Gonorrhea is an infectious and highly contagious disease in which the mucous membranes of the urogenital tract are affected, but infection of the oropharynx or rectum is also possible. Both men and women suffer from this disease.
It causes gonorrhea gonococcus (Neisseria gonorrhoeae), so named after the physician-researcher Albert Neisser. The disease is transmitted only from a sick person to a person.
The main route of transmission of gonorrhea is sexual (genital), but infection with anogenital and oral contact is possible.
In addition, the vertical pathway of infection is known – during childbirth the child is infected, passing through the birth canal of the sick mother.
The household transmission path is not excluded, but its reliability has not been established, since the pathogen is unstable in the external environment.
There are genital and extragenital (not sexual) gonorrhea. Genital gonorrhea is characterized by lesions of the urinary organs.
The group of extragenital gonorrhea includes:
- gonorrhea anorectal localization (inflammation of the rectum),
- gonorrhea of the bone and muscular systems (gonorrheal arthritis),
- gonorrheal damage to the conjunctiva of the eye (gonoblina),
- gonorrheal defeat of the pharynx (gonococcal pharyngitis).
The course of the disease is divided into fresh, chronic and latent gonorrhea.
Fresh gonorrhea is said when infection occurred less than 2 months ago. Fresh gonorrhea is divided into acute, subacute and torpid (there are no complaints, but there are insignificant secretions).
If the infection occurred more than 2 months ago, chronic gonorrhea is diagnosed.
Latent or latent gonorrhea has no clinical manifestations.
The first signs of the disease appear 2–14 days after infection (incubation period). But in some circumstances (for example, treatment with antibiotics, the presence of good immunity) the first manifestations of the disease occur in 1-2 months.
Gonorrhea in men
The disease in men begins with the defeat of the urethra. Patients complain of discomfort (burning and itching) that occurs during urination. Also urination becomes painful.
If you press on the head of the penis there is a drop of pus. With the involvement of the posterior part of the urethra, urination becomes more frequent.
After intercourse, a bloody drop may occur.
On examination, hyperemia (redness) of the foreskin and penis head is noticeable.
The inguinal lymph nodes are often inflamed, they grow and become painful.
In the case of an ascending infection, gonorrhea spreads to the prostate gland, affects the seminal vesicles and testicles. At the same time, fever may occur, aching pain in the lower abdomen and erection problems occur.
Gonorrhea in women
More than half of the infected women have gonorrhea without marked clinical manifestations.
At the very beginning of the disease, the urethra, vagina and cervix are involved in the process. Inflammation of the urethra occurs with pronounced signs: there are pale yellow discharge from the urethra, a feeling of itching and burning in this area, urination becomes painful.
When gonorrheal vaginitis and cervicitis from the genital tract, purulent, greenish leucorrhoea with an unpleasant odor, sometimes a curd consistency , are secreted . There is also a burning sensation and itching, soreness during intercourse.
In case of irritation with infected secretions of the vulva, it becomes inflamed, red and swollen, and an itchy perineum joins.
When viewed in the mirrors marked hyperemia (redness) of the cervix and purulent discharge from the cervical canal.
If the infection rises higher, the uterus and its appendages are affected.
Gonorrhea in women must be differentiated from other sexually transmitted infections ( trichomoniasis , candidiasis , bacterial vaginosis ).
In men, with urethritis and prostatitis of another infectious or non-infectious etiology.
The diagnosis of gonorrhea is established on the basis of the characteristic complaints of the patient and the typical clinical signs established during the examination.
But to confirm the disease it is necessary to conduct laboratory tests:
For taking smears, material is taken from the urethra, the cervical canal, the vagina and the anus. Before this, the doctor treats the listed anatomical structures with a swab dipped in saline. Before taking the test, it is necessary to refrain from urinating and stop taking antibacterial drugs for 4-5 days. All strokes are taken in duplicate. The first batch of smears is stained with methylene blue, and the second according to Gram.
The essence of the cultural (bacteriological) method consists in planting secretions from the urogenital tract organs on nutrient media. The conclusion is given after 7 days, but gives a 100% result. In addition, this method allows to determine the sensitivity of the planted gonococci to antibiotics.
Immune fluorescence response
The method consists in painting smears with special dyes, after which the gonococci glow under a microscope.
Linked immunosorbent assay
The essence of the method consists in identifying antibodies to the pathogen, and for the analysis are taken not swabs, but urine.
Polymerase Chain Reaction (PCR)
For PCR, you can use smears from the anatomical structures of the urinary tract and urine. The method is effective, but expensive.
If chronic gonorrhea is diagnosed (repeated and ineffective treatment, negative results of bacterioscopic and bacteriological analyzes), provocative tests are carried out, after which the pathogen is detected on the mucous membranes.
There are chemical, biological, thermal, nutritional and physiological provocations. For the most accurate result, a combined provocation is carried out (simultaneous carrying out of two or more samples). Smears after provocation are taken in a day, two and three.
Gonorrhea is usually treated by a dermatovenereologist. But in some cases (for example, complicated gonorrhea), the gynecologist deals with the treatment of the disease in women and the urologist in men.
Uncomplicated gonorrhea is treated on an outpatient basis, all other cases are hospitalized. Treatment is indicated to both sexual partners, regardless of the results of the tests. For the period of therapy, it is necessary to observe sexual rest, the rules of personal hygiene (compulsory hand washing after using the toilet and taking a shower), and refusing spicy food and alcohol.
Etiotropic treatment (elimination of the cause of the disease) consists in getting rid of gonococci and consists in prescribing antibacterial drugs.
With fresh gonorrhea are appointed.
- fluoroquinolone antibiotics (ciprofloxacin, abactal, ofloxacin),
- cephalosporins (ceftriaxone, cefixime),
- macrolides (azithromycin, josamycin),
- tetracyclines (unidox).
The course of treatment lasts 7, maximum 10 days. It is advisable to combine the treatment with antibiotics that are active against chlamydia and ureaplasma (since gonorrhea often occurs on their background).
Chronic gonorrhea is treated much longer.
At first, gonovaccine is administered by courses of 6-8-10 intramuscular injections and drugs that stimulate nonspecific immunity (pyrogenal, ribonuclease) and only after that antibiotic therapy is given.
Control tests are taken after the end of treatment and monthly for three months.
Running gonorrhea is dangerous by the development of complications.
- endometritis , adnexitis ;
- obstruction of the fallopian tubes and infertility in women;
- bartholinitis in women;
- pelvioperitonitis and tubo-ovarian abscess (in women);
- ectopic pregnancy.
- prostatitis ;
- inflammation of the testes and seminal vesicles;
- violation of spermatogenesis;
- male infertility
The prognosis for the timely treatment of fresh gonorrhea is favorable, with chronic gonorrhea, both in men and women, is relatively favorable.