Pathogenicity and virulence of NEISSERIA GONORRHOEAE

Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea and is an obligate human pathogen, colonizing mucosal epithelia of the male urethra and the female endo/ectocervix, resulting in urethritis and cervicitis. These manifestations represent uncomplicated gonorrhea and highlight the gonococcus as a primarily mucosal pathogen. However, gonococci can ascend the female reproductive tract to cause pelvic inflammatory disease and may disseminate to distant anatomical sites. The gonococcus expresses a diverse array of virulence factors that mediate transmission, mucosal colonization, immune modulation, and disease progression. In this review, we outline the mechanisms of gonococcal transmission and colonization of the genital tract epithelium, and examine host-pathogen interactions that drive inflammation, immune evasion, and immune suppression. We also discuss the mechanisms underlying dissemination and the resulting spectrum of clinical outcomes. Continued investigation of gonococcal biology and host interactions will advance understanding of pathogenesis and support the development of improved treatments and preventative vaccines.