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Clinical Microbiology Reviews, October 2004, p. 965-981, Vol. 17, No. 4
0893-8512/04/$08.00+0     DOI: 10.1128/CMR.17.4.965-981.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

The Molecular Mechanisms Used by Neisseria gonorrhoeae To Initiate Infection Differ between Men and Women

Jennifer L. Edwards and Michael A. Apicella*

Department of Microbiology, The University of Iowa, Iowa City, Iowa

The molecular mechanisms used by the gonococcus to initiate infection exhibit gender specificity. The clinical presentations of disease are also strikingly different upon comparison of gonococcal urethritis to gonococcal cervicitis. An intimate association occurs between the gonococcus and the urethral epithelium and is mediated by the asialoglycoprotein receptor. Gonococcal interaction with the urethral epithelia cell triggers cytokine release, which promotes neutrophil influx and an inflammatory response. Similarly, gonococcal infection of the upper female genital tract also results in inflammation. Gonococci invade the nonciliated epithelia, and the ciliated cells are subjected to the cytotoxic effects of tumor necrosis factor alpha induced by gonococcal peptidoglycan and lipooligosaccharide. In contrast, gonococcal infection of the lower female genital tract is typically asymptomatic. This is in part the result of the ability of the gonococcus to subvert the alternative pathway of complement present in the lower female genital tract. Gonococcal engagement of complement receptor 3 on the cervical epithelia results in membrane ruffling and does not promote inflammation. A model of gonococcal pathogenesis is presented in the context of the male and female human urogenital tracts.

* Corresponding author. Mailing address: The University of Iowa, 51 Newton Rd., BSB 3-403, Iowa City, IA 52242. Phone: (319) 335-7807. Fax: (319) 335-9006. E-mail: michael-apicella{at}uiowa.edu.

Clinical Microbiology Reviews, October 2004, p. 965-981, Vol. 17, No. 4
0893-8512/04/$08.00+0     DOI: 10.1128/CMR.17.4.965-981.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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