Attachment to mucosal epithelium, mediated in part by pili and Opa (outer membrane opacity proteins), is followed by penetration of N. gonorrhoeae through epithelial cells to the submucosal tissue within 24 to 48 hours. A vigorous response by neutrophils begins with sloughing of the epithelium, development of submucosal microabscesses, and exudation of pus. Stained smears usually reveal large numbers of gono-cocci within a few neutrophils, whereas most cells contain no organisms.8

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