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Gc infections are often asymptomatic, which can lead to serious complications such as cervicitis, epididymitis, endometriosis, or pelvic inflammatory disease, and although rare, Gc can also disseminate to the bloodstream, causing infective arthritis or endocarditis (1, 2).

The occurrence of diabetic ketoacidosis in pregnancy compromises both the fetus and the mother.

Perceived diversity, however, can be influenced by sample preparation, primer selection, and formation of chimeric 16S amplification products.

Chimeras are hybrid products between multiple parent sequences that can be falsely interpreted as novel organisms, thus inflating apparent diversity.

While Gc primarily colonizes the urogenital epithelium, ocular gonorrhea can occur in the eyes of newborns as they pass through the birth canal, resulting in a leading cause of blindness in developing countries (5).We used this assay to analyze mutations and conditions previously shown to affect pilin Av, confirming many but not all of the previously reported phenotypes.We show that mutations or conditions that cause growth defects can result in Av phenotypes when analyzed by phase variation-based assays.It usually occurs in the later stages of pregnancy and is also seen in newly presenting type 1 diabetes patients.Despite improvement in its incidence rates and outcomes over the years, it still remains a major clinical problem since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis.

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