The influence of gonococcus on the human body. The first signs of gonorrhea and the causes of the disease What is gonorrhea and its symptoms

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 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.

skin-joint syndrome caused by gonorrhea

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 localizations are the lower lip, gums, soft palate;
• Plaque does not disappear when treated with fungicidal drugs, but is sensitive to the effects of methylene blue (blue solution).

With anal infection with gonococci, proctitis, inflammation of the rectum, develops. 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.

Symptoms: 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.

4) Tripper during pregnancy

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). Characteristic is the development of gonorrheal vaginitis, 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 narrow or are completely blocked by adhesions, resulting in infertility. With unilateral epididymitis - in 35% of cases, with bilateral - in 87%.

2) Gonorrheal prostatitis

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 the 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

Video: specialist about gonorrhea

Gonorrhea is a sexually transmitted infectious disease caused by the gonococcus Neisseria gonorrhoeae. The pathology belongs to the group of STDs – sexually transmitted diseases. The infectious process, as a rule, affects the mucous membranes of organs related to the genitourinary system. Most often, young people under the age of 35 who are sexually promiscuous suffer from gonococcal infection. The inflammatory process negatively affects the functioning of all organs and systems of the patient, so the infection must be treated. In recent years, the causative agent of gonorrhea has mutated, so some patients experience an asymptomatic form of the disease. A patient can live with the infection for several years, infect others, but not even suspect that they are carriers.

Of course, gonorrhea is not as terrible and destructive for the body as syphilis, but it also has serious consequences for the body: infertility, impotence, infection of a newborn during delivery, etc. Like syphilis, gonorrhea can be infected several times; immunity to Neisseria gonorrhoeae.

Infection with gonococcal infection occurs through unprotected sexual contact:

• vaginal;
• anal;
• oral (in rare cases).

Medical statistics show that about 98 percent of infections occur through sexual contact.

With one-time sexual contact (unprotected), the probability of infecting a healthy male partner is from thirty to forty percent. But the probability of infection in a woman is much higher, it is 85 percent. The difference in indicators is explained by the anatomical features of the female reproductive system, as well as hormonal levels.

During childbirth, a woman infected with gonorrhea can infect her baby. The infection provokes the development of gonococcal conjunctivitis in the child.

There is an assumption that the virus can be contracted in a swimming pool or bathhouse, as well as through personal hygiene products. But, based on medical statistics, such cases of infection are very rare - no more than one percent.

Gonococcus dies instantly outside the human body, so the likelihood of contracting gonorrhea through non-sexual contact is minimal.

From infection to the appearance of the first symptoms (incubation period) takes from three to fourteen days. In some cases, up to thirty days may pass before the first symptoms appear.

In representatives of the stronger sex, the first symptom indicating the development of a gonococcal infection is discharge from the genitals that has a yellowish tint. An infected patient may complain of pain and stinging when urinating.

In the fairer sex, gonorrhea manifests itself with the following symptoms:

• abnormal discharge from the genitals of a white-yellow color;
• pain when urinating;
• nagging pain in the lower abdomen;
• bleeding from the vagina.

If Neisseria gonorrhoeae gets into the throat, the patient may develop pharyngitis. Symptoms of pharyngitis are mild, but some patients complain of a sore throat that occurs when swallowing.

If the infection affects the rectum, then gonococcal proctitis may develop.

Statistics show that in recent years, asymptomatic gonorrhea has become increasingly common. About seventy percent of the fair sex infected with gonorrhea do not have any symptoms of the pathology.

Thirty percent of patients experience pain and cramping in the lower abdomen, as well as when urinating, and purulent discharge from the genitals may be observed. In some patients, the genital glands are damaged and pain appears in the labia.

In the ascending form of the disease, the tissues, prostate gland, and then the glands of the seminal vesicles are affected. The patient's temperature rises and severe chills may occur.

If an STD is not treated, it can become chronic: periods of remission are followed by exacerbations. Patients suffering from chronic gonorrhea often experience adhesions in the tubes, as well as disruptions in the menstrual cycle. In men, chronic infection increases the risk of impotence.

The manifestation of clinical symptoms characteristic of gonorrhea is not an absolute indicator of gonococcal infection. Most sexually transmitted diseases have similar symptoms.

The following laboratory tests will help diagnose the infection:

• ELISA and PCR – diagnostics;
• microscopic analysis of a smear from the genital mucosa;
• Isolation of a gonococcus culture using bacterial culture from a smear.

Standard diagnostics do not always give the expected result, since gonococcal infection is prone to mutations.

To diagnose an asymptomatic disease in children and pregnant women, it is recommended to use a culture isolation technique. This diagnostic method has high accuracy - up to 90 percent. This reliable method allows you to identify the pathogen even in minimal quantities.

To diagnose Neisseria gonorrhoeae gonococcus, there is no need to use a “provocation”, that is, use a gonovaccine.

In many patients, the disease occurs against the background of other sexually transmitted infections. Therefore, it is advisable to check a patient suffering from gonococcal infection for other sexually transmitted diseases, as well as pathologies of the genitourinary system.

The following additional tests are required:

• colposcopy;
• cytological studies of the cervical canal mucosa;
• urethroscopy;
• analysis for hepatitis A, B and C;
• ultrasound diagnostics of the pelvic organs;
• general urine and blood tests.

Based on the results of diagnostic studies, a venereologist or infectious disease specialist will assess the patient’s general health and select an effective treatment regimen for him.

It is not recommended to treat gonorrhea on your own. Self-medication is dangerous to health, since the process may become chronic. In addition, improper treatment can provoke irreversible consequences in the functioning of all organs and systems of the patient.

The course of therapy should be completed not only by the patient infected with gonorrhea, but also by all his sexual partners who have been in contact with the infected person for the last two weeks.

If the pathology is asymptomatic and detected during a preventive examination, it is necessary to check for the presence of STDs all sexual partners of the infected person over the past 60 days.

During the course of therapy, it is strictly forbidden to have sex; even one sexual act can be dangerous for the patient’s healthy partner. You also need to completely abstain from alcoholic beverages - drinking alcohol will negate the treatment.

After successful treatment, but during the period of clinical observation, the patient is allowed to have sex with a condom.

In recent years, infectious disease specialists and venereologists have been prescribing effective medications to their patients that allow them to quickly cope with the infection.

When selecting an effective course of therapy, the doctor takes into account the patient’s medical history: the duration and degree of development of the pathological process in the body, the localization of Neisseria gonorrhoeae gonococci, the presence of other STDs, concomitant diseases, etc.

If an ascending form of infection that occurs acutely is detected, the patient will require hospitalization.

Therapy for gonococcal infection includes the following treatment:

• antibiotic therapy;
• immunotherapy;
• local treatment;
• physiotherapy;
• surgical intervention (in the presence of abscesses).

Let's look at each stage of treatment in more detail.

The main method of treating gonococcal infection is taking a course of antibiotics. Drugs are prescribed taking into account age restrictions, as well as the location of the pathogen. Also, when selecting an antibiotic, the venereologist takes into account the resistance of certain types of gonococci to drugs (for example, drugs of the penicillin group).

If the selected drugs do not give the expected effect, antibiotics from another group are selected.

For a pregnant woman infected with gonorrhea, the doctor selects medications that do not have a negative effect on the fetus. For example, Erythromycin, Ceftriaxone or Spectinomycin are considered safe for the fetus.

Children born to infected mothers are given preventive treatment. For this purpose, Ceftriaxone is administered intramuscularly to newborns, and Erythromycin ophthalmic ointment is also placed in the eyes (prevention of gonococcal conjunctivitis).

If the patient also has other STDs, the course of antibiotic therapy can be adjusted or changed completely.

To achieve effective treatment, therapy must be comprehensive. It is important to combine antibiotics with drugs that enhance immunity, physiotherapy and local treatment.

Local treatment

Local therapy for infection consists of introducing weak solutions of silver nitrate and protorgol into the genital tract of an infected patient. Women with gonorrhea are advised to douche with chamomile decoction.

Therapy with immunomodulators is indicated during the period of remission, when it is necessary to increase the patient’s immunity and prepare him to fight infection.

There are two types of immunotherapy indicated for gonorrhea:

• specific treatment: the patient is given gonovaccin;
• nonspecific therapy: autohemotherapy, treatment with pyrogenal, prodigiosan, etc.

Treatment with immunomodulators and gonovaccine is contraindicated in children under three years of age.

Physiotherapy

Physiotherapy can be performed only during the period of improvement, when the patient does not have an acute inflammatory process.

Types of physiotherapy:

• electrophoresis;
• laser and magnetic therapy;

If complications such as salpingitis or pelvioperitonitis (purulent abscesses) occur, immediate surgical intervention is necessary. In a hospital setting, the patient undergoes laparotomy or laparoscopy.

After a course of antibiotics, the patient must take lacto- and bifidobacteria (intravaginally and/or orally).

If seven to ten days after therapy, the patient’s tests do not reveal a gonococcal infection, then the course of treatment is considered successful.

Complications and prevention of gonorrhea

At an early stage, gonococcal infection is very difficult to identify without tests, especially if the pathology occurs without symptoms, or a short course of antibiotics was administered for other diseases, which suppressed the symptoms. An untreated infection is very dangerous to health, as it causes serious complications.

As for women, if gonorrhea is ascending, this is caused by menstruation that began immediately after infection, surgery or damage to the genital mucosa.

Ascending gonorrhea affects the uterus, fallopian tubes and ovaries. If emergency treatment is not started, a purulent abscess may develop.

During pregnancy, the infection provokes miscarriages, premature birth or developmental pathologies in the fetus.

In men, pathogens can penetrate the bladder, kidneys and intestines, which can lead to damage to internal organs.

In addition, gonococcal infection affects not only the process of sperm production, but also the male libido. If STDs are left untreated, the risk of developing impotence increases significantly.

Only properly selected treatment, as well as compliance with all doctor’s recommendations, will help quickly cure the infection and prevent the development of complications.

The following preventive measures will help prevent the development of STDs:

• protected sex life;
• compliance with personal hygiene rules;
• regular preventive examination.

During pregnancy, a woman must be examined for gonorrhea. And if an infection is found, then treatment by a venereologist is necessary.

Gonorrhea (gonorrhoea)- a sexually transmitted disease that affects the mucous membrane of the genitourinary organs, less often the mucous membrane of the mouth, rectum, and conjunctiva. It was described 3.5 thousand years ago in the “Papyrus of Ebres”, then in the second century AD Galen first gave the name “gonorrhea”, which is translated as “ejaculation”. In his work, he pointed out the difference between this condition and the eruption of semen during erection. The discovery of the pathogen is the merit of Albert Neisser. He isolated it from the pus of the urethra and conjunctiva. The causative agent of gonorrhea, Neiser's gonococcus, was named in his honor.

Video about symptoms and treatment of gonorrhea

Venereologist Sergei Lenkin says:

The causative agent of gonorrhea

Gonoccocus Neissera is the causative agent of gonorrhea.

Gonococcus has the appearance of beans, folded with concave sides inward. It is unstable in the external environment, but very stable inside the body. This happens thanks to a protective capsule that protects the gonococcus from the action of immunoglobulins (substances that protect our body from microbes).

Another feature of the gonorrhea pathogen is the production of beta-lactomase, which nullifies the effects of antibiotics taken. These same beta-lactam strains are most often responsible for the chronic course of the disease and numerous complications.

How is gonorrhea transmitted?

Gonorrhea is transmitted sexually and can also be transmitted during childbirth from mother to fetus. In addition to sexual contact, infection also occurs through oral and anal intercourse. When the genitals only touch, without inserting the penis into the vagina, infection with gonorrhea is also possible.

Women “catch” gonorrhea from men in almost 100% of sexual intercourse with a sick person.

Gonococci can also be introduced into the genitals of girls by contaminated mother's hands, towels, sponges, and bed linen.

Gonorrhea symptoms

The incubation period of gonorrhea (from the moment of infection to the appearance of the first symptoms) lasts from 2 to 7 days. Sometimes it can drag on for up to 2 - 3 weeks, this is facilitated by taking antibiotics in the wrong dose for gonococcus, and a decrease in immunity, which is not uncommon in our time. Once on the mucous membrane of the urethra, gonococci multiply on its cells. Then they penetrate into the intercellular space, thereby causing a strong inflammatory reaction.

The course of the disease is divided into acute and chronic. It is believed that the acute form of gonorrhea lasts 2 months, and then becomes chronic. But this is a conditional division. Each person has their own body characteristics, their own immune system, etc. So it is possible that the infection will “penetrate too far” much earlier, especially if there was or is a history of prostatitis (inflammation of the prostate gland in men), inflammation of the appendages in women.

Therefore, at the first symptoms of gonorrhea, immediately contact a dermatovenerologist.

The symptoms of gonorrhea in men and women, due to anatomical and physiological characteristics, are somewhat different.

Symptoms of gonorrhea in men

In men, gonorrhea begins with burning and itching, especially during urination. When pressing on the head, a drop of pus is released. The glans penis and foreskin are inflamed.

When infection penetrates into the back of the urethra, frequent urination appears. A drop of blood may be added to the end of this act. The process quite often involves the inguinal lymph nodes with their inflammation and enlargement.

If gonorrhea is not treated, the process spreads to the entire urethra, prostate, seminal vesicles, and testicles. Painful, frequent, difficult urination appears. The temperature may rise, chills, and pain during bowel movements may occur.

Symptoms of gonorrhea in women

In women, the initial stage of gonorrhea usually involves the urethra, vagina, and endocervix (cervical canal). With inflammation of the urethra there will be itching, painful and frequent urination, and with inflammation of the vagina and endocervix - purulent discharge, pain, including during sexual intercourse. If pus gets on the external genitalia, inflammation (vulvitis) often appears with corresponding symptoms.

Unfortunately, in the female sex the symptoms are not as obvious as in the stronger sex; 50-70% of women with gonorrhea do not have any unpleasant sensations, and we often diagnose gonorrhea in them in a chronic form. That is why you need to listen to your body, and even with the slightest changes, consult a doctor. Late seeking medical help with asymptomatic gonorrhea leads to the disease spreading from the cervix to the uterine mucosa, fallopian tubes, and ovaries. There is a risk of ectopic pregnancy, infertility, and complications during childbirth.

Separately, ascending gonorrhea is distinguished, when the infection immediately penetrates the bladder, prostate gland, and appendages during its acute course.

Gradually, the symptoms subside, a period of imaginary well-being appears, and gonorrhea becomes chronic, which is characterized by a lot of complications, which I will talk about later.

Gonorrhea during pregnancy

You can become infected with gonorrhea both during and before pregnancy. Unfortunately, the disease can be asymptomatic (without pain in the lower abdomen, discharge), but can lead to premature birth, miscarriages and intrauterine infection, especially in girls. Infection with gonococci in the mucous membrane of the eyes (blenorrhea in children) is extremely dangerous, leading to blindness. That is why, after birth, all children are immediately given 30% sodium sulfacyl. A few days after birth, the baby's eyes become red and yellow or green discharge begins to appear. You should immediately consult a doctor and begin treatment to prevent damage to the cornea and all eye tissues, leading to blindness.

Extragenital forms of gonorrhea

Currently, there are extragenital forms of gonorrhea. Most often this is associated with non-traditional sexual contacts

1) Gonorrhea of ​​the rectum. The rectum becomes infected during anal intercourse and the introduction of pus into it. As a rule, it occurs hidden or with itching in the anus and painful defecation.

2) Gonococcal pharyngitis, tonsillitis(inflammation of the pharyngeal mucosa, tonsils) is a marker of oral connections. Usually not bothersome or may be slightly painful when swallowing. This is why this condition is dangerous, since a person remains contagious until appropriate treatment is prescribed. There is a popular saying misconception about the safety of oral sex. Here is my answer to this...

3) (blenorrhea of ​​adults) - may be the result of the spread of infection or the introduction of the pathogen through dirty hands. In this case, there will be purulent discharge from the eyes and lacrimation. As the process spreads, it all ends in partial or complete blindness.

Tests for gonorrhea

Differential diagnosis of gonorrhea is carried out with other urogenital infections, which can also be combined with gonorrhea. And to do this, you need to come to the doctor’s appointment with morning urinary retention (best), otherwise with a 3-hour delay. A smear is taken from the urethra in men, and from the vagina, endocervix, and urethra in women. If there were extragenital sexual intercourse - scraping from the pharynx, rectum. The material is examined under a microscope or sown on nutrient media. It is also necessary to be examined for other STDs (syphilis, AIDS, hepatitis B, C, trichomoniasis, chlamydia, mycoplasma, ureaplasma). A combination of trichomonas and gonococci is often common.

Treatment of gonorrhea

The very first antibiotic for the treatment of gonorrhea was penicillin and a group of penicillin antibiotics, but in this time period, gonococci have become resistant to it, and they do not act on latent infections (mycoplasmas, ureaplasmas), which can be “obtained with gonorrhea.”

Currently, fluoroquinolones (abactal), the tetracycline series (Unidox), and macrolides (summamed, josamycin) are widely used. In case of chronic and complicated gonorrhea, it is mandatory to prescribe immunomodulators (gonovaccine, pyrogenal), absorbable treatment (lidase), biostimulants (aloe), local treatment (instillation of miramistin solution into the urethra, as well as baths), physical treatment for the prostate, appendages, ovaries (UHF, ultrasound).

During treatment for gonorrhea, drinking alcohol and having sex is strictly prohibited.

Sexual intercourse only after complete control. Daily toileting of the genitals with warm water and soap and a change of underwear are required. When using tetracycline antibiotics, avoid exposure to the sun, as they increase the skin's sensitivity to ultraviolet radiation and you can simply burn.

It is imperative to undergo monitoring after treatment for gonorrhea, even if you feel well. Control in men and women is carried out 7-10 days after the end of the course of antibiotics. Smears are taken for microscopy and culture after provocation (injection of gonovaccine or pyrogenal). Then, for men, the same algorithm occurs after 2-3 weeks, for women, within 2-3 menstrual cycles.

Effective treatment for gonorrhea appeared only in the era of antibiotics, and therefore the use of folk remedies is a direct path to complications.

Complications of gonorrhea

Complications are very diverse. The most common complications are gonorrheal prostatitis, orchitis and adnexitis, ophoritis (inflammation of the prostate gland, testicles in men and appendages and ovaries in women). The consequence is infertility, as scar tissue forms in these organs. As a result, the quality of the seminal fluid suffers and the penetration of sperm into the egg and the egg itself become difficult.

Urethral stricture is a narrowing of the urethra due to the formation of scar tissue, leading to impaired urination and ejaculation.

Gonorrheal phimosis and paraphimosis (partial or complete difficulty opening or closing the head of the penis). The cause is infection of the outer and inner layers of the foreskin in men. Paraphimosis is especially dangerous, since compression of the head occurs, disruption of its blood circulation, followed by necrosis (tissue death).

In advanced cases, generalization of the infection is possible: gonococcal peritonitis (inflammation of the peritoneum), arthritis (inflammation of the joints), sepsis (blood infection). To summarize this I would say:

"Gonorrhea can be a fatal disease."

Gonorrhea prevention

As I already wrote in previous articles about STDs, the most reliable prevention is a monogamous relationship. Condoms save you from gonorrhea, but do not provide a 100% guarantee, although if you still have them in your life, you should never neglect them. It is also necessary to use the toilet of the external genitalia with warm water and soap + rinsing the urethra with a solution of chlorhexidine, miramistin. For women, use Hexicon suppositories, Pharmatex. If you have several sexual partners, you must be examined annually by a urologist/gynecologist, even if there are no symptoms of the disease.

It should be added that gonorrhea is the most common sexually transmitted disease in Russia, it is much more common than syphilis. You can get sick with it, just like with syphilis, several times. Many, not suspecting that they are sick, continue to be sexually active, infecting their partners, are not treated, and the disease progresses, leading to severe complications.

Consultation with a doctor about gonorrhea:

Question: Is it possible to diagnose gonorrhea by donating blood from a vein?
Answer: Such work has been carried out, but not at the moment. Only a general smear and culture.

Question: Can you get gonorrhea from a swimming pool?
Answer: No. Gonococci are unstable in the external environment.

Question: Does casual oral sex have to be done with a condom?
Answer: Yes. Mandatory + subsequent prevention, as I wrote about above.

Dermatologist, venereologist Mansurov A.S.

Gonorrhea is still one of the most common sexually transmitted diseases. In women, the disease often occurs latently, so they continue to infect other people, unaware of the presence of infection in their body.

Treatment for gonorrhea is required for both sexual partners. The sooner it is started, the less likely it is that the patient will develop severe complications, including.

Gonorrhea in women - what is it?

Gonorrhea is a sexually transmitted sexually transmitted disease, popularly known as gonorrhea. The causative agent of the disease is gonococcus (Neisseria gonorrhoeae). This bacterium was named in honor of the scientist who discovered it, Neisser. If we turn to the Greek language, the term “gonorrhea” can be translated as “discharge of semen.”

Gonorrhea is a common disease. About 62 million people are infected with it every year. In 2000, 170,000 cases were recorded in Russia.

Gonorrhea is divided into acute, subacute and chronic. In the first two cases, the disease lasts no more than 2 months. In the chronic form of infection, the infection period is more than 2 months. In this case, gonorrhea can have a hidden, asymptomatic course.

The disease tends to spread in an ascending manner. Once in a woman's genital tract, gonococci lead to inflammation of the uterus, ovaries, fallopian tubes, and pelvic peritoneum.

Causes of gonorrhea infection

Gonorrhea is transmitted sexually. Moreover, the type of sex does not matter. Infection occurs through genital-oral, traditional and anal contact. The infection can be transmitted even during petting.

Scientists do not rule out the possibility of infection through domestic means, but such a situation rarely occurs. The household route of transmission occurs when hygiene rules are violated, when using other people's towels, when wearing other people's underwear, etc.

Newborn babies can be infected with gonorrhea while passing through the birth canal of a sick mother.

Once in the external environment, gonococci lose their high ability to live. They die when heated to +55 °C and when exposed to ultraviolet rays.

Gonococcus, which lives in the mucous membranes of humans, is very contagious. Infection occurs in 70% of cases, even after a single sexual intercourse. As a “monoinfection,” gonorrhea is rare. In 80% of cases, a person is additionally infected with chlamydia and/or trichomonas.

There are women who are at increased risk for contracting gonorrhea:

Sexual intercourse with different men.

Women under 25 years of age.

Women who have had gonorrhea before.

Women with other sexually transmitted infections.

Pregnant women.

Women who lead an antisocial lifestyle abuse alcohol and drugs.

Infection of a woman is possible even when the disease in a man is practically asymptomatic, becoming chronic, because the gonococcal infection continues to be released from the genitourinary system. Even many years after suffering from acute gonorrhea, a man can infect his partner.

After the infection enters the body, it takes from 3 days to 3 weeks. During this period, there may be no symptoms of the disease. Although most often gonorrhea makes itself felt 5 days after the infection occurs. The specific timing depends on the intensity of the immune system.

If the immune system is weak, then the first signs of the disease may appear as early as 1-2 days after the infection has occurred. A recent illness, steroid therapy, treatment of cancer, etc. can trigger a decline in defenses.

Late manifestation of gonorrhea symptoms is associated with good functioning of the immune system, or with the use of antibiotics during this period. A person can use them to treat other diseases. The drugs will dull the symptoms of gonorrhea, so the disease will manifest itself later.

Gonorrhea causes disorders in those organs that are affected by gonococci. During sexual intercourse, they penetrate from the urethra into the woman’s genital tract, colonizing the cervix. Then the infection rises higher, affecting the uterus itself, ovaries and appendages. Sometimes the peritoneum is involved in the inflammation process. The rectum and urethra may be affected. This happens during anal intercourse. Oral contact leads to development.

The first symptom of gonorrhea is discharge. The leucorrhoea changes its natural color to yellow, it becomes thick, and an unpleasant odor begins to emanate from it. Often women perceive a change in the nature of discharge as candidiasis or nonspecific colpitis, so they are in no hurry to consult a doctor. Self-medication leads to the fact that the signs of the disease are suppressed, and it becomes chronic.

Gonococci can cause symptoms such as:

Gonorrheal cervicitis. A woman experiences itching, burning and tickling in the perineal area. When examining the cervix, the doctor notices redness and swelling. A yellow leucorrhoea is released from the cervical canal, which stretches like a ribbon.

Gonorrheal endometritis and salpingoophoritis. If gonorrhea is not stopped in time, it will lead to inflammation of the appendages and uterus. The woman begins to complain of abdominal pain, which is concentrated in the lower part. The pain can be sharp or nagging. At the same time, a change in the nature of the discharge occurs. They may contain pus and blood. Body temperature increases to 39 °C, general intoxication of the body increases, which is manifested by weakness, malaise, nausea and vomiting. Appetite disappears.

When the uterine mucosa is involved in the inflammatory process, a characteristic symptom of the disease is pain that occurs during intimacy.

Gonorrheal urethritis, cystitis and pyelonephritis. Gonorrheal urethritis develops when an infection affects the urethra. A woman complains of pain when emptying her bladder. The urethra itself becomes swollen and inflamed, and responds with pain to the touch. As the disease progresses, gonococci will invade new areas and lead to inflammation of the bladder and even the kidneys.

Gonorrheal proctitis. This symptom is characterized by itching and burning in the anal area. The act of defecation becomes painful, and false urges to empty the bowel appear. In addition to feces, yellow mucus begins to be released from the anus, in which blood may be visible. The anus is red, and pus is visible in the folds of the anus.

Gonorrheal pharyngitis. This disease may remain undetected for a long time, as it will masquerade as. When swallowing food, a woman develops a sore throat, and the lymph nodes located under the jaw increase in size. , but may persist at low-grade levels. It often happens that gonococcal pharyngitis produces meager symptoms, which manifest themselves exclusively as a sore throat. During the examination, the doctor visualizes red tonsils, which will be covered with a yellow-gray coating.

How does urine change with gonorrhea? In acute gonorrhea, the infection is localized in the anterior urethra, so the first portion of urine will always be cloudy, and the second will be clear. If the infection spreads to the posterior urethra, then frequent urination and increasing pain at the end are added to the existing symptoms. The urine portion will be cloudy in both portions.

Symptoms of the chronic form of the disease are subtle. Sometimes they will be missing. The disease can be suspected by vaginal discharge, but it is most often insignificant. From time to time a woman experiences pain in the lower back and lower abdomen. However, it is difficult to associate such manifestations of gonorrhea with infection.

Chronic gonorrhea causes the menstrual cycle to be disrupted. This failure is caused by inflammation of the uterus. Bleeding can occur in the middle of the cycle; the periods themselves differ in duration and pain. During menstruation, symptoms of gonorrhea such as: urethritis may worsen.

The vagina is not damaged by gonococci, since its mucous membrane is represented by squamous epithelium. While these pathogens prefer to reproduce in cylindrical cells. However, during pregnancy and in girls, symptoms of vulvovaginitis caused by gonococci may occur.

A woman does not find out about her infection immediately, but only after the incubation period, the duration of which usually ranges from 3-4 days to 2-3 weeks. It all depends on the properties of the pathogenic bacteria and the general condition of the patient’s body. Before the first symptoms appear, women most often feel quite healthy. 50-70% of patients do not experience any discomfort at all during the illness, and it is asymptomatic, due to which gonorrhea is diagnosed in a chronic form.

Gonorrhea is a dangerous disease, as it can cause the following complications:

Inflammation of the Bartholin glands, which are located near the entrance to the vagina.

Female infertility, which will be caused by obstruction of the appendages, or a violation of the structure of the endometrium of the uterus.

Decreased sexual desire.

Complications of pregnancy and the period after childbirth. The likelihood of spontaneous early onset of labor, delayed fetal development, early breaking of water, and ectopic pregnancy increases. If a child is infected with gonococci, he may die in the first hours after birth, or even in the womb. The woman herself increases the likelihood of purulent complications and.

The birth of a child with gonorrhea. The disease can cause otitis media, genital infections and even blood poisoning in the fetus.

Spread of the pathogen throughout the body. The dermis, joints, kidneys, liver, heart, and brain may be affected.

Conjunctivitis caused by gonococci. Infection occurs due to gross violation of hygiene rules.

Chronic gonorrhea in women often causes infertility, since inflammation leads to deformation of the fallopian tubes, the formation of adhesions, and infection (obliteration) of the tube lumen with connective tissue, thereby disrupting their patency. This pathology occurs in women in 8-20% of cases of chronic infection.

Practical experience: Tuboovarian complications in women with gonorrhea are not uncommon. During my night shift, a patient was admitted to the hospital with symptoms of body intoxication and complaints of severe abdominal pain. She also showed clear signs of pelvioperitonitis (irritation of the peritoneum). I have never seen such an advanced form of gonorrhea.

The patient was urgently sent for surgery, which lasted about 3 hours. All internal genital organs were surrounded by adhesions, and the appendages could not be visualized. The pus had already entered the peritoneal cavity, so it took some effort to remove it. The test results obtained after the operation revealed that the patient had gonorrhea. I have repeatedly operated on women with tubo-ovarian abscess, but I have never encountered such a severe course of the pathology.

To prevent all these undesirable consequences, women are recommended to undergo an examination at least once a year, and preferably more often, by a gynecologist in a district consultation, to use protective equipment during sexual intercourse, and to have a regular sexual partner.

Infection with gonorrhea is dangerous during pregnancy, since it develops very quickly due to good blood supply to the genitourinary organs and a decrease in the body's defenses. In addition, most often the disease is asymptomatic. If infection with gonococci occurs in the first trimester, this leads to spontaneous miscarriage due to the development of endometritis; at later stages, various complications and postpartum pathologies arise.

There is also a big risk:

Early rupture of amniotic fluid,

Premature birth,

Infection of a child in utero or during its movement through the birth canal,

Development of fetal pathology.

Intrauterine gonococcal infection is a huge problem for doctors and parents, since a newborn can develop sepsis, which poses a real threat to the baby’s life. Even if the child is not infected in utero, when passing through the birth canal, gonococci will certainly enter the ears and eyes of the newborn, which is why he will subsequently develop otitis media and conjunctivitis.

To avoid all of the above problems, experts recommend that women wishing to have a child undergo mandatory screening for the presence of gonococcal infection (gonorrhea) before pregnancy. And besides, during this period sex should always be protected.

To clarify the diagnosis, you will need to perform laboratory diagnostics:

Collection and microscopic examination of a smear from the cervical canal, vagina, rectum, urethra. The material is stained with gram, methylene blue, or brilliant green.

Collection of mucus from the urethra and cervix with its placement in nutrient media.

REEF. In this case, the material is colored with fluorescent dyes.

ELISA with urine testing.

RSK. To implement this serological test, you will need to take blood from a vein. This highly sensitive diagnostic method allows you to detect the chronic form of infection.

PCR. To conduct the study, you will need the patient's urine or smear.

You can do rapid testing for gonorrhea at home. Sometimes standard methods do not allow identifying the causative agent of the disease. This often occurs when the infection is chronic.

In this case, methods of provoking the disease are used:

Chemical provocation with lubrication of the urethra with a silver solution (1-2% concentration). Applying a solution of 2-5% concentration to the cervical canal.

Biological provocation. A gonococcal vaccine or Pyrogenal is injected into the patient's muscle.

Provocation with drinks and food. The patient is asked to drink alcohol or eat spicy or salty foods.

Thermal provocation. Diathermy is carried out for 3 days. Smears are taken 3 times, an hour after the procedure.

Physiological provocation. A smear test is performed during menstrual bleeding.

To obtain a reliable result, several types of provocation are simultaneously combined. A smear is taken 3 times every 1-2-3 days.

Practical experience: This story reminded me of my favorite writer Bulgakov. A well-groomed and well-dressed woman came to my appointment, but with fear in her eyes. She said that while traveling for work, her husband had intimate relations with a woman of easy virtue. Moreover, sexual intercourse took place without using a condom. As a result, he contracted gonorrhea. The woman came to get tested and find out her diagnosis. The Gram smear gave a negative result. I performed a provocative smear. It also turned out to be negative. This made the patient very happy. At the same time, I was pleased to work with her, since most often I detect gonorrhea in women during an examination for another reason, or during the development of purulent complications. This diagnosis comes as an unpleasant surprise to them. The whole problem is that Russian women often self-medicate and put off visiting a gynecologist. If there were more responsible patients in the country, as in the case I described, then the prevalence of the disease could be reduced.

How to prevent infection after unprotected sexual intercourse?

After rape or after questionable intimacy without using a condom, preventive measures need to be taken. They must be an emergency.

The likelihood of infection is reduced if you follow these recommendations:

Empty your bladder immediately after intimacy. It's good if you can do this several times. Pathogenic microorganisms will be removed from the urethra along with urine.

The inner thighs and perineum should be washed with soap.

Miramistin or Betadine must be injected into the urethra and vagina using a urological nozzle. The procedure must be performed no later than 2 hours after intimacy has occurred.

The perineum and inner thigh should be treated with an antiseptic. This could be a solution of potassium permanganate, Chlorhexidine, Miramistin.

Miramistin reduces the risk of contracting sexually transmitted diseases by 10 times: gonorrhea, genital herpes.

No later than 2 days later, you need to visit a doctor, and after another 14 days you need to take a smear for testing using the PCR method.

To cope with the infection, the woman will need to take antibiotics. Both sexual partners should receive treatment. During therapy, it is prohibited to drink alcohol or have intimate relations.

If gonorrhea has affected only the organs of the reproductive system, then the patient is prescribed a single administration of an antibacterial drug (oral administration is also possible):

Ceftriaxone 0.25 g. This drug is the most commonly prescribed antibiotic for the treatment of gonorrhea. It is used for patients of any gender. Ceftriaxone is active against various types of gonococci.

Gentamicin 2.0 g.

Sumamed 2 g. As an option, it is possible to take such medications as: Azitrox, Z-factor, Hemomycin, Azicide, Ecomed.

Cefixime 0.4 g.

Ciprofloxacin 0.5 g.

If the disease has spread to the upper parts of the reproductive system, the treatment regimen is slightly modified:

Ceftriaxone 1 g intramuscularly. The drug is administered once a day for a week. The patient is also prescribed Ciprofloxacin 500 mg intravenously 2 times a day for a week and Ofloxacin 0.4 g 2 times a day for a week. Treatment with Ceftriaxone can be supplemented with Doxycycline.

In addition to the listed antibacterial drugs, other antimicrobial agents can be used, for example, Clindamycin, Hemomycin, Sumamed, Zitrolide, Tetracycline, Rifampicin, Bicillin, Josamycin, etc.

To boost the immune system and to most successfully fight the disease, a woman is prescribed a gonococcal vaccine. This may be Pyrogenal, Methyluracil, Levamisole, Prodigiosan.

Autohemotherapy allows you to activate a woman’s own immunity and more successfully resist infection.

It often happens that gonorrhea is accompanied by other sexually transmitted infections. Therefore, the treatment regimen can be supplemented with drugs such as: Doxycycline (treatment course is 10 days) and Metronidazole (treatment course is 5-7 days). The urethra is washed with a solution of silver nitrate, and the vagina is douched with antiseptic agents. For this purpose, a solution of potassium permanganate and protargol can be used. Miramistin and chamomile decoction are also used.

Increasingly, doctors are faced with resistant gonococci that do not respond to standard treatment regimens. Thus, leading UK health expert Sally Davis points out that in 2013, about 80% of patients with gonorrhea did not respond to tetracycline treatment. Therefore, experts insist on complex therapy of the disease using 2 antibiotics at once. Azithromycin should be taken orally, and Gentamicin should be administered as an injection. Alternatively, Azithromycin is taken orally with Gemifloxacin.

If the patient develops complications, then surgery is indicated. Laparotomy with removal of the uterine appendages and lavage of the abdominal cavity is performed for pelvioperitonitis with suppuration (provided that conservative therapy did not achieve the desired result). Acute bartholinitis requires opening and drainage.

If a woman is diagnosed with chronic gonorrhea, then it can only be dealt with through the use of broad-spectrum antibiotics. When a patient develops gonococcal pharyngitis, or pathogens attack the intestines, Metronidazole is required (1 tablet 3 times). The course of therapy is 10 days. It is also possible to use Trichopolum vaginal tablets. Before insertion, the tablets are kept under running cool water and inserted into the vagina. Then you need to lie down for at least 30 minutes. Trichopolum is used once a day, 7-10 days.

If a woman suffers from thrush, then antifungal agents will be required. This may be Fluconazole, Miconazole, Pimafucin.

In addition, treatment can be supplemented with medications such as:

Bifidobacteria, probiotics, prebiotics, acidophilus bacteria. Their use allows you to normalize the microflora of the intestines and vagina, eliminate dysbiosis, normalize the acidity of the environment, and increase immunity at the local level. These may be medications such as: Acipol, Normobact, Yogulact, Linex, Acylact, Bifiform, Bifidumbacterin.

Local antiseptics. They allow you to speed up recovery and consolidate the therapeutic effect, as they effectively disinfect the vagina. To do this, you can use a solution of Furacilin or Hexicon.

Vaginal suppositories and tablets with an antibacterial effect: Vagisept, Pimafucin, Terzhinan.

Depending on the characteristics of the disease, the treatment regimen may vary. Self-administration of medications is not allowed.

To prevent the development of gonorrhea, the following recommendations must be followed:

During intimacy, you should always use a condom. The best protection is provided by condoms made from latex. Membrane products provide protection of no more than 87%.

Both partners should receive treatment.

Infection through household contact is rare. However, to reduce all risks to zero, you need to boil the bed linen and wash the dishes used by the sick person with hot water.

You need to refrain from intimacy until the end of therapy. You can resume sexual intercourse after test results are received indicating that there are no gonococci left in the body.

Education: Diploma in Obstetrics and Gynecology received from the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at NIMU named after. N.I. Pirogova.