Gonorrhea is a venereal infection that causes damage to the mucous membranes of organs lined with cylindrical epithelium: urethra, uterus, rectum, pharynx, conjunctiva of the eyes. It belongs to the group of sexually transmitted infections (STIs), the causative agent is gonococcus. It is characterized by mucous and purulent discharge from the urethra or vagina, pain and discomfort during urination, itching and discharge from the anus. When the pharynx is affected – inflammation of the throat and tonsils. Untreated gonorrhea in women and men causes inflammatory processes in the pelvic organs, leading to infertility; gonorrhea during pregnancy leads to infection of the baby during childbirth.
Gonorrhea (clap) is a specific infectious and inflammatory process affecting mainly the genitourinary system, the causative agent of which are gonococci (Neisseria gonorrhoeae). Disease is a venereal disease, as it is transmitted mainly through sexual contact. Gonococci die quickly in the external environment (when heated, dried, treated with antiseptics, in direct sunlight). Gonococci mainly affect the mucous membranes of organs with cylindrical and glandular epithelium. They can be located on the cell surface and intracellularly (in leukocytes, trichomonads, epithelial cells), they can form L-forms (not sensitive to the effects of drugs and antibodies).
There are several types of gonococcal infection at the site of the lesion:
- of the genitourinary organs;
- of the anorectal region (gonococcal proctitis);
- of the musculoskeletal system (gonarthritis);
- gonococcal infection of the conjunctiva of the eyes (blennorrhea);
- gonococcal pharyngitis.
Gonorrhea from the lower parts of the genitourinary system (urethra, periurethal glands, cervical canal) can spread to the upper (uterus and appendages, peritoneum). Disease vaginitis almost does not occur, since the flat epithelium of the vaginal mucosa is resistant to the effects of gonococci. But with some changes in the mucosa (in girls, in women during pregnancy, during menopause) its development is possible.
Disease is more common among young people in their 20s and 30s, but it can occur at any age. There is a very high risk of complications – various genitourinary disorders (including sexual ones), infertility in men and women. Gonococci can enter the blood and, circulating throughout the body, cause joint damage, sometimes gonorrheal endocarditis and meningitis, bacteremia, severe septic conditions. Infection of the fetus from the mother infected with gonorrhea during childbirth is noted.
When the symptoms are erased, patients aggravate the course of their disease and spread the infection further without knowing about it.
Infection with gonorrhea
Gonorrhea is a highly contagious infection, in 99% it has a sexual transmission pathway. Gonorrhea infection occurs in various forms of sexual contact: vaginal (normal and “incomplete”), anal, oral.
In women, after sexual intercourse with a sick man, the probability of contracting gonorrhea is 50-80%. Men do not always get infected during sexual contact with a woman with gonorrhea – in 30-40% of cases. This is due to some anatomical and functional features of the genitourinary system in men (narrow urethral canal, gonococci can be washed away by urine). The probability of contracting gonorrhea of a man is higher if a woman has menstruation, sexual intercourse is prolonged and has a stormy conclusion.
Sometimes there may be a contact way of infection of a child from a mother with gonorrhea during childbirth and household, indirect – through personal hygiene items (bed linen, washcloth, towel), usually in girls. The incubation (latent) period for gonorrhea can last from 1 day to 2 weeks, less often up to 1 month.
Infection with gonorrhea of a newborn child
Gonococci cannot penetrate intact fetal membranes during pregnancy, but premature rupture of these membranes leads to infection of the amniotic fluid and fetus. Infection with gonorrhea of a newborn can occur when it passes through the birth canal of a sick mother. At the same time, the conjunctiva of the eyes is affected, girls also have genitals. Blindness in newborns in half of cases is caused by infection with gonorrhea.
Symptoms of gonorrhea
Based on the duration of the disease, there is a distinction between fresh gonorrhea (from the moment of infection < 2 months) and chronic gonorrhea (from the moment of infection > 2 months).
Fresh gonorrhea can occur in acute, subacute, low-symptomatic (torpid) forms. There is gonococcal disease, which is not subjectively manifested, although the causative agent of gonorrhea is present in the body.
Currently, gonorrhea does not always have typical clinical symptoms, as a mixed infection (with trichomonas, chlamydia) is often detected, which can change the symptoms, lengthen the incubation period, complicate the diagnosis and treatment of the disease. There are many asymptomatic and asymptomatic cases.
Classic manifestations of acute gonorrhea in women:
- purulent and serous-purulent vaginal discharge;
- hyperemia, swelling and ulceration of the mucous membranes;
- frequent and painful urination, burning, itching;
- intermenstrual bleeding;
- pain in the lower abdomen.
In more than half of cases, gonorrhea in women proceeds either sluggishly, with little symptoms, or does not manifest itself at all. In this case, a late visit to the doctor is dangerous for the development of an ascending inflammatory process: gonorrhea affects the uterus, fallopian tubes, ovaries, peritoneum. The general condition may worsen, the temperature may rise (up to 39 ° C), there is a violation of the menstrual cycle, diarrhea, nausea, vomiting.
Gonorrhea in girls has an acute course, manifested by swelling and hyperemia of the mucous membrane of the vulva and the vestibule of the vagina, burning and itching of the genitals, the appearance of purulent discharge, pain when urinating.
Gonorrhea in men occurs mainly in the form of acute urethritis:
- itching, burning, swelling of the urethra;
- copious purulent, serous-purulent discharge;
- frequent painful, sometimes difficult urination.
With the ascending type of gonorrhea, the testicles, prostate, seminal vesicles are affected, the temperature rises, chills occur, painful defecation.
Gonococcal pharyngitis can manifest itself with redness and sore throat, an increase in body temperature, but more often it is asymptomatic. With gonococcal proctitis, there may be discharge from the rectum, soreness in the anal area, especially during defecation; although usually the symptoms are not pronounced.
Chronic gonorrhea has a prolonged course with periodic exacerbations, manifested by adhesions in the pelvis, decreased sexual desire in men, menstrual cycle disorders and reproductive function in women.
Asymptomatic cases are rarely detected at an early stage, which contributes to the further spread of the disease and gives a high percentage of complications.
The ascending type of infection in women with gonorrhea is promoted by menstruation, surgical termination of pregnancy, diagnostic procedures (curettage, biopsy, probing), the introduction of intrauterine spirals. Disease affects the uterus, fallopian tubes, ovarian tissues up to the occurrence of abscesses. This leads to a violation of the menstrual cycle, the occurrence of adhesions in the tubes, the development of infertility, ectopic pregnancy. If a woman with gonorrhea is pregnant, there is a high probability of spontaneous miscarriage, premature birth, infection of the newborn and the development of septic conditions after childbirth. When infected with gonorrhea of newborns, they develop inflammation of the conjunctiva of the eyes, which can lead to blindness.
A serious complication of gonorrhea in men is gonococcal epididymitis, a violation of spermatogenesis, a decrease in the ability of sperm to fertilize.
Disease can spread to the bladder, ureters and kidneys, pharynx and rectum, affect lymph glands, joints, and other internal organs.
It is possible to avoid undesirable complications if you start treatment in a timely manner, strictly follow the instructions of a venereologist, and lead a healthy lifestyle.
To diagnose gonorrhea, it is not enough to have clinical symptoms in a patient, it is necessary to identify the causative agent of the disease using laboratory methods:
- examination of smears with material under a microscope;
- bakposev of the material on specific nutrient media for isolation of pure culture;
- ELISA and PCR diagnostics.
In microscopy of smears stained with Gram and methylene blue, gonococci are determined by their typical bean-shaped shape and pairing, gram negativity and intracellular position. The causative agent of gonorrhea can not always be detected by this method due to its variability.
In the diagnosis of asymptomatic forms of gonorrhea, as well as in children and pregnant women, a culture method is more suitable (its accuracy is 90-100%). The use of selective media (blood agar) with the addition of antibiotics makes it possible to accurately identify even a small number of gonococci and their sensitivity to drugs.
The material for the study of gonorrhea is purulent discharge from the cervical canal (in women), urethra, lower rectum, oropharynx, conjunctiva of the eyes. In girls and women after 60 years, only the cultural method is used.
Gonorrhea often occurs as a mixed infection. Therefore, a patient with suspected gonorrhea is examined additionally for other STIs. Antibodies to hepatitis B and C, HIV, serological reactions to syphilis, general and biochemical analysis of blood and urine, ultrasound of the pelvic organs, urethroscopy, colposcopy in women, cytology of the cervical canal mucosa are carried out.
Examinations are carried out before the treatment, again 7-10 days after treatment, serological – after 3-6-9 months.
The need to use “provocations” to diagnose gonorrhea is decided by the doctor individually in each case.
Independent treatment of gonorrhea is unacceptable, it is dangerous by the transition of the disease into a chronic form, and the development of irreversible lesions of the body. All sexual partners of patients with symptoms of gonorrhea who have had sexual contact with them in the last 14 days, or the last sexual partner, if the contact occurred earlier than this period, are subject to examination and treatment. In the absence of clinical symptoms, a patient with gonorrhea is examined and treated for all sexual partners in the last 2 months. Alcohol and sexual relations are excluded for the period of gonorrhea treatment, and sexual contacts with the use of a condom are allowed during the period of dispensary observation.
Modern venereology is armed with effective antibacterial drugs that can successfully fight gonorrhea. In the treatment, the prescription of the disease, the symptoms, the location of the lesion, the absence or presence of complications, concomitant infection are taken into account. In acute ascending type of gonorrhea, hospitalization, bed rest, and therapeutic measures are necessary. In case of purulent abscesses (salpingitis, pelvioperitonitis), emergency surgery is performed – laparoscopy or laparotomy. The main place in the treatment is given to antibiotic therapy, while taking into account the resistance of some strains of gonococci to antibiotics (for example, penicillins). If the antibiotic used is ineffective, another drug is prescribed, taking into account the sensitivity of the causative agent of gonorrhea to it.
Gonorrhea of the genitourinary system is treated with the following antibiotics: ceftriaxone, azithromycin, cefixime, ciprofloxacin, spectinomycin. Alternative treatment regimens for gonorrhea include the use of ofloxacin, cefosidim, kanamycin (in the absence of hearing disorders), amoxicillin, trimethoprim.
Children under 14 years of age in the treatment are contraindicated fluoroquinolones, pregnant women and nursing mothers tetracyclines, fluoroquinolones, aminoglycosides. Antibiotics that do not affect the fetus are prescribed (ceftriaxone, spectinomycin, erythromycin), preventive treatment of newborns in mothers with gonorrhea is carried out (ceftriaxone – intramuscularly, eye washing with silver nitrate solution or laying erythromycin eye ointment).
Treatment can be adjusted if there is a mixed infection. In torpid, chronic and asymptomatic forms, it is important to combine the main treatment with immunotherapy, local treatment and physiotherapy.
Local treatment includes the introduction into the vagina, urethra of 1-2% protorgol, 0.5% silver nitrate, microclysms with chamomile infusion. Physiotherapy (electrophoresis, UFO, UHF currents, magnetotherapy, laser therapy) is used in the absence of an acute inflammatory process. Immunotherapy for gonorrhea is prescribed outside of exacerbation to increase the level of immune reactions and is divided into specific (gonovacin) and non-specific (pyrogenal, autohemotherapy, prodigiosan, levamiosol, methyluracil, glyceram, etc.). Immunotherapy is not performed for children under 3 years of age. After treatment with antibiotics, lacto- and bifidopreparations are prescribed (orally and intravaginally).
The successful result of the treatment of gonorrhea is the disappearance of the symptoms of the disease and the absence of the pathogen according to the results of laboratory tests (7-10 days after the end of treatment).
Currently, the need for various types of provocations and numerous control examinations after the end of treatment of gonorrhea, conducted with modern highly effective antibacterial drugs, is disputed. One follow-up examination of the patient is recommended to determine the adequacy of this treatment. Laboratory control is prescribed if clinical symptoms remain, there are relapses of the disease, possible re-infection with gonorrhea.
Prevention of gonorrhea, like other STDs, includes:
- personal prevention (exclusion of casual sexual relations, use of condoms, compliance with personal hygiene rules);
- timely detection and treatment of patients with gonorrhea, especially in risk groups;
- occupational examinations (for employees of children’s institutions, medical personnel, nutrition workers);
- mandatory examination of pregnant women and pregnancy management.
In order to prevent gonorrhea, a solution of sodium sulfacyl is instilled into the eyes of newborns immediately after birth.