnaires' disease">Legionnaires' disease</a></li></ul></li> <li><i><a href="/wiki/Coxiella_burnetii" title="Coxiella burnetii">Coxiella burnetii</a></i> <ul><li><a href="/wiki/Q_fever" title="Q fever">Q fever</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Thiotrichales" title="Thiotrichales">Thiotrichales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Francisella_tularensis" title="Francisella tularensis">Francisella tularensis</a></i> <ul><li><a href="/wiki/Tularemia" title="Tularemia">Tularemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Vibrionaceae" title="Vibrionaceae">Vibrionaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Vibrio_cholerae" title="Vibrio cholerae">Vibrio cholerae</a></i> <ul><li><a href="/wiki/Cholera" title="Cholera">Cholera</a></li></ul></li> <li><i><a href="/wiki/Vibrio_vulnificus" title="Vibrio vulnificus">Vibrio vulnificus</a></i></li> <li><i><a href="/wiki/Vibrio_parahaemolyticus" title="Vibrio parahaemolyticus">Vibrio parahaemolyticus</a></i></li> <li><i><a href="/wiki/Vibrio_alginolyticus" title="Vibrio alginolyticus">Vibrio alginolyticus</a></i></li> <li><i><a href="/wiki/Plesiomonas_shigelloides" title="Plesiomonas shigelloides">Plesiomonas shigelloides</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Pseudomonadales" title="Pseudomonadales">Pseudomonadales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Pseudomonas_aeruginosa" title="Pseudomonas aeruginosa">Pseudomonas aeruginosa</a></i> <ul><li><a href="/wiki/Pseudomonas_infection" title="Pseudomonas infection"><i>Pseudomonas</i> infection</a></li></ul></li> <li><i><a href="/wiki/Moraxella_catarrhalis" title="Moraxella catarrhalis">Moraxella catarrhalis</a></i></li> <li><i><a href="/wiki/Acinetobacter_baumannii" title="Acinetobacter baumannii">Acinetobacter baumannii</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Xanthomonadaceae" title="Xanthomonadaceae">Xanthomonadaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Stenotrophomonas_maltophilia" title="Stenotrophomonas maltophilia">Stenotrophomonas maltophilia</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Cardiobacteriaceae" title="Cardiobacteriaceae">Cardiobacteriaceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Cardiobacterium_hominis" title="Cardiobacterium hominis">Cardiobacterium hominis</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Aeromonadales" title="Aeromonadales">Aeromonadales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Aeromonas_hydrophila" title="Aeromonas hydrophila">Aeromonas hydrophila</a>/<a href="/wiki/Aeromonas_veronii" title="Aeromonas veronii">Aeromonas veronii</a></i> <ul><li><a href="/wiki/Aeromonas_infection" title="Aeromonas infection"><i>Aeromonas</i> infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Campylobacterota" title="Campylobacterota">ε</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Campylobacterales" scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Campylobacterales" title="Campylobacterales">Campylobacterales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Campylobacter_jejuni" title="Campylobacter jejuni">Campylobacter jejuni</a></i> <ul><li><a href="/wiki/Campylobacteriosis" title="Campylobacteriosis">Campylobacteriosis</a>, <a href="/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome" title="Guillain–Barré syndrome">Guillain–Barré syndrome</a></li></ul></li> <li><i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> <ul><li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic ulcer</a>, <a href="/wiki/MALT_lymphoma" title="MALT lymphoma">MALT lymphoma</a>, <a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">Gastric cancer</a></li></ul></li> <li><i><a href="/wiki/Helicobacter_cinaedi" title="Helicobacter cinaedi">Helicobacter cinaedi</a></i> <ul><li><a href="/wiki/Helicobacter_cellulitis" title="Helicobacter cellulitis"><i>Helicobacter</i> cellulitis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Taxon_identifiers" style="padding:3px"><table class="nowraplinks hlist navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Taxon_identifiers" style="font-size:114%;margin:0 4em"><a href="/wiki/Help:Taxon_identifiers" title="Help:Taxon identifiers">Taxon identifiers</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: left;"><i>Neisseria gonorrhoeae</i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><span style="white-space:nowrap;"><a href="/wiki/Wikidata" title="Wikidata">Wikidata</a>: <span class="uid"><span class="external"><a href="https://www.wikidata.org/wiki/Q131129" class="extiw" title="wikidata:Q131129">Q131129</a></span></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Wikispecies" title="Wikispecies">Wikispecies</a>: <span class="uid"><span class="external"><a href="https://species.wikimedia.org/wiki/Neisseria_gonorrhoeae" class="extiw" title="wikispecies:Neisseria gonorrhoeae">Neisseria gonorrhoeae</a></span></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/BacDive" title="BacDive">BacDive</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://bacdive.dsmz.de/strain/10470">10470</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Catalogue_of_Life" title="Catalogue of Life">CoL</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://www.catalogueoflife.org/data/taxon/4655M">4655M</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Encyclopedia_of_Life" title="Encyclopedia of Life">EoL</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://eol.org/pages/974457">974457</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Global_Biodiversity_Information_Facility" title="Global Biodiversity Information Facility">GBIF</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://www.gbif.org/species/3220217">3220217</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/INaturalist" title="INaturalist">iNaturalist</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://inaturalist.org/taxa/570711">570711</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Interim_Register_of_Marine_and_Nonmarine_Genera" title="Interim Register of Marine and Nonmarine Genera">IRMNG</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://www.irmng.org/aphia.php?p=taxdetails&id=11068173">11068173</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Integrated_Taxonomic_Information_System" title="Integrated Taxonomic Information System">ITIS</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://www.itis.gov/servlet/SingleRpt/SingleRpt?search_topic=TSN&search_value=964012">964012</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/List_of_Prokaryotic_names_with_Standing_in_Nomenclature" title="List of Prokaryotic names with Standing in Nomenclature">LPSN</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://lpsn.dsmz.de/species/neisseria-gonorrhoeae">neisseria-gonorrhoeae</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/National_Center_for_Biotechnology_Information" title="National Center for Biotechnology Information">NCBI</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=485">485</a></span></span></li> <li><span style="white-space:nowrap;">NZOR: <span class="uid"><a rel="nofollow" class="external text" href="https://www.nzor.org.nz/names/04128909-4755-468c-8633-e0c5eea2276c">04128909-4755-468c-8633-e0c5eea2276c</a></span></span></li> <li><span style="white-space:nowrap;"><a href="/wiki/Open_Tree_of_Life" title="Open Tree of Life">Open Tree of Life</a>: <span class="uid"><a rel="nofollow" class="external text" href="https://tree.opentreeoflife.org/taxonomy/browse?id=286811">286811</a></span></span></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox authority-control" aria-label="Navbox" style="padding:3px"><table class="nowraplinks hlist navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Help:Authority_control" title="Help:Authority control">Authority control databases</a>: National <span class="mw-valign-text-top noprint" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q131129#identifiers" title="Edit this at Wikidata"><img alt="Edit this at Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><ul><li><span 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