Gonococcal infection is caused by the bacterium gonococcus. Forms of gonorrhea, incubation period. What complications may occur if gonorrhea is not treated?

Gonorrhea is a sexually transmitted disease. It can occur in both men and women. The infection is often asymptomatic, which entails late seeking medical help and the development of serious complications, including infertility. The causative agent of the disease is gonococcus (Neisseria gonorrhoeae). In everyday life you can hear another name for gonorrhea - “grip”.
Despite the fact that in recent decades there has been significant progress in the treatment of infection, gonococcus is gradually becoming resistant to modern antibacterial agents. Therefore, if the regimen for taking them is violated, gonorrhea may become chronic. Having been ill once, a person can become infected again and again.
Although susceptibility is the same in both sexes, after the first intimate contact with a patient, every second to fourth man and every fifth to seventh woman become infected with gonorrhea. In the vast majority of cases (70-80%), simultaneous infection with chlamydia, trichomoniasis and other STDs occurs.

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1. Manifestations of gonorrhea in women

Due to the peculiarities of anatomy and physiology, gonococcal infection in women often occurs almost unnoticed or has very few symptoms.

Bacteria can affect not only the mucous membranes of the genitourinary organs, so the symptoms of gonorrhea may vary from woman to woman. This depends not only on the route of infection; the state of the immune system and the presence of chronic diseases are also of great importance.

1.1.

First symptoms The first signs appear immediately after the end of the incubation period, which for a woman can range from 3 days to 1 month, but usually does not exceed two weeks. They can be pronounced or weak.

• Typically, when infected during vaginal intercourse, the following symptoms are observed:
• Vaginal discharge of white, white-green, green, gray-white color (mucous and mucopurulent, copious, viscous).
• Urinary disorders (frequent painful urination, increased frequency of trips to the toilet, burning and itching in the urethra).

Nagging pain in the lower abdomen.

The general condition may not suffer: body temperature does not rise, weakness, chills do not occur.

First of all, gonococci cause an inflammatory process in the urethra, the vestibule of the vagina and inside it, the paraurethral and Bartholin's glands.

The most common signs of gonococcal urethritis, vulvovaginitis, cervicitis:

• Intense or moderate pain at the end/beginning of urination, quite sharp.
• Enlarged inguinal lymph nodes.
• Pain and discomfort during sexual intercourse.
• Gonorrhea discharge is abundant or scanty, mucopurulent, thick, gray-green, yellow-green, gray-white with an unpleasant odor.
• Frequent, painful urination.
• Swelling and redness of the urethral opening, vulva, vaginal walls, and with endocervicitis - the cervical area.

An inflammatory process may occur in the Bartholin glands with the development of an abscess. They are round formations with a diameter of 1-2 cm and are filled with pus. When the infection spreads to the overlying sections and pelvic organs, endometritis, adnexitis, and pelpioperitonitis develop.

1.3.

Gonococcal pharyngitis

Infection of the pharyngeal mucosa occurs mainly during oral sex. Gonococcal pharyngitis often occurs latently.

• The following symptoms may be observed:
• Feeling of dryness and pain when swallowing, soreness.
• Hoarseness of voice.
• Enlargement of the submandibular lymph nodes.
• Redness of the throat area.
• Purulent plaque on the tonsils, their redness and increase in size.
• Bad breath.

Possible inflammation of the gums and oral cavity (gingivitis, stomatitis).

1.4. Proctitis

1. Infection occurs during anal sex, as well as when vaginal discharge flows into the anus.
2. The disease manifests itself:
3. 1 Itching and burning in the anus.
4. 2 Constipation, false painful urge to defecate.

3 Periodic purulent discharge from the anus, sometimes mixed with blood.

4 Going to the toilet becomes more frequent and brings discomfort.

2. Gonococcal conjunctivitis

Gonococcal eye infection can occur at any age and occurs as inflammation of the iris (iridocyclitis) or conjunctiva (conjunctivitis).

• Most often this is associated with infection through dirty hands, as well as through shared use of hygiene items, including towels. Separately, blenorrhea (gonococcal ophthalmia) of newborns is distinguished when a child becomes infected while passing through the mother’s birth canal.
• Symptoms:
• Severe swelling of the eyelids (they become swollen).
• Redness of the conjunctiva, increased bleeding.

In advanced cases, corneal ulcers appear, perforation occurs, and blindness develops.

3. Gonorrhea of ​​other organs and systems

Sometimes gonococcal infection occurs with damage to the joints - arthritis, joint capsules (bursae) - bursitis, bone tissue - osteomyelitis.

Gonorrheal arthritis is characterized by inflammation of a small number (two or three) large joints, and subsequently by persistent limitation of mobility up to the development of ankylosis. Bursitis and osteomyelitis have a typical course.

Gonococci enter other distant organs through the bloodstream due to the weakening of the body's defenses. In this case, classic diseases develop:

• myocarditis, endocarditis;
• meningitis;
• pneumonia;
• brain abscess;
• sepsis and so on.

4. Features of mixed infection

In recent years, an atypical course of gonorrhea has often been observed against the background of simultaneous infection with gonococcus, chlamydia, mycoplasma, trichomonas, etc. In this case, the classic symptoms of gonorrhea fade into the background. Mixed infection is more difficult to treat and more often becomes chronic.

4.1.

Chlamydia

Against the background of chlamydia, the incubation period of gonorrhea is often extended to three months. Mixed chlamydial-gonococcal infection tends to be chronic, difficult to cure after the first course of antibiotics, and usually requires the use of provocative techniques.

Trichomonas are single-celled microorganisms that can “disguise” as human cells and “evade” the immune system.

Another property of them is to penetrate deep into the tissues of the host. Gonococci are able to remain inside Trichomonas for quite a long time and “hide” from unfavorable environmental conditions.

Simply put, prescribing antibiotics may not be effective. Gonococci existing inside Trichomonas survive and then begin to actively reproduce.

For this reason, combined infection (gonorrhea + trichomoniasis) tends to have a long, wave-like course with a high risk of chronicity.

1. Its symptoms depend on the state of the body and the depth of the inflammatory process:
2. 1 With good immunity - an asymptomatic course, the presence of scanty discharge with an unpleasant odor, pain or simply a feeling of discomfort during sexual intercourse or urination.

Gonorrhea can also be combined with diseases such as syphilis, genital herpes, HPV infection, HIV, candidiasis and others.

5. Diagnosis and treatment

If any warning symptoms appear, you should undergo a comprehensive examination for STDs.

As a rule, for this purpose a smear is necessarily taken for microscopic examination (for flora and GN), and a comprehensive analysis is also carried out that detects the DNA of the main pathogens of sexually transmitted infections using the polymerase chain reaction method (PCR, real-time PCR).

The doctor prescribes treatment based on the results obtained. The regimen must include one or more antibacterial drugs. All sexual partners are treated at the same time. Otherwise, therapy will be useless.

The drugs of choice that are most effective for gonorrhea are:

• Ceftriaxone;
• Cefixime;
• Cefotaxime;
• Spectinomycin.

Most often, treatment for gonorrhea is offered on an outpatient basis; only pregnant women, children, as well as women with complications and requiring further examination are hospitalized.

2 weeks after the end of the course of antibiotics, repeat tests are performed (NASBA - detection of gonococcal RNA in scrapings). The PCR method can be used no earlier than 30 days after the end of therapy.

Gonorrhea is considered cured when the result is twice negative. If the therapy is ineffective, alternative antibiotics are prescribed after culture with sensitivity determination.

Gonococcus (neisseria gonorrhoeae) is the causative agent of a severe venereal disease that affects the genitourinary system. - anthroponotic infection causing purulent inflammation of the mucous membrane of the urogenital tract. Currently, gonococcal infection is considered a fairly common and significant sexually transmitted disease.

The term “gonorrhea” translated from ancient Greek means “discharge of seminal fluid.” This The sexually transmitted disease most often occurs in sexually active men and women aged 15-35 years. For young girls, this infection is very dangerous. It can cause inflammation of the pelvic organs and lead to infertility. There are known cases of death among patients with generalization of the infectious process.

Gonococcal infection is widespread in Siberia and the Far East. Most often, antisocial people get sick - prostitutes, homosexuals and bisexuals.

Neisseria gonorrhoeae

Gonococcus Neisser is a gram-negative diplococcus that looks like two coffee beans with the concave side facing each other. They are surrounded by a microcapsule, do not have flagella, and do not form spores. Gonococci were discovered by the scientist A. Neisser at the end of the 19th century and received the name of the same name. The study of morphological, tinctorial, cultural, antigenic and biochemical properties of gonococci is carried out by private microbiology, immunology and epidemiology.

Epidemiology

Gonorrhea is a sexually transmitted disease that primarily affects sexually active individuals. The risk group includes prostitutes and their clients, businessmen, tourists, and drug addicts. The main source and reservoir of infection are sick men with asymptomatic forms of urethritis. Ways of transmission of infection: sexual, household, vertical. Gonococci are spread during vaginal, anal or oral intercourse without a condom; when using infected sex toys; in utero or during childbirth. The greatest danger comes from the secretions of a patient with gonorrhea - semen, vaginal discharge, intestinal and throat mucus.

The entrance gates of gonococcal infection are epithelial cells of the vagina, urethra, cervix, and rectum. Gonococci attach to epithelial cells using pili, causing their death and desquamation. A pathological process occurs at the site of introduction of neisseria gonorrhoeae. The whitish-yellow discharge becomes thick if left untreated. Its accumulations block the excretory ducts of the glands located in the groin. Gradually, the exudate is replaced by fibrous tissue, which leads to a narrowing of the urethra.

As the epithelium is destroyed, gonococci begin to penetrate the superficial lymphatic and blood vessels. This process is accompanied by an enlargement of the inguinal lymph nodes. Having reached the connective tissue, gonococci cause inflammation and the development of pathology - vulvovaginitis. The bacteria then enter the blood, invade and multiply in white blood cells. Transient bacteremia occurs. Subsequently, the microbes disseminate with the development of septicemia, the formation of abscesses in the subcutaneous fat near the anus and prostate.

Symptoms

Gonococcal infection in men can occur as urethritis.

In women, gonococcal infection also has several morphological forms: cirvicitis, endomyometritis, . In patients, urination becomes frequent and painful, unusual, often purulent vaginal discharge, menstruation becomes very painful and heavy, and intermenstrual bleeding, lower abdominal pain. Symptoms of infection in women are not as pronounced as in men.

Anal intercourse without a condom with a sick man often ends in the development of gonococcal proctitis. This disease is most common among homosexuals. Itching and burning occur in the anus, purulent discharge from the rectum appears, the act of defecation becomes painful, and blood is found in the stool.

Orogenital contacts lead to the development of gonococcal pharyngitis. The disease is usually asymptomatic and detected incidentally. In rare cases, patients have a sore throat, dryness and soreness, and hoarseness. Upon examination, the pharynx is hyperemic, the pharyngeal mucosa is swollen.

Diagnostics

For diagnostic purposes, they take samples from patients, conduct a study, and decipher the data obtained. In women, a smear is taken from the mucous membrane of the vagina, cervix, and in men - from the urethra. After applying the material to a glass slide, it is sent to the laboratory. Before taking a smear, patients should not urinate for 2 hours and not take antibiotics or local antiseptics for a month.

• Bacterioscopic examination- preparation, fixation and staining of the smear with methylene blue. Under microscopy, gonococci are blue in color, and the remaining cells are light blue. Gram-stained specimens reveal bean-shaped gram-negative diplococci.
• for gonococci is carried out by inoculating biomaterial on nutrient media. The crops are placed in a desiccator for a day. To prepare nutrient media, use nutrient agar from rabbit meat or bovine heart. Polymyxin or Lincomycin is added to meat-peptone or whey agar to suppress the growth of foreign microflora. If there is no growth of gonococci, the cups are placed in a thermostat for up to 8 days. They review them daily. Neisseria gonorrhoeae grows as round, convex colonies with smooth edges, a shiny surface and a slimy consistency. Their colonies resemble dew drops. After obtaining a pure culture, the study continues using the microscopic method. Taking into account morphological, cultural, enzymatic and other properties, isolated microbes are identified to species, and then their sensitivity to antibiotics is determined.
• Serodiagnosis- reaction of immunofluorescence, latexaglutination, coaglutination, indirect hemagglutination, compliment binding. Sometimes enzyme immunoassay is used.
• – diagnostics is aimed at identifying DNA fragments of neisseria gonorrhoeae. The method is highly sensitive and specific. This is a qualitative analysis that reflects all sexually transmitted infections in a particular subject. Normally, STIs are absent in healthy individuals.
• Allergy tests— intradermal administration of 0.1 ml of fresh gonococcal vaccine. The reaction is considered positive if, after 24 hours, hyperemia and swelling appear on the skin.

If the gonococcal infection is sluggish and chronic, they resort to provocative methods. Artificial exacerbation of the pathology leads to an increase in the number of gonococci in the discharge.

Treatment

Treatment of gonococcal infection is carried out in specialized hospitals. Patients are prescribed antibiotics, sulfa drugs, good nutrition, immunostimulants, and local treatment.

Both sexual partners need treatment. During therapy, it is forbidden to visit the pool or have sex. Experts recommend washing your genitals daily with warm water and soap, drinking plenty of fluids, and eliminating spicy foods and alcohol from your diet. After carrying out therapeutic measures, you should undergo a repeat test for gonorrhea. A control smear is taken from patients ten days after completion of antibiotic therapy.

Gonorrhea is a serious disease that can only be cured with the help of modern antibacterial drugs. Traditional medicine is absolutely powerless in this regard. To avoid the development of serious complications and serious consequences, you must consult a doctor when the first symptoms of the pathology appear. With timely and complete treatment, the prognosis of the disease is quite good.

Prevention

Measures to prevent the development of gonorrhea:

• Monogamous relationship
• Be careful when choosing a sexual partner
• Using condoms in polygamy
• Antiseptic treatment of the external genitalia and urethra after casual sexual contact,
• The use of drugs "Pharmatex", "Heksikon",
• Regular medical examination by a gynecologist or urologist,
• Sanitary education work among the population,
• Examination of contact persons,
• Dispensary registration and observation of patients with gonorrhea.

Gonococci are the causative agents of one of the most common sexually transmitted diseases. Gonorrhea is often asymptomatic. Patients do not suspect that they have the disease and continue to be sexually active, infecting their partners. In the absence of timely treatment, the disease progresses and can cause serious disorders, which leads to severe complications in the reproductive sphere of the body. Gonorrhea is a bacterial infection that is one of the most common causes of male and female infertility.

Video: doctor about gonococcal infection

The causative agent of gonorrhea is a gram-negative diplococcus - Neisseria gonorrhoeae; gonococci can be detected in a smear in women and men. The bacterium was discovered in 1879 thanks to the work of the German dermatovenerologist Albert Ludwig Neisser.

• Epidemiology
• • Routes of infection
• Incubation period
• Laboratory research
  • Deciphering a smear in women
• What methods are used to detect gonococcus?
• Treatment regimen for gonorrhea
• Treatment

Epidemiology

The Neisseria gonorrhoeae bacterium causes an inflammatory reaction in the mucous membrane of the urethra, cervical canal, rectum, oral cavity, and pharynx. At the same time, gonococcal infection affects the parauteral glands and conjunctiva.

In women, complications of gonorrhea include inflammatory diseases of the pelvic organs, which are one of the main causes of infertility. The most common complication of gonorrhea in men is acute epididymitis.

The disseminated gonococcal process is observed in the case of gonococcal infection spreading hematogenously (through the bloodstream) and can occur in the form of infective endocarditis, arthritis, meningitis, dermatitis. Intranatally (during passage through the birth canal of an infected mother), the child’s conjunctiva may become infected with the development of purulent gonococcal conjunctivitis.

Gonorrhea is a sexually transmitted disease and is a common disease among people who have an active sexual lifestyle and are at risk. A high prevalence of gonococcal infection has been recorded in the Siberian and Far Eastern Federal Districts. Among the patients, people with low socio-economic status prevailed; the number of sick women and men did not differ significantly. Conducted studies indicate that the prevalence of gonococcal infection is higher among commercial sex workers, homosexuals and bisexual men.

How does gonococcus infection occur?

Gonorrhea is a classic infection, the main route of transmission is unprotected sexual contact. Any type of sex can cause you to become infected with gonorrhea.

The bacterium affects not only the genitals, but also the eyes, throat, and anus. The mother can infect the baby during childbirth.

Important! Gonorrhea is a serious and dangerous disease.

And you need to remember about the ways of infection with this disease.

Routes of infection

Most often, infection of men and women occurs during genital-genital, anal-genital, oral-genital sexual contact with a patient with gonococcal infection. The risk of infection from a sick person with a single genital-genital contact is 30-50%; with anal-genital contact, the risk of infection increases and decreases with oral-genital contact.

Infection of children occurs during childbirth when a child passes through the birth canal of a sick woman, or through sexual contact with an infected adult. Conducted studies indicate that most often forced sexual contacts with children are committed by close relatives (uncle, brother, stepfather, grandfather). Contact and household transmission occurs in exceptional cases with gross violations of the rules of personal hygiene, and refers to casuistic cases.

Incubation period

In men, in most cases, urethritis develops from 2 to 5 days after infection. In women, the first manifestations of gonorrhea are observed within 5 to 10 days. However, the asymptomatic course of gonococcal urethritis in males is observed in 1–5% of cases, in 75% of women the disease is asymptomatic.

How not to miss the first symptoms of gonorrhea?

The latent period of the disease lasts an average of ten days.

During the incubation period, it is almost impossible to diagnose the disease. But clinical symptoms are characteristic of this disease.

A man or woman may suspect that they have gonorrhea.

In women, the infection manifests itself with the following symptoms:

In the stronger sex, gonococcus affects the urethra and causes its inflammation.

Symptoms of urethritis occur: purulent discharge from the penis, pain when trying to urinate, redness and swelling of the urethra. This is a common clinic for acute gonorrhea in men and women.

There are different types of sexual intercourse, so there are lesions of other organs by bacteria: eyes, throat, anus.

When a throat infection occurs, the symptoms resemble a sore throat: redness, difficulty swallowing. When the eyes are damaged, conjunctivitis occurs.

In the modern world, there are many antimicrobial drugs and it is not difficult to purchase them. Due to uncontrolled use of antibiotics, many erased types of gonorrhea have appeared. Now gonorrhea can manifest itself with scanty symptoms and a mild chronic course. It becomes difficult to determine that it is gonococcus in the clinic. Different types of gonorrhea can lead to serious complications - inflammation of the internal genital organs of men and women. Irreversible changes and disruption of childbirth are also possible.

Clinical picture and symptoms of gonorrhea

Men experience purulent discharge from the urethra, painful urination, pain in the epididymis and groin area, perineum with irradiation to the rectum. The pain can spread to the lumbar region and sacrum.

In women, purulent discharge from the vagina, urethra, small glands of the vestibule of the vagina, excretory duct of the large gland of the vestibule of the vagina, pain when urinating, pain in the lower abdomen, intermenstrual bleeding.

The localization of the infectious process depends on the type of sexual intercourse, so during anal-genital contact, gonococcal proctitis occurs, with redness in the anus, copious purulent discharge from the anus, pain and burning during defecation, feces mixed with blood. With oral-genital contact, the infection affects the oropharynx causing gonococcal pharyngitis, with mucosal hyperemia, regional lymphadenitis, and sore throat when swallowing, but in most cases it is asymptomatic.

What are the reasons for the detection of gonococci?

The main route of infection with genital gonorrhea. This disease is transmitted through unprotected sexual contact.

If a person has had sexual intercourse with a partner who has gonorrhea, the likelihood of infection is maximum. After 10 days, which is how long the incubation period of the disease lasts, symptoms will appear.

In any case of infection there will be a bright clinic. This disease does not occur latently or as a carrier.

Gonococcus is a pathogenic microorganism. And when severe symptoms appear, a person must consult a doctor and conduct the necessary laboratory tests. He is diagnosed with gonococci.

Laboratory research

The material for research is the contents of the urethra, vagina, cervical canal, rectum, and oropharynx. The collection is carried out by a doctor using a probe or a cotton swab. Diagnosis of gonorrhea is based on the results of laboratory tests, among which are:

• The microscopic method is a direct method for detecting objects and visualizing them under a microscope. The method is highly sensitive (90% - 100%) and specific (90% - 100%) for the acute form of the disease. Analysis of material from the rectum and oropharynx is characterized by low sensitivity (45% - 65%).

Material is collected from the urethra in men using a type A urethral probe. To do this, the probe is inserted into the urethra 1-2 centimeters, after which the probe is removed and the contents are applied to a glass slide. After drying and staining the preparation using the Gram method, the resulting material is examined under a microscope. This inexpensive and accessible method allows you to identify diseases such as gonorrhea, trichomoniasis, bacterial vaginosis, and determine the number of leukocytes and epithelium.

Interpretation of a smear from the urethra in men

Leukocytes – normally the number does not exceed 5 in the field of view. An increase in the number of white blood cells indicates inflammation of the urethral mucosa (urethritis). Urethritis can be caused by either a sexually transmitted infection or an allergic reaction. The introduction of antiseptics such as Miramistin into the urethra can lead to damage to the mucous membrane and an increase in leukocytes.

Epithelium - normally the number of epithelial cells varies from 1 to 10; a larger number of epithelium (solidly or in layers) indicates a chronic inflammatory process, often observed with chlamydia.

Mucus - as a rule, the amount of mucus is indicated by the number of “pluses”; up to 2 pluses (++) are considered normal; a larger number of “pluses” may indicate inflammation of the urethra or increased activity of the urethral glands.

Gonorrhea (gonococcus) is normally absent from the contents of the urethra. The detection of gonococcus in a smear indicates the presence of a sexually transmitted disease.

Trichomoniasis (Trichomonas) is not normally detected in smears. Detection of trichomonas in the urethral contents indicates the disease.

Key cells are not normally detected; the presence of key cells is caused by the presence of the pathogenic bacterium Gardnerella vaginalis.

Deciphering a smear in women

Material for microscopic examination of women is taken from three points - the vagina (V), the cervical canal (C), and the urethra (U). The norms of cellular and bacterial composition for each anatomical formation vary depending on hormonal levels, age, immunity, and the day of the menstrual cycle. However, there is a norm for smear results in menstruating women.

Many people are interested in deciphering the smear results; below we explain what the smear results say.

White blood cells - an increase in the number of white blood cells indicates inflammation of the vagina, which can be caused by a sexually transmitted infection.

Epithelium - an increased number of epithelial cells also indicates inflammation; if the number of leukocytes is not significantly increased, then we can think of a chronic inflammatory process.

Mucus – increases in the presence of sexually transmitted diseases. An increase in the amount of mucus with unchanged other indicators has no diagnostic value.

Gonococci - the detection of these bacteria indicates the presence of the sexually transmitted disease gonorrhea.

Trichomonas - detection of trichomonas in a smear indicates the presence of trichomoniasis.

Key cells - the appearance of these cells in the smear is caused by the pathogenic bacterium gardnerella, which causes the disease gardnerellosis.

Yeast – the presence of yeast cells in a smear is observed in candidiasis (thrush).

Microflora - the presence in the smear of a large amount of gram-negative flora, streptococci, staphylococci indicates a violation of the microflora.

• The culture method is the most accurate diagnostic method. Allows you to isolate and analyze a pure culture of bacteria artificially grown on nutrient media. The use of this method is the norm in modern laboratory diagnostics. The method is used for diagnosis and to identify sensitivity to various antibacterial drugs - antibiogram. To do this, analyze the inhibition of bacterial growth under the influence of various antibiotics. Explanation: the issued analysis (result) contains the name of the bacteria; a separate antibiogram analysis is written out, which reflects the delay in bacterial growth in millimeters. Normal: no growth of Neisseria gonorrhoeae in healthy individuals.
• PCR is a method aimed at identifying DNA fragments and demonstrates high sensitivity and specificity. This method allows you to analyze biological material when taken from the urethra, vagina, or oropharynx. Deciphering the results is not difficult; the resulting analysis results reflect all sexually transmitted infections, and the corresponding “detected” mark is placed against the detected ones. Normal: absence of sexually transmitted infection in healthy individuals.

In girls before menarche, as well as when the infectious process is localized in the oropharynx, rectum, conjunctiva, it is recommended to use the cultural method for diagnosis.

The norm of microflora in a smear of women

1. Aerobic microorganisms
   • Lactobacillus – 10%
   • Corynebacterium – 0.5 -1%
   • Streptococcus – 0-15%
   • Streptococcus epid. – 10-15%
   • Pseudomonas – 0-0.1%
   • Flavobacterium – 1%
2. Anaerobic microorganisms
   • Lactobacillus – 10%
   • Propionibacterium – 0.2-0.3%
   • Eubacterium – 1-2%
   • Petrococcus – 1%
   • Petrostreptococcus – 3-5%
   • Flavobacterium – 1%
   • Fusodacterium – 0-0.5%
   • Bacteroides – 0-0.1%
   • Clostridium – 0.5-1%
   • Campyiobacter – 0-0.2%

What methods discover gonococcus?

The diagnosis of gonorrhea cannot be made solely by clinical symptoms. To be sure that it is gonococcus, laboratory tests must be performed.

Methods for detecting gonococcus or antibodies to it:

• smear taking and microscopy;
• cultural method - sowing material on a medium;
• polymerase chain reaction and enzyme immunoassay.

Smear microscopy is a fast and accurate method for identifying secreted gonococci. Allows you to quickly detect the pathogen and make a diagnosis.

Pregnant women at the antenatal clinic are swabbed twice for gonococcus. It is important to treat gonorrhea before birth to avoid infecting the baby.

The culture method takes longer, since the bacteria must grow on a nutrient medium. But the advantages of this method are that it is possible to determine the sensitivity of gonococcus to groups of antibacterial drugs.

Material for sowing is taken from the vagina, urethra, eyes, and pharynx. It all depends on what is affected by the gonococcus. With the ELISA method, blood is examined for antibodies to bacteria.

Which doctor can help with gonorrhea?

The most important thing for any infection is to consult a doctor in time. If symptoms similar to gonorrhea appear, you should quickly consult a specialist.

The doctor who deals with this problem is a venereologist. He will conduct an examination, prescribe all the necessary studies, ultrasound, laboratory tests and select the right treatment.

The differences apply to pregnant women; to confirm the diagnosis, they need a consultation with a venereologist, but this specialist must select treatment together with a gynecologist. Not all drugs can be used during pregnancy. Some antibiotics can be dangerous for a child.

What complications can occur if gonorrhea is left untreated?

If you neglect the disease, do not get examined, do not contact a venereologist and do not get treatment, complications that are dangerous for the body may arise. The infection will spread and cause inflammation of various organs.

In women, gonococcus can infect the uterus, tubes, and ovaries.

Inflammatory diseases of these organs lead to further impossibility of pregnancy.

In men, gonococcus can spread to the prostate and testicles, which can lead to impaired reproductive function. The rectum, bladder, and kidneys may be affected. When the infection generalizes, the joints become involved in the process: gonorrheal arthritis develops. It can affect the knees, ankles, elbows, and joints of the hands and feet. When arthritis appears, the joints swell, turn red, pain appears, and movement in them is impaired.

It is important to contact a specialist in time and treat gonorrhea so that such complications do not arise.

Because they end with serious consequences.

The worst thing that gonorrhea can lead to is sepsis.

Treatment regimen for gonorrhea

You cannot prescribe treatment or take antibacterial drugs on your own. It is necessary to visit a venereologist and receive treatment prescriptions.

It is important to conduct an antibiotic sensitivity test in order to choose the right drug to target gonococcus.

The following groups of antibacterial agents are currently used:

• cephalosporins;
• fluoroquinolones;
• aminoglycosides.

All antibacterial agents must be prescribed by a specialist. In each case of detection of gonorrhea, an individual approach is needed.

Treatment

Drugs that need to be used once after consulting a dermatovenerologist:

• Cefixime;
• Ciprofloxacin;
• Ceftriaxone;
• Ofloxacin.

Treatment used for mixed infection:

• Doxycycline;
• Azithromycin.

Treatment for pregnant women:

• Ceftriaxone;
• Cefixime;
• Spectinomycin.

Do I need to be tested again after treatment?

Of course, this needs to be done.

Nowadays, there are many forms of bacteria resistant to antibiotics; laboratory tests must be repeated to ensure the absence of the pathogen.

A smear and culture are done a week after treatment. Blood is tested three months after treatment.

What methods of prevention are there?

Gonorrhea is a classic venereal disease. And it definitely requires prevention.

It is better to take measures to prevent the occurrence of a disease than to treat it.

Methods for preventing gonorrhea:

• absence of accidental unprotected contacts;
• use of barrier methods of contraception;
• use of individual towels and washcloths;
• regular visits to the doctor;
• examination of pregnant women.

After birth, albucid is dripped into the baby's eyes to prevent gonoblenorrhea. If even minor symptoms appear, there is no need to hesitate. You should consult a doctor quickly.

Gonorrhea poses a great danger to human health and body.

Emergency prevention of gonorrhea involves the immediate introduction, no later than two hours, of an antiseptic into the urethra for men and the vagina for women. Miramistin (Chlorhexidine) can be used as an antiseptic.

The infection spreads through sexual contact with an infected person. After unprotected sexual intercourse, you have two hours to prevent infection.

The following urgently needs to be done:

The venereologist will prescribe medications for emergency prevention and may perform instillations. A visit to the doctor will be most effective within 24 hours after contact. Carrying out preventive measures will have an effect no later than 72 hours.

For prevention purposes, you need to remember and know!

• Refrain from casual contacts;
• use barrier types of contraception;
• try to have sexual intercourse with only one partner, the principle of monogamy.

Is it possible to be completely cured?

Yes, getting rid of this disease is possible, complications may not develop.

Once the course of treatment is complete, complete recovery is possible. If you follow preventive measures, you can no longer become infected with gonococcus.

The main thing is not to neglect your health and visiting a doctor. Regular preventive visits can reveal a hidden and asymptomatic course before the development of irreversible complications.

Remember! If you have symptoms, you should contact a venereologist as soon as possible.

The doctor will conduct all the necessary tests and select antibiotic therapy.

Treatment of children under 14 years of age:

• Ceftriaxone;
• Spectinomycin.

Gonorrhea, or tripper, is a well-known and very common sexually transmitted infection. But few people know that in addition to inflammation of the genitourinary system, its pathogen can lead to other health problems. What diseases does gonococcus cause? We’ll look at it in a detailed review and video in this article.

Gonococci (bacteria of the species Neisseria gonorrhoeae) are small gram-negative diplococci that are pathogenic to humans. The most common cause is the anthroponotic venereal disease gonorrhea, which develops purulent inflammation of the membranes of the genitourinary system.

The photo shows small paired bacteria

Gonococcus is a microorganism with a high degree of infectiousness and pathogenicity. The first mention of “suppuration” from the genital tract dates back to the 2nd century BC. and even earlier sources. However, the identification of the pathogen occurred relatively recently - at the end of the 19th century by the German scientist Neisser.

Note! Gonorrhea statistics are disappointing: about 200 million cases of infection are diagnosed annually in the world. The real picture (due to the asymptomatic course of the disease) is probably even more frightening.

The classification of gonorrhea involves dividing the disease according to duration and intensity.

She may be:

• fresh(lasting less than 2 months). In it, in turn, the following forms of gonorrhea are distinguished:
  1. acute;
  2. subacute;
  3. torpid (asymptomatic);
• chronic(lasting 2 months or more).

Transmission routes

In 99% of cases it occurs through sexual intercourse. Household infection (through common hyena personal items - towels, washcloths, underwear) is unlikely, but sometimes occurs in girls who are not sexually active. Sometimes the pathogen is transmitted from a sick mother to her child during childbirth.

The incubation period of the disease is short and averages 3-7 days. In the future, the development of gonorrhea can occur in several scenarios.

Classic gonorrhea

In men

They appear no more than a week after infection.

Most often, men complain about:

• pain, burning or other manifestations of discomfort in the urethra;
• increased urge to urinate, which can be very painful;
• the appearance of whitish mucopurulent discharge from the penis;
• hyperemia and swelling of the head of the penis.

If the discharge is light, the easiest way to notice it is after a night's sleep (a symptom of a morning drop).

Without timely detection and treatment, the infection can spread to other organs of the genitourinary system.

The most common complications in men are:

• Gonorrheal prostatitis according to the type of acute inflammation of the prostate gland. Has three forms:
  1. Catarrhal disease occurs without pronounced symptoms, there is a slight increase in urination and nocturia, cloudy urine;
  2. Follicular is accompanied by pain, a feeling of heat in the perineum and anus, and frequent urination, which causes discomfort in the patient. When emptying the bladder, a large amount of pus may be released;
  3. Parenchymatous is difficult. The outflow of urine is significantly impaired, up to complete delay. Pain during bowel movements and constipation are possible. The prostate is usually significantly enlarged.

Chronic prostatitis caused by gonococci is difficult to treat and quickly leads to the development of impotence and infertility.

• Gonorrheal epididymitis. In acute inflammation, hyperemia, swelling and severe pain of the scrotum on the affected side are observed. The chronic form of the disease is manifested by discomfort and pain in the testicle, which can radiate to the abdomen, leg, and lower back.
• Vesiculitis(inflammation of the seminal vesicles).
• Strictures(pathological narrowing) of the urethra.

Important! Gonorrheal infection in men often leads to a sad and irreversible outcome - infertility.

Among women

Due to the structural features of the organs of the reproductive system, in 80% of the fair half of humanity, even acute gonorrhea is practically asymptomatic. This leads to chronicization of the pathological process and the development of complications.

They may complain about:

• discomfort in the vulva;
• burning and itching;
• redness and swelling of mucous membranes;
• mucopurulent discharge;
• pain in the lower abdomen.

Chronic inflammation over time leads to the spread of infection to nearby organs.

The following types of gonorrhea are distinguished:

• descending, in which damage occurs to the urinary and lower parts of the reproductive system (urethra, bladder, vagina, Bartholin glands);
• ascending, characterized by inflammation of the endometrium, fallopian tubes and ovaries.

Gonorrheal vaginitis (colpitis) is characterized by inflammation of the mucous epithelium of the vagina and manifests itself:

• white-yellow (less often greenish) purulent discharge;
• hyperemia and swelling of the vaginal walls;
• nagging pain in the lower abdomen.

If the patient has developed gonorrheal vulvovaginitis, these symptoms are accompanied by swelling, pain and itching in the area of ​​the VV, and severe discomfort during sex. When bacteria spread into the uterine cavity, endometritis occurs.

This pathology is characterized by:

• pain in the lower abdomen;
• irregularity of MC;
• painful menstruation;
• purulent discharge of varying intensity;
• signs of intoxication(headaches, weakness, malaise, fever up to 38-39 C°.

Acute inflammation of the uterine appendages (salpingoophoritis) of gonococcal etiology occurs rapidly, accompanied by severe abdominal pain, nausea and vomiting, and increased body temperature. When the pathology becomes chronic, the pain becomes less intense (but periodically intensifies), but various MC disorders develop and, as a consequence, infertility.

Proctitis

Gonorrheal proctitis is a less common, but quite probable form of the disease, characterized by a specific inflammation of the rectal mucosa. It can develop as a secondary infection when purulent discharge from the vagina flows into the anus or be a consequence of genital-anal contact in heterosexual and homosexual couples.

Symptoms of the disease are mild. Only a third of patients develop complaints of:

• burning;
• slight pain in the anus;
• mucus and pus in the stool;
• frequent urge to have bowel movements;
• sometimes - blood discharge in feces.

If a doctor examines the rectum during gonorrheal inflammation, he will notice swelling, tissue hyperemia and erosion. To confirm the diagnosis, standard medical instructions provide for bacterioscopic and bacteriological examination of purulent discharge.

Pharyngitis

Gonococcal pharyngitis is another form of the disease that is diagnosed in people who practice non-traditional types of sex. It develops through unprotected genital-oral contact.

Infection of the oral cavity by Niesseria gonorrhoeae most often begins in the posterior pharyngeal wall and then spreads to the upper palate, tonsils, and upper respiratory tract.

Pharyngitis of gonococcal etiology is most often asymptomatic, but in some cases patients complain of:

• sore throat that gets worse when swallowing;
• dry mucous membranes;
• soreness;
• cough - with gonorrhea, it may indicate the spread of infection to the larynx and trachea;
• general signs of toxic damage to the body.

Conjunctivitis

Gonorrheal conjunctivitis, or gonoblennorrhea, is a specific inflammatory lesion of the conjunctiva of the eye.

Note! This form of the disease can also occur in adults, but most often affects newborn children who become infected with gonococcus from the mother during passage through the birth canal.

Symptoms of gonoblennorrhea develop on the 2-3rd day of the baby’s life. Characteristic:

• redness or blueness of the eyelids;
• severe swelling up to the inability to open the eyes;
• copious purulent discharge from the eyes;
• conjunctival hyperemia;
• sometimes – an increase in temperature.

Blennorea is a very dangerous condition that can lead to:

• abscess of the eyeball;
• perforations;
• complete loss of vision
• generalization of infection.

Disseminated infection

Hematogenous spread of gonococci throughout the body rarely develops.

However, medicine knows cases of the development of the inflammatory process in various organs and tissues, including:

• joints;
• endocardium;
• meninges;
• liver;
• skin, etc.

Dissemination of Neisseria gonorhoeae is facilitated by:

• long-term undiagnosed and untreated forms of infection;
• irrational therapy, self-medication;
• pregnancy in women;
• concomitant severe diseases;
• congenital/acquired immunodeficiency;
• trauma to the urethral mucosa.

Disseminated gonorrhea can occur in two main ways.

Table: Forms of common gonorrhea:

Important! Patients with any form of generalized infection should be hospitalized immediately. Sometimes the price of delay is not only health, but also human life.

It's amazing what a small bacteria can cause so many diseases. Gonorrheal damage to internal organs leads to serious complications, so prevention, as well as timely diagnosis and treatment of these pathologies is one of the primary tasks of the healthcare system.

Questions for the doctor

Specialist in the treatment of gonorrhea

Hello! I'm 23 years old, girl. Recently, a guy was “delighted” that his tests revealed gonorrhea. Basically, nothing worries me. Do I need to get examined? And if so, which doctor should I see for gonorrhea?

Hello! It is imperative to be examined - do not forget that in 80% of women this disease is practically asymptomatic. You can undergo all diagnostic tests and receive a treatment plan from a dermatovenerologist. Avoid sexual intercourse for you and your partner during treatment. Be healthy!

Incubation period

I read the article, and it’s like I have all the symptoms of tripper (pain when urinating, sometimes pus drips), but it so happens that I haven’t had sex for two months. Can the incubation period be longer than 3-7 days? Or do these signs occur, for example, with a cold, hypothermia, etc.?

Good day! PI for gonorrhea is usually 3-7 days, but can increase to 14 days. Two months is a long time. Similar symptoms occur with many STIs (chlamydia, trichomoniasis, etc.). In any case, you need to see a doctor and get examined.

Gonorrhea– a sexually transmitted infection, about a quarter of a billion clinical cases are registered annually. Despite modern treatment methods, the disease cannot be completely controlled: the causative agent of gonorrhea mutates, gradually acquiring resistance to the newest antibiotics.

Immunity to gonorrhea is not developed; the risk of getting sick again is approximately the same in women and men.

The disease is a classic of venereology and has its own history. Ancient medical treatises ( Galen) mention the “passive leakage of sperm” - gonorrhea, referring to the characteristic discharge from the penis. The Dutch and Germans preferred to rename gonorrhea gonorrhea, associating the disease with travel and love affairs.

Towards the end of the 19th century, the causative agents of gonorrhea were discovered. They turned out to be diplococci - paired bacteria of a round shape, reminiscent of coffee beans. He was the first to describe all their signs, methods of reproduction and effects on the human body. Neisser(1872) and gave the microorganisms their own name - gonococci. The grateful scientific community, in recognition of the scientist’s merits, officially renamed the gonococci into Neisseria. Since then, the causative agent of gonorrhea has received a sonorous name - Neisseria gonorrhoeae.

Transmission and prevalence

It has been proven that the predominant route of transmission of gonococcal infection is sexual contact. 50-70% of women become infected after the first contact, among men the infection rate is 25-50%.

It is recognized that gonorrhea is contracted equally both during “everyday” sexual intercourse and during oral or anal sex. The last two methods of infection are most common among gay and lesbian couples. There are no living gonococci on household items, in swimming pool water or on bath accessories: Neisseria do not reproduce outside the body and die when released into the external environment within 2-4 hours.

Transmission of gonococci through contact and household contact is possible through bed and underwear, towels and toothbrushes, if fresh biomaterials of an infected person remain on them - saliva in the oral form of gonorrhea, discharge from the urethra, anus or vagina in the corresponding localizations of gonorrhea. The child is infected through non-sexual contact during childbirth if the mother is sick or is a carrier of gonococci. In such cases, children develop neonatal blenorrhea, a specific inflammation of the conjunctiva, between 2 and 4 days of life.

The prevalence of gonorrhea does not depend on the degree of development of society or the economic well-being of countries. Statistical data for the European Union revealed that the maximum incidence rate is observed in traditionally rich countries and states with a “Nordic” character. The sad champion in the number of cases per 100,000 population was England (27.6), Latvia (18.5) was in second place, Iceland (14.7) and Lithuania (11.7) occupied an honorable third position. It was also revealed that up to 60% of patients with gonorrhea from the Netherlands and France were infected through homosexual contacts, in Norway - up to 40%.

For many years, statistics have not changed regarding the age of most patients with gonorrhea. The risk group remains young people from 15 to 34 years old, they account for up to 75% of all identified cases. It has been noted that in countries that respect traditional marriage and family values, gonorrhea is much less common: in Greece, Romania, the Czech Republic and Spain, the incidence rate tends to zero.

The causative agent of gonorrhea

solitary gonococcus

Gonococci are very sensitive to living conditions. They die if the temperature is below 35 or more than 55 ° C, they are susceptible to drying and exposure to sunlight, and to the effects of even weak antiseptics. In fresh purulent masses, live gonorrhea pathogens are only preserved; They can multiply comfortably inside cells - in the cytoplasm of leukocytes, in the epithelial layer of the mucous membranes of the genitals, rectum, mouth and eyes.

Gonococci cannot move and are not able to form spores. However, with the help of the thinnest pili threads, they are fixed on the membrane of red blood cells, sperm and epithelial cells, due to which they move inside the body and end up outside it. Around the Neisseria there are some kind of capsules that protect against the effects of cellular enzymes. Therefore, leukocytes that “attack” gonococci cannot digest them, and red blood cells and trichomonas become a barrier that complicates the treatment of gonorrhea.

The phenomenon of resistance (immunity) to antibiotics is explained by the formation of L-forms of gonococci, which, if gonorrhea is not treated correctly, lose some properties important for triggering the immune response. L-forms are difficult to treat: they do not give a clear clinical picture of the disease, but are sexually transmitted and remain viable for a long time. Under favorable conditions (hypothermia, stress, colds, fasting), the infection becomes more active and signs of gonorrhea appear.

Forms of gonorrhea, incubation period

Based on duration, a distinction is made between the fresh form of gonorrhea, which lasts no more than two months, and the chronic form, which lasts more than 2 months.

Chronic gonorrhea is also diagnosed if the period of limitation of the disease has not been established. The classification, based on the severity of symptoms, divides gonorrhea into acute, subacute and torpid - low-symptomatic and asymptomatic variants, or carriage of gonococci. Gonococci infect mainly the lower parts of the genitourinary system, which are covered with columnar epithelium. This mucous membranes of the paraurethral glands and urethra - in men; urethra, cervical canal, fallopian tubes, Bartholin glands - in women

. The vaginal walls are covered with stratified squamous epithelium; normally it is immune to gonococci. The development of gonorrheal occurs when the epithelium loosens during pregnancy, puberty, or menopause.

After genital-oral contacts, gonorrheal tonsillitis, stomatitis (erosions and ulcers in the mouth) or pharyngitis (sore throat) appears, after genital-anal contacts - proctitis, and when the mucous membrane of the eyes is infected - gonorrheal conjunctivitis. The disease spreads beyond the mucous membranes, destroys tissue under the epithelium and provokes local inflammation. Without treatment, gonococci spread throughout the body through the lymph and blood, affecting the liver, joints, kidneys, and brain. Sepsis may develop.

Differences in the localization of gonococcal inflammation and its consequences: gonorrhea of ​​the lower parts of the genitourinary system with and without complications, upper parts, pelvic organs, gonorrhea of ​​other organs.

The incubation period varies from 2 to 14-15 days, sometimes a month can pass from the moment of infection with gonococci to the first symptoms.

In case of carriage, there are no signs of disease, but a person always poses a danger as a spreader of infection.

Gonorrhea symptoms

purulent discharge is typical for both women and men

The onset of the disease is sometimes violent. The first signs of gonorrhea, acquired through conventional sexual contact, are copious mucopurulent discharge, reminiscent of thick cream, from the urethra (in men) and the cervical canal (in women). Redness and swelling around the urethra or cervical canal are visually determined. Locally, the temperature may rise to 38-39, signs of general intoxication appear - chills, muscle pain, thirst and weakness.

If the infection occurs orally, inflammation of the throat and tonsils occurs - gonorrheal tonsillitis and pharyngitis, as well as inflammation of the mucous membrane in the mouth - stomatitis.

• First, local redness with uneven edges forms, then erosion and a white coating characteristic of gonorrhea. Its thickness and prevalence are constantly increasing; without adequate treatment, stomatitis covers almost the entire oral cavity and spreads to the throat.
• It is important to distinguish gonorrheal inflammation of the mouth and throat from candidiasis:
• The smell from plaque during gonorrhea is immediately associated with rot;
• After its removal, the surface bleeds;
• Erosions form on the anterior 2/3 of the tongue, leaving the edges free;

Frequent starting localization is the lower lip, gums, soft palate; Rectal symptoms of gonorrhea: copious discharge from the anus, severe itching, burning and swelling of the tissues surrounding the anus. Complications are the formation of perianal ulcers (paraproctitis), gonorrheal myocarditis and pneumonia, sepsis. The purulent process in the lower third of the rectum is especially dangerous in terms of the spread of gonococci. Venous blood from this area does not pass through the liver, where infection and tissue breakdown products could linger, but goes directly into the inferior vena cava system. The further path of infected blood is the heart and lungs, then again the heart and aorta, then the kidneys and all internal organs.

Gonorrhea of ​​the eyes is more common in newborns; the infection is transmitted during childbirth from a mother infected or sick with gonorrhea. It begins as a banal conjunctivitis - with redness of the mucous membranes and swelling of the eyelids, but the inflammation quickly turns purulent. The discharge becomes abundant, forms yellowish crusts on the eyelids and eyelashes, and the disease spreads to the cornea of ​​the eye. Without adequate treatment, a child may lose vision, so all newborns are given prophylaxis by instilling sodium sulfacyl solution into the eyes. Gonorrheal conjunctivitis, acquired during childbirth, manifests itself before the 4-5th day of the baby’s life.

Gonorrhea in women

The course of the disease varies depending on the location and severity of inflammation caused by gonococci.

1) Gonorrhea in the lower genitourinary system

The disease, localized in the urethra, vagina, cervix, Bartholin glands, often occurs without subjective discomfort. Discharge is present, but a woman may not notice it or confuse it with, the itching is not particularly bothersome or disappears after douching with a weak solution of potassium permanganate. Gradually, the disease becomes a carrier state or a chronic form with mild exacerbations in the form of the same itching and scanty vaginal discharge. Upon examination by a gynecologist, thick swelling and redness of the cervical canal and the urethral orifice are noticeable.

The main complications are purulent inflammation of the Bartholin glands, cervix and vagina. In these cases, the symptoms immediately worsen: the temperature rises sharply (39-40), pain appears in the perineum and lower abdomen, and copious purulent discharge appears. When a one- or two-sided swelling is detected in the area of ​​the posterior commissure of the labia majora, palpation is painful. Hospitalization, opening and drainage of festering glands, antibiotics and droppers are indicated.

2) Ascending gonococcal infection

It spreads to the upper part of the genitourinary system, that is, above the internal opening of the cervical canal. The process involves the uterus, fallopian tubes, ovaries, para- and perimetrium (the outer lining of the uterus and the tissue around it), often the pelvic nerve plexus. The reasons are medical procedures: diagnostic curettage and abortion, probing of the uterus, cervical biopsy, insertion of an intrauterine device. Acute inflammation may be preceded by menstruation or childbirth.

Gonococcal eye infection can occur at any age and occurs as inflammation of the iris (iridocyclitis) or conjunctiva (conjunctivitis). severe pain in the lower abdomen, high fever, nausea and vomiting, loose stools, intermenstrual bleeding with bright scarlet blood, frequent.

Upon examination, purulent-bloody discharge from the cervical canal is detected; soft enlarged uterus and sharply painful on palpation; Ultrasound shows swollen fallopian tubes and ovaries. The main complications are ovarian abscesses, peritonitis (inflammation of the peritoneum). In both cases, the picture of an “acute abdomen” is characteristic, when any pressure on its anterior wall causes sharp pain. The woman assumes the fetal position: lies on her side, bends her knees and pulls them towards her stomach, crosses her arms over her chest and lowers her head. In this position, the abdominal muscles relax as much as possible, irritation of the peritoneum is minimal and the pain becomes slightly less.

Treatment is carried out only in a hospital; the ovaries often have to be removed. If pyometra (accumulation of pus in the uterus) is determined and the patient’s general condition is satisfactory, then the uterus is drained and treated with antibiotics. If there is a threat of sepsis and the therapeutic approach is ineffective, the organ is removed.

3) Chronic form

Chronic gonococcal inflammation is not expressed symptomatically, but the consequences of an invisible disease are dangerous complications.

The menstrual cycle is disrupted and adhesions develop in the pelvis, leading to ectopic pregnancy, spontaneous abortions and infertility, and chronic pelvic pain.

Gonorrhea in pregnant women is manifested by inflammation of the vagina and cervix, premature opening of the membranes or their inflammation, labor fever, and septic abortion.

Quite rarely, before the 4th month of pregnancy, a gonococcal infection can occur as (inflammation of the fallopian tubes). The development of gonorrheal vaginitis is characteristic, which usually does not occur outside of pregnancy and is associated with hormonal changes in the vaginal epithelium. The symptoms are similar to thrush, but standard medications do not help. Danger for the child is intrauterine infection with gonococci, postpartum gonorrheal conjunctivitis, and in girls – gonorrhea of ​​the genital organs. Pregnant women with gonorrhea are treated in a hospital.

Gonorrhea in men

photo: gonorrheal discharge from the urethra in men Signs of gonorrhea may appear 2-3 days after sexual intercourse

, but often asymptomatic periods last up to 2-3 weeks. The scenario for the development of the disease is directly dependent on age, the state of the immune system, and the presence of other diseases. In young people, resistance is higher, acute forms of gonorrhea are more often observed, which are quickly and safely cured, while older men mainly suffer from low-symptomatic variants of the disease, which develop into chronic gonorrhea or carriage of gonococci.

1) Acute gonorrheal epididymitis - inflammation of the epididymis

The infection spreads from the urethra along the vas deferens. It begins with swelling of the testicle and such sharp pain in the scrotum that the man actually cannot move. Then pain appears in the lower back, moving to the side of the abdomen and to the groin area. The pain is stronger on the side where the inflammation is more intense. As swelling increases, the epididymis increases 2-4 times in just a couple of hours; At the same time, pain during urination increases, and blood appears in the urine.

The temperature is understood, the person feels a strong chill, the pulse quickens. The main complications of epididymitis are the formation of an epididymal abscess and the spread of infection to the testicle (). The normal functions of the epididymis are limited to transporting, storing and maturing sperm. When the ducts become inflamed, they become narrowed or completely blocked by adhesions, resulting in infertility. With unilateral epididymitis - in 35% of cases, with bilateral - in 87%.

Gonococci enter the prostate through the ducts connecting the gland to the urethra. Acute inflammation is characterized by pain in the lower back and lower abdomen, radiating to the scrotum and groin areas. The prostate gland swells and can compress the urethra, making it difficult to urinate; mucus and blood appear in the urine. Chronic forms develop unnoticed, but ultimately lead to adhesions inside the ducts, acute forms lead to purulent inflammation with the formation of an abscess. In both cases, the possible outcome is infertility and impotence.

3) Gonorrheal inflammation of the periurethral canals and glands, foreskin, head of the penis

They can be complicated by narrowing of the urethra and its opening, fusion of the internal layers of the foreskin, and erosions on the skin of the genital organs.

Gonorrheal epididymitis and prostatitis are diagnosed by a smear from the urethra, and appropriate antibiotics and restoratives are prescribed. Purulent complications are treated in a hospital, chronic and subacute forms are treated on an outpatient basis, also with the use of antibiotics and then physiotherapy. To reduce pain, it is suggested to put a suspensor on the testicles; if urinary retention occurs, drink a decoction of parsley and make local baths with chamomile or sage. Recommendations for the regimen: restriction of activity with temporary cessation of sexual activity, as well as cycling and horseback riding. Diet with limited fats and spices, without alcoholic beverages.

Diagnostics

The first point of the diagnostic algorithm is patient interview. The doctor finds out what exactly is bothering you at the moment, when the problems started and what they may be associated with, whether such symptoms existed before.

Then proceeds to inspection, urological or gynecological, if necessary, evaluates the condition of the genital organs by palpation (palpation). In women with acute form of gonorrhea, hyperemia of the cervical canal is visible, liquid yellowish-milky pus is released from it.In men, the discharge is in the form of a drop, the color is the same, there may be an admixture of blood. Chronic gonorrhea gives a more modest picture: there is little discharge, they appear after pressing on the opening of the urethra.

Gonorrhea smear taken with a sterile loop or swab. If gonorrheal inflammation outside the genital organs is suspected, material is obtained from the mucous membrane of the mouth and throat, from the anus, and from the corners of the eyes. With standard localization of gonorrhea: in women - from the urethra, cervical canal, vagina and the mouth of the Bartholin glands, in men - from the urethra.

If necessary, a sample of discharge from the prostate gland is additionally examined. To do this, the doctor massages the prostate through the rectum, and the patient holds the test tube near the opening of the urethra. The procedure is unpleasant, but goes quickly. With normal inflammation, the prostatic secretion contains only leukocytes and columnar epithelium, with gonorrhea - leukocytes, epithelium and gonococci, and Neisseria are located inside the cells.

Culture method

This involves inoculating material from the area of ​​inflammation on nutrient media, isolating gonococcal colonies and determining their sensitivity to antibiotics. Used as a definitive diagnosis of gonorrhea to prescribe specific treatment.

Antibiotic sensitivity test: gonococci isolated from colonies are mixed with a nutrient medium, which is placed in a special container (Petri dish). Pieces of paper, similar to confetti, soaked in solutions of various antibiotics are placed on the surface in a circle. After the growth of gonococci in it, the medium becomes cloudy, and only round transparent areas are visible around the “confetti” with certain antibiotics. They are measured, with a diameter of 1-1.5 cm, the sensitivity of a given microflora to an antibiotic is considered average, a diameter of 2 cm or more indicates high sensitivity. It is this medicine that can successfully cope with the infection.

The disadvantage of the method is the long execution time; it takes 7 to 10 days for colonies to grow successively on two media. Plus – detection of gonorrhea in 95% of cases.

Smear microscopy

The material to be studied is placed on a glass slide, the preparation is stained and examined under a microscope. The causative agents of gonorrhea are found in the form of bluish-violet diplococci, located mainly inside other cells. The technique is not complicated, but depends on the qualifications of the laboratory doctor, so its accuracy is only 30-70%. Microscopy is used to make a preliminary diagnosis.

Analyzes

Blood for general clinical research, for PCR and ELISA tests.

1. General clinical analysis reveals signs of inflammation: leukocytosis, increased lymphocyte count, ESR, and possibly increased platelets.
2. , polymerase chain reaction. The method is highly sensitive and is based on the determination of gonococcal DNA. Used for preliminary diagnosis, it is often false positive. To confirm it is supplemented.
3. (linked immunosorbent assay). The results may be distorted by concomitant autoimmune diseases. In general, the method has a confidence level of 70%, is inexpensive and can be done quickly.

Hardware methods are used after treatment to assess the severity of the consequences of gonorrhea for the internal genital and other organs. In women, sclerosis (replacement of active tissue with scar tissue) of the ovaries and fallopian tubes is possible, in men – of the seminal ducts and urethra. In both cases, infertility occurs.

Treatment with antibiotics

The main principle: be sure to treat sexual partners, in whom gonococci were detected using the culture method. Acute and chronic gonorrhea require an etiotropic approach, that is, an impact on the cause of the disease.

Sexual contact and alcohol are prohibited for the entire treatment period!

Therapy with antibiotics taken orally is always carried out against the background hepatoprotectors(karsil) and probiotics(Linex, yogurt). Local remedies with eubiotics (intravaginal) - acylact, lacto- and bifidumbacterin. It would also be useful to prescribe antifungal drugs (fluconazole).

It is better to stop the temptation to heal yourself immediately , since the antibiotic may not work and gonorrhea will become chronic, and medications are increasingly causing allergies and its complication - anaphylactic shock - develops at lightning speed. And most importantly: only a doctor can reliably diagnose gonorrhea, based on objective data.

Acute uncomplicated gonorrhea of ​​the lower genitourinary system is treated literally according to instructions compiled on the basis of official recommendations. Preferably one of the following antibiotics is prescribed:

• tablets for gonorrhea, single dose - azithromycin (2 g), cefixime (0.4 g), ciprofloxacin (0.5 g);
• intramuscularly, once - ceftriaxone (0.25 g), spectinomycin (2 g).

Exist alternative schemes, in which ofloxacin (0.4 g) or cefozidime (0.5 g), kanamycin (2.0 g) intramuscularly, once are used (once, orally). After treatment, it is necessary to monitor the sensitivity of gonococci to antibiotics.

Acute complicated gonorrhea of ​​the lower and upper parts of the genitourinary system requires long-term treatment. The antibiotic is changed after a maximum of 7 days, or the drugs are prescribed in long courses - until the symptoms disappear, plus another 48 hours.

1. Ceftriaxone 1.0 IM (intramuscular) or IV (intravenous), x 1 per day, 7 days.
2. Spectinomycin 2.0 IM, x 2 per day, 7 days.
3. Cefotaxime 1.0 IV, x 3 per day or Ciprofloxacin 0.5 IV, x 2 per day - until symptoms disappear + 48 hours.

After the acute manifestations of gonorrheal inflammation have been relieved (the temperature should return to normal, discharge is scanty or undetectable, there is no acute pain, local swelling has decreased), antibiotics continue to be used. Twice a day - ciprofloxacin 0.5 or ofloxacin 0.4 g.

In the presence of a mixed infection of gonorrhea, the regimen is expanded by adding azithromycin tablets (1.0 g once) or doxycycline (0.1 x 2, 7 days). Trichomoniasis can be treated with metronidazole, ornidazole, or tinidazole. , accompanying gonorrhea, is treated with penicillins or tetracyclines. If you are allergic to these groups of drugs, erythromycin or oleandomycin is prescribed, which are also active against chlamydia.

How are pregnant women and children treated?

Treatment of gonorrhea during pregnancy

At any stage of pregnancy, it is important to use only antibiotics that do not have a negative effect on the child: ceftriaxone (0.25 IM once) or spectinomycin (2.0 IM once). Drugs from the group of tetracyclines (doxycycline), sulfonamides (Biseptol) and fluoroquinolones (ofloxacin) are strictly contraindicated. For complications of gonorrhea chorioamnionitis Urgent hospitalization and antibiotics are indicated (ampicillin 0.5 IM x 4 per day, 7 days).

Always add immunomodulators, combined with local treatment of gonorrhea and drugs that affect metabolic processes and improve blood circulation (trental, chimes, actovegin). A week after treatment for a pregnant woman, the first control for gonococci is carried out; this is repeated for three months in a row. The partner or husband is also treated, and children are necessarily examined.

Treatment of gonorrhea in children

Antibiotics of the same groups are prescribed that are used to treat pregnant women. The dosage is calculated based on body weight: up to 45 kg - ceftriaxone 0.125 IM once or spectinomycin 40 mg per kilogram (no more than 2 g) IM once; after 45 kg - dosages as for adults. For newborns, ceftriaxone at the rate of 50 mg per kg of weight (not more than 125 mg), intramuscularly once.

Other treatments for gonorrhea

Local impact– instillation of the urethra or vagina with protargol (1-2%), silver nitrate solution 0.5%, microenemas with chamomile infusion. It is prepared at the rate of 1 tbsp. spoon of dry chamomile in 1 cup of boiling water, leave for 2 hours, then strain through cheesecloth. All of the above products have astringent and antiseptic properties.

Physiotherapy It is used only outside of acute inflammation and its manifestations. They use UHF, treatment with electromagnetic fields, laser and UV rays, electro- and phonophoresis of drugs. All effects are aimed at reducing the effects of inflammation, local improvement of lymph and blood flow.

Immunotherapy: the goal is to activate the immune response to gonococcal infection, increasing the susceptibility of cells to antibiotics. Gonococcal vaccine, autohemotherapy, and drugs (pyrogenal) are used. Begin only after treatment of acute manifestations of gonorrhea and always against the background of antibiotics; for chronic or subacute gonorrhea - before starting a course of antibiotics.

Treatment for acute ascending infection

A prerequisite is hospital treatment. In case of severe pain in the lower abdomen (for women) or the scrotum and penis, apply cold lotions or a rubber “hot water bottle” with ice, and, if necessary, numb the pain with medication. Medicines are administered intravenously. Droppers with physical therapy are prescribed. glucose solution and novocaine, no-spa and insulin, antihistamines (suprastin, diphenhydramine). Hemodez and rheopolyglucin are administered. The purpose of infusion therapy is to reduce intoxication, reduce blood viscosity to prevent thrombosis and DIC syndrome, reduce smooth muscle spasm and relieve pain.

Acute inflammation of the fallopian tubes and/or ovaries is treated conservatively for the first 24 hours using antibiotics and infusion therapy. If the patient’s condition does not improve, an operation is performed to drain the purulent focus or the organ is removed. When diffuse peritonitis develops, active drainage of the abdominal cavity is used. The outcome of treatment depends on the general condition of the woman, so if you suspect a purulent ascending gonococcal infection, it is important to consult a doctor as soon as possible.

Treatment control

Gonorrhea cure criteria are used to assess the effectiveness of treatment.

• There are no symptoms of inflammation, gonococci are not detected in smears.
• Once provoked, the symptoms of the disease do not return. Provocation can be physiological (menstruation), chemical (the urethra is lubricated with a solution of silver nitrate 1-2%, the cervical canal - 2-5%), biological (gonovax IM), physical (locally - inductothermy) and food (spicy, salty, alcohol) or combined.
• Three-time examination of smears from the urethra, cervical canal or anus, taken at intervals of 24 hours. In women - during menstruation.
• Combined provocation, tank. examination of smears (three times microscopy every other day, culture).

If gonococci are not detected, then gonorrhea is considered completely cured. It is recommended to do tests after 3 months. after completion of treatment.

Home treatment

Treatment at home is a supplement to the basic regimen with local procedures, diet and herbal medicine, but not for acute manifestations of gonorrhea. Some folk remedies recommended for chronic gonorrhea during periods of exacerbations and remissions, during the period of recovery after an acute form.

1. Baths for the external genitalia and gargling, douching and microenemas with chamomile, sage, eucalyptus oil. Antiseptic, anti-inflammatory effect.
2. A decoction of burdock, dill, and parsley is diuretic and anti-inflammatory.
3. Tincture of ginseng, golden root – immunomodulatory.

Gonorrhea prevention

Preventing infection with gonococci and blocking the spread of the disease are the main goals of gonorrhea prevention.

The risk of infection during sexual intercourse is reduced by using a condom and subsequent use of chlorine-based antiseptics (miramitan). Washing with plain water and soap is ineffective, as are spermicides. The best way to maintain health remains a reliable partner, preferably in the singular.

Safe sex with gonorrhea without a condom with a patient or carrier of the infection is possible, but such actions can hardly be called full sexual intercourse. Experts include body massage, dry kissing, oral contact with the body with the exception of the external genital area, self-masturbation and individual sex toys. Identification of patients with gonorrhea and carriers takes place during routine examinations, registration of medical records, and during the registration of pregnant women. All sexual partners should be tested

, if after contact, symptoms of gonorrhea appeared within 30 days, and in the asymptomatic form - within 60 days before diagnosis, if at least one of them showed signs of the disease. Mothers whose children have gonorrhea are examined, and girls if their parents or guardians have been diagnosed with gonorrhea.

Video: STI encyclopedia about gonorrhea