Gonorrhea in girls is an infectious disease caused by Neisser’s gonococci. Due to the peculiarities of the structure of the genitourinary system in young girls, the disease proceeds with a vivid clinical picture, damage to the urethra, vagina, anal area. Less often, the oral cavity and eyes are involved. Diagnosis is based on symptoms, confirmation of the type of pathogen by bacterioscopic, cultural examination and ELISA. For treatment, antibiotics from the group of cephalosporins are used intramuscularly, intravenously or alternative drugs. It is mandatory to monitor the cure after the end of antibiotic therapy.
A54 Gonococcal infection
Gonorrhea is most often diagnosed in girls 5-7 years old, up to 13 years old, the contact and household path of infection prevails. The source of infection is usually close people. 76% have vulvovaginitis, less often – urethritis, proctitis. Complications are not typical for this age. In girls aged 13-17, the frequency of gonorrhea increases due to sexual relations. In 47%, the disease turns into a chronic form with damage to the cervix, endometrium and appendages. In adolescents, gonococcal infection is more often combined with syphilis, chlamydia and trichomoniasis.
Gonorrhea is caused by gram-negative diplococcus Neisseria gonorrhoeae. Bacteria are tropic to multilayered flat and cylindrical epithelium. Infection occurs from a person with an acute or chronic form of gonorrhea. In girls, a high risk of infection is associated with the lack of protective properties of the vagina, the proximity of the urethra. Pathogens are transmitted in the following ways:
- Intranatally. Bacteria enter the vulva, the eyes of a child when passing through the birth canal of a mother with gonorrhea, leading to gonorrheal vulvovaginitis, conjunctivitis.
- In a domestic way. Fresh purulent discharge can be applied to the genitals of a girl through a wet towel, a washcloth or the hands of parents if the rules of personal hygiene are not observed in the family
- Sexually. Sexual relations in adolescence, as well as in cases of violence or acts of a depraved nature against a girl, lead to the transmission of infection from a person with gonorrhea.
Gonococci mainly affect the cylindrical epithelium of the genitourinary tract. In girls, due to insufficient protective factors, organs lined with multilayer epithelium are involved in the inflammatory process. When the fetus passes through the birth canal, bacteria are introduced to the mucous membrane of the eyes and cause conjunctivitis, less often – iridocyclitis.
The epithelial lining in the vagina of girls is loose, so gonococci with the help of saws are fixed on the surface of cells and penetrate inside, into the intercellular cracks and under the epithelium. An inflammatory reaction develops, intensifying the destruction of tissues. Bacteria secrete gonotoxin, which suppresses the activity of other microorganisms.
Infection of the urethra, vulva and vagina is more typical for children. At an older age, inflammation spreads to the cervix. The internal pharynx of the cervix has not yet been formed, and the folds of the cervical canal pass into the endometrium, so pathogens easily penetrate into the uterine cavity. For girls, gonorrhea is characterized by multiple foci involving the genitals, rectum, eyes and oropharynx, but gonococcal myositis and arthritis do not occur.
Gonococcal infection is classified according to the duration and severity of clinical symptoms. Fresh gonorrhea is isolated when infection occurred no more than 2 months ago, and chronic if the time of infection is unknown, or more than 2 months have passed. Fresh gonorrhea can be acute, subacute and torpid. In practice, classification by lesion area is also used:
- Inflammation of the lower genitourinary tract: urethritis, cystitis, vulvovaginitis, cervicitis.
- Abscessing of the lower parts of the genital tract: bartholin abscess, vestibulitis.
- Lesion of internal genitalia: endometritis, salpingoophoritis, pelvioperitonitis.
- Gonorrhea of the eyes: conjunctivitis, iridocyclitis, ophthalmia of newborns.
- Defeat of the tonsils and oropharynx: gonorrheal pharyngitis.
- Gonorrhea of the anorectal area: proctitis, inflammation of the anal canal.
- Gonorrhea of other organs: myocarditis, pericarditis, meningitis, pneumonia, sepsis.
The disease begins acutely, but the severity of symptoms depends on the state of the body and the properties of the pathogen. Simultaneously with the appearance of purulent discharge from the urethra, genital tract and rectum, insomnia, irritability, increased excitability of the nervous system worries. Appetite may worsen, the temperature often rises. The girl complains of pain and burning when urinating, itching in the anal area.
Discharge from the vagina and urethra is abundant, yellow-white in color. They drain onto the underwear, cause irritation of the perineum, groin, inner thighs. The skin in the places of contact and friction turns red, looks inflamed and macerated. Dysuric disorders include frequent urge to go to the toilet, reduced urine intake, and sometimes incontinence.
Rarely gonorrhea in adolescent girls takes a torpid course with a transition to chronic. In this case, the labia are not changed externally, but there is hyperemia and pastyness on the inner surface. The urethra is not always involved, the clinical symptoms are insignificant and characterized by unexpressed dysuria. With the upward spread of gonococci, menstruating girls are concerned about abdominal pain, fever, symptoms of intoxication.
In girls, gonorrhea rarely occurs with complications. The risk increases with immunodeficiency caused by HIV infection, concomitant tuberculosis, low social status and lack of timely treatment. Chronic inflammation of the appendages and uterus causes menstrual cycle disorders in adolescents, an adhesive process that leads to persistent infertility in the reproductive age.
The spread of infection to the heart muscle causes pericarditis, myocarditis, which do not have gonorrhea-specific symptoms. Inflammation affects the functioning of the conduction system, heart failure is formed. When the meninges are affected, meningitis occurs with severe neurological disorders. Sometimes foci of infection form abscesses in the brain, liver, lead to sepsis.
The examination of girls with symptoms of gonorrhea is carried out by a pediatric dermatovenerologist. If the child’s eyes are affected, an ophthalmologist additionally examines them. According to the indications, a consultation of a urologist, ENT doctor is prescribed. Diagnosis of gonorrhea is mandatory if the mother is undergoing treatment for gonococcal infection, as well as at the birth of a child from an infected woman. The following research methods are used in girls:
- Examination of the external genitalia. The vulva, the external opening of the urethra are swollen and hyperemic, a large amount of pus is noticeable, which increases when pressing on the urethra. Painful inguinal lymph nodes are palpated.
- Vaginoscopy. The mucous membrane of the vagina is inflamed, covered with a yellowish coating, erosions may form. The cervix is hyperemic, pus is abundantly released from the pharynx.
- Anoscopy. The folds around the anus are edematous, red in color. Sometimes cracks appear, purulent discharge. The inflammation is spread over 3-4 cm of the terminal part of the rectum.
- A smear from the urethra and vagina. The smear is colored by Gram, gonococci in the form of pink coffee beans are arranged extracellularly and intracellularly in pairs.
- Bacteriological research. It is carried out in the presence of a clinical picture of gonorrhea and negative smears. For sowing on nutrient media, secretions from the urethra or vagina, washing water from the rectum are used. It is possible to determine sensitivity to antibiotics.
- RSK. The Borde-Zhangu reaction is used. Diagnosis is carried out with chronic or complicated gonorrhea, when a bacteriological study did not give a result.
- REEF. To detect antigens, a discharge from the urethra, vagina or a urine sample is necessary. The test has a high sensitivity and 100% specificity, allows you to quickly make a diagnosis.
In the absence of complications, the disease is treated on an outpatient basis. In case of the spread of infection and the development of salpingo-oophoritis, as well as in case of damage to other organs, hospitalization in a skin and venereological dispensary is necessary. The purpose of treatment of gonorrhea is the elimination of the pathogen, therefore, only bactericidal drugs are used in children, antibiotics with bacteriostatic action are not recommended.
The drug of choice is ceftriaxone, an alternative remedy is spectinomycin. In children weighing up to 40 kg, the dosage is calculated by weight, after 45 kg, schemes similar to adults are prescribed. The drug is administered intravenously or intramuscularly, regardless of the form of gonorrhea. In newborns with gonococcal conjunctivitis, topical application of ointment with erythromycin is possible.
The use of local antiseptic drugs, immunomodulators and systemic enzyme therapy has no clinical evidence of efficacy, therefore it is not recommended for the treatment of gonorrhea in girls. Pathogenetic therapy is justified only in the complicated course of the disease involving the cardiovascular, nervous system, with the development of sepsis.
Control of cure
14 days after taking antibiotics, biological material is taken from the urethra or vagina for bacteriological seeding and control of the cure of gonorrhea. Previously, biological methods of provocation were used, but it has been proven that they do not affect the result of the examination, so they are not currently being carried out. If the diagnosis is negative and there are no clinical symptoms, follow-up is not required.
Prognosis and prevention
The prognosis for gonorrhea in girls is favorable. If treatment is started in a timely manner, the pathogen is completely eliminated, there is no risk of complications. To prevent infection, silver nitrate, sodium sulfacyl is instilled into the eyes of all newborns in the delivery room, or an ointment with erythromycin is placed once. If the mother has been diagnosed with a gonococcal infection, the child is given a prophylactic dose of an antibiotic.
In the families of girls where gonorrhea is found in their parents, you can not use a common towel, a washcloth, and joint sleep is limited. When caring for children, it is necessary to wash your hands thoroughly to avoid infection.