Gonococci are survivors.

Gonococci are capable of prolonged survival in untreated infection, and frequently reinfect persons with repeated and recent infection, despite considerable mucosal and systemic immune response to infection. Multiple mechanisms help to explain how this is achieved, including variations in surface antigen expression; production of an extracellular IgA protease; employment of antigens that preferentially stimulate host production of antibodies that block the killing activity of other antibodies; masking of critical epitopes by chemical modification of surface structures; molecular mimicry of host antigens; shedding of antigens in the form of outer membrane blebs; and, subverting certain nonimmunological antimicrobial defenses to the use of the bacterium. Moreover, gonococci are capable of considerable phenotypic adaptation to changing environmental conditions in vivo. This paper briefly reviews these concepts.