Symptoms and signs of gonorrhea in women and men. How to treat gonorrhea

Gonorrhea (gonorrhea or just tripac) is a common sexually transmitted disease that can cause complications for a person if left untreated, and can also be transmitted to a newborn child.

This disease was known even before the birth of Christ; it has long been identified with one of the stages. But only in the 30s of the 19th century, in France, Dr. Philippe Ricor, working at the Midi Hospital for Venereal Diseases, concluded that gonorrhea existed as an individual disease.

Later, towards the end of the century, in 1879, the German doctor Albert Neisser discovered the bacterium gonococcus, which causes gonorrhea.

The entire genus of these bacteria (Neisseria) was named in his honor. It was Neisser who developed methods for treating this infectious disease.

What it is?

Gonorrhea is an infectious disease that primarily affects the human genitourinary system. Gonococcus bacteria inhabit the mucous membranes of the genitourinary tract of men and women, as well as the rectum, nasopharynx and eyes. It all depends on the immunity and the stage at which the tripper is located.

Gonococci are oval-shaped bacteria located in the human body in pairs. Their size variation is about 0.8-1.2 microns. They populate mainly in the cytoplasm of leukocytes of purulent discharge.

Chronic tripper and exposure to various medications can cause mutation of the gonococcus. Bacteria exist in capsule form and develop in a swarm-like community. In the external environment, when the temperature rises above 50°C, gonococci die instantly.

The bacteria are sensitive to penicillin antibiotics and streptomycins, but over time they become resistant to them.

Causes and factors for the development of the disease

The cause of the disease is sexual contact of various kinds with an infected partner.

Percentage of infection men from a sick partner - about 35%, among women the probability of infection is higher - about 65%.

Since men have a longer urethra, they are more likely to wash away bacteria with urine before damaging the urethral mucosa.

There is a possibility of infection of a child during childbirth from a sick mother and in living conditions (use of general hygiene products - washcloth, towel).

This is especially true for girls.

Gonococci can penetrate into a newborn baby in the event of premature damage to the fetal membrane, during the passage of the fetus through the birth canal (infection of the eyes or genital organs of girls occurs). Often a child is born blind.

The gonorrhea bacterium quickly dies in the external environment, but thrives on the surface of mucous membranes and inside epithelial cells and leukocytes. Gonococcal infection is divided into several types according to the location of damage to body tissues:

• in the genitourinary system.
• in the rectum (or inflammation).
• in the knee joint (gonarthritis).
• in the eyes (purulent conjunctivitis or blenorrhea).
• inflammation in the pharynx ().

The incubation period, when the gonorrhoea is in a latent state, ranges from 1-2 days to a couple of weeks, sometimes up to 1 month. In men, the disease manifests itself faster.

Symptomsgonorrhea in men

In the first case, when the male genitourinary system is damaged by gonococcal bacteria, copious purulent discharge from the urethra and pain when urinating in the form of a burning sensation.

Unlike women, symptoms in men appear faster (on the second day a cutting pain may bother you).

If tripera in men penetrates the posterior part of the urethra, the testes, epididymis, etc. may be affected. In case of insufficient human immunity, the disease threatens to develop into (blood poisoning).

During the infection, acute urethrocystitis (inflammation of the mucous membranes of the urethra and bladder) can develop. In this case, the symptoms intensify, and blood may appear at the end of urination. If the patient is still affected, then his condition will worsen.

Triperal disease in men, in almost half of the cases, affects the rectum. The inflammatory process begins redness, growths, and rash appear in the anus. After bowel movement, a burning sensation and slight bleeding may occur.

The disease can develop independently or together with inflammation of the urethra. This infection occurs as a result of oral-genital contact between partners. In addition to damage to the pharynx, the tonsils and the entire oral cavity can be infected.

Inflammatory symptoms of the mucous membrane

The symptoms of pharyngitis are mild. Sometimes it bothers me, pain and soreness during swallowing.

When examined by a doctor, there may be swelling, a grayish coating in some areas of the oral cavity, and an increase.

Gonococcal arthritis

Gonococcal arthritis usually affects those who have proctitis. The main signs of the disease are redness and swelling of the joints of the fingers, ankles, and wrists.

The disease is detected by taking blood and joint fluid tests.

Signs and complications of chronic disease in men

At the stage of chronic gonorrhea, inflammatory processes are expressed in the following male organs:

• the skin of the head of the penis and the inner part of the foreskin (see photo above);
• Cooper's gland;
• prostate;
• seminal vesicles;
• epididymis;

Signs of a chronic course of the disease are gluing of the lips of the urethra in the morning, small discharge and changes in the epithelium of the urethra. Among the complications, it can also be noted.

Symptomsgonorrhea in the female half

In women, as in men, tripak affects various organs and is not noticeable at the initial stage. The first signs of the disease in women can appear only after 1-2 weeks(see photo above). Gripper disease in its classic form provokes the following symptoms in women:

• small purulent whitish or grayish vaginal discharge;
• painful urination (burning, itching, sometimes stinging);
• redness, swelling, the appearance of ulcers in mucous areas;
• pain in the lower abdomen;
• bleeding during the absence of menstruation.

Symptoms of inflammation of the cervix and urethra

When gonorrhea spreads in the cervix, a woman experiences frequent purulent discharge with an unpleasant odor.

During sexual activity, pain and slight bleeding occur.

Bacterial damage to the urethra is accompanied by the same discharge and pain when urinating. Both organs can be infected at the same time.

When the pelvic organs are infected, the body temperature may rise, nausea and vomiting may occur, and sexual intercourse may be painful.

Symptoms in women are the same as in men:

• arthritis;
• proctitis

Complications during the course of the disease in women

In women, when the ovaries and fallopian tubes become inflamed, ectopic pregnancy, tubal obstruction and infertility may subsequently occur.

A newborn child, due to gonorrheal conjunctivitis, may remain blind forever (see photo above).

Diagnostics

To detect the disease, it is enough to take a smear in the rectum, cervix (women), or throat.

Most often, gonorrhea is diagnosed bacteriological diagnostics, which gives 90% correct research results. There is a method polymerase chain reaction- This is an experimental method, it is more sensitive.

Treatment of infection

Nowadays, tripper is an infection that increasingly resists penicillin antibiotics and often affects the body along with.

For pregnant women, the doctor will select individual treatment ( Spectinomycin or other similar drugs).

In case of complications or chronic course of the disease, the patient requires hospitalization. Here are a few of them:

• the disease affected various human organs;
• the infection has spread through the blood throughout the body ();
• the patient avoided treatment;
• unexpected relapses of gonorrhea.

During treatment, the patient is prohibited from sexual intercourse; it is required to eliminate bad habits, lead a calm lifestyle and not get too cold. To boost immunity, the doctor prescribes various medications.

All treatment efforts, taken together, will give a positive result.

Important: Never self-medicate, go to a clinic. Only a specialist can determine the necessary medications and their dosages.

Interesting

Sexually transmitted infections can occur quite unexpectedly if there are unprotected contacts and insufficient hygiene. Commonly known as the gonorrhea, gonorrhea is a disease caused by gonococcus that occurs frequently in both women and men. After reading the article, you will learn how you can protect yourself from such an infection and how to treat it if the protection has failed.

Gripper is the most common sexually transmitted disease. In most men, the infection manifests itself within the first week after infection, but for women the situation is different. With strong immunity, this infection does not make itself felt until its acute form.

Gonorrhea can affect not only the vaginal tissue, but also the rest of the mucous membranes of the body:

• Eyes
• oral cavity
• rectum
• in rare cases, lungs and joints

The main route of infection with gonorrhea is unprotected sex. A woman has about a 50/50 chance of catching an infection from a sick partner.

It is also possible to transmit gonorrhoea through household items, for example, using a bathroom, shower, or washcloth of a sick person. To be fair, it is worth noting that only 1 out of 100 patients became infected this way.

Types of gonorrhea

Gonococcal infections are divided according to the time of infection:

• Fresh - less than 2 months have passed since the estimated moment of infection
• Chronic - more than 2 months

By manifestation:

• Acute - appears suddenly and has pronounced symptoms
• Symptoms develop gradually - subacute form
• The symptoms of the torpid course of the disease are hardly noticeable
• Asymptomatic latent variation is also noted

According to the location of inflammation, they are distinguished:

• gonorrhea of ​​the upper part of the genitourinary system (pelvic organs, uterine cavity, appendages and fallopian tubes);
• lower sections (cervix, vagina and urinary tract);
• other organs (eyes, mouth, lungs and joints).

Gonorrhea of ​​the lower sections may be accompanied by inflammation of the Bartholin glands (responsible for lubrication). A painful formation appears at the entrance to the vagina; it is treated surgically.

Latent form of gonorrhea

In 75-80% of women, gonorrhea occurs in this form. There are practically no symptoms throughout the entire course of the disease. The woman continues to feel well, but the infection is spreading further. This means that the disease promises to become chronic.

Gonococcus can go into a latent form under the influence of medications that are not able to eliminate it. Therefore, if you suspect any STD, you should contact a venereologist or gynecologist.

Chronic gonorrhea in women

Since most women have vague symptoms of gonorrhoea, they are more likely than men to develop the disease into a chronic condition. Chronic gonorrhea may be suspected:

• Frequent ailments (within a month)
• Persistent vaginal discharge (does not necessarily look like pus)
• Bloody discharge not during menstruation
• Many people become constipated
• Fatigue, irritability, sleep disturbances

More than half of the patients with a latent form received it as a result of incomplete treatment. That is, after treatment for acute gonorrhea, they did not pass the control test or, when they felt better, stopped taking antibiotics.

Treatment of chronic gonorrhea has its own specifics:

1. To aggravate the course of the disease, you will be prescribed a special drug that will increase the activity of bacteria.
2. After testing, the doctor will identify the pathogen and test its sensitivity to antibiotics.
3. Then you will be prescribed exactly the drug that will suppress your strain of gonococcus.

Signs of gonorrhea in women

The first symptoms of gonorrhea in women are too similar to the signs of other diseases, which is why many do not consult a gynecologist in time. The statistics are sad: 8 out of 10 sick women were unaware of their illness until gonorrhea became acute.

Symptoms of incipient gonorrhea:

• Unpleasant sensations when urinating, frequent urge to empty the bladder. Ladies often mistake this symptom for the onset of cystitis.
• Minor discharge very similar to thrush.

With such symptoms, a woman can live through the entire incubation period - from 2 to 10 days, rarely 1 month - only then notice a worsening of the condition. Unfortunately, by the time of diagnosis, the woman is diagnosed with chronic gonorrhea.

Signs of acute vaginal gonorrhea:

• Purulent discharge - appears when bacteria begin to multiply very actively
• Severe pain when urinating
• Lower abdominal pain
• Bloody discharge during the intermenstrual period
• Swelling, irritation of the genitals
• Sometimes gonorrhea is accompanied by fever and weakness

Vaginal gonorrhea can be accompanied by lesions of gonococcal infection on other mucous membranes of the body and manifests itself as:

• symptoms of conjunctivitis (with eye gonorrhea);
• bad breath, pus on the walls of the throat, dry mouth, usually indicating stomatitis (oral gonorrhea);
• sore throat, headache and other symptoms of sore throat (with gonorrhea of ​​the throat).

Together with the previous symptoms, these signs may clearly indicate the presence of a disease such as gonorrhea.

The latent form of gonorrhea, as the name implies, shows almost no symptoms. With it, gonococcus destroys the epithelial tissue of the genital organs. Instead, a scar forms. So, without noticing it, a woman can remain infertile.

Gonorrhea of ​​the rectum (in those who practice unprotected anal sex) is characterized by:

• Purulent-bloody discharge from the anus
• Itching and burning at rest
• Painful bowel movement

Complications of gonorrhea in women

Complications of this disease directly depend on the location of the gonococcus. The overall result of delaying treatment can be sepsis, as well as infection of other organs, since the infection can spread through the bloodstream to any part of the body.

The most likely complication is infertility. The second most likely is an increase in the chances of an ectopic pregnancy due to worsening tubal patency of the uterine appendages.

Smear test for gonorrhea in women

Diagnosis of gonorrhea is as follows:

• Anamnesis collection. You need to describe the symptoms as accurately as possible and talk about all sexual contacts.
• Taking tests. A sample of blood, urine, and a swab from the vagina (possibly the oral and nasal cavities, anus and eyes) is taken.

Along with tests for gonococcus, tests for other STDs are carried out. Based on the results, the doctor will select treatment for you for the entire range of diseases at the same time.

In the chronic form, diagnosis is complicated by a small number of microorganisms in the sample. Therefore, you should contact those institutions where there is a modern research laboratory.

How to treat gonorrhea in women?

Treatment for patients with gonorrhea includes:

• antibiotic treatment
• treatment with antibacterial solutions
• relief of pain symptoms
• restoration of microflora of the affected mucosa

It should be noted that all sex partners must undergo treatment at the same time. At the end, you need to be observed by a doctor for some time (for 2-3 months), and 10-14 days after finishing taking the medication, you need to be tested for gonorrhea again.

Features of treatment of gonorrhea:

• Every year the number of strains resistant to standard treatments increases, which is why the number of new drugs to combat the disease increases every year. Because of this, treatment should be carried out under the strict supervision of a doctor who will select medications specifically for your case.
• Folk remedies cannot cure gonorrhea, but they can easily harm your health and aggravate the situation.
• Gonorrhea coupled with trichomoniasis (almost half of the cases) requires complex treatment.
• During treatment, you should follow a diet excluding salty, smoked, spicy, and alcoholic drinks.

What drugs are used to treat gonorrhea in women?

Please note that this paragraph is for informational purposes only. Do not self-medicate under any circumstances! This has serious health consequences.

Most often, treatment for gonorrhea is complex and the doctor prescribes a number of drugs and procedures. The main medications for the treatment of gonorrhea are:

1. Gonorrhea of ​​the lower part of the genitourinary system without complications - Tsifran, Orfamax, Rocephin
2. Gonorrhea of ​​the lower part of the genitourinary system with complications - Orfamax, Rocephin, Trobitsin
3. When combined with chlamydia - Metronidazole, Tiberal, Gairo, Fazizhin, Naxodzhin

Prevention of gonorrhea in women

The main method of preventing gonorrhea is protected sexual intercourse. Even women who have regular partners can become victims of this common infection, because it is not possible to give a 100% guarantee that a sexual partner will not have casual relationships.

Methods for preventing gonorrhea:

1. Elimination of casual sexual contacts;
2. Use a condom as a method of contraception;
3. Significantly reduces the risk of infection by treating the genitals with disinfectants (Miramistin, Betadine, etc.) within a couple of hours after sexual intercourse;
4. Periodic examination by a gynecologist.

Don't wait for serious problems with women's health before turning to a specialist. Visit your gynecologist regularly, and if strange symptoms occur, do not delay your visit to the doctor. Be healthy and may unpleasant diseases pass you by.

Video: Gonorrhea - symptoms, treatment, prevention

Gonorrhea is an infectious disease that is sexually transmitted and affects the mucous membranes of the external and internal genital organs, urethra, rectum, pharynx, and eyes.

The causative agent of gonorrhea is the bacteria Neisseria gonorrhoeae. A feature of gonococci is that they can live on the membranes of body cells and in the cells themselves. There are strains of gonococci that are resistant to antibiotics and antibodies produced by the body. This significantly complicates the treatment of the disease.

The disease is transmitted sexually and is therefore considered venereal. Infection with gonorrhea is possible through any type of sexual contact - vaginal, anal and oral. Women are more likely to contract gonorrhea. Statistics show that women have an up to 80% chance of contracting gonorrhea through contact with an infected partner, and up to 40% for men. The male genital organs are more protected from gonorrhea: the urogenital canal is narrower, and urine can wash away gonococci during urination.

Infection with gonorrhea through household means is very rare, since the bacteria die in an aggressive external environment when exposed to the sun and household chemicals. Infection is possible through hygiene items, such as a towel, or a shared restroom. Women are also more likely to become infected at home than men.

Another way of infection is during childbirth. An infected mother can pass gonococci to her baby as the baby passes through the cervix and vagina. In this case, the eyes of newborns and genitals are affected. Genitourinary congenital gonorrhea is diagnosed mainly in girls. In boys, the conjunctiva of the eyes often suffers from gonorrhea, which can cause vision loss.

Types of gonorrhea

Gonorrhea can affect different parts of the body.

Depending on the location of gonorrhea, several types of the disease are distinguished:

• gonorrhea of ​​the urethra and genitals;
• gonorrhea of ​​the anal and rectal area;
• gonorrhea of ​​the skeletal and muscular system;
• gonococcal pharyngitis;
• gonococcal eye infection;
• gonorrheal endocarditis;
• gonorrheal meningitis.

Gonorrhea of ​​the genitourinary organs affects the mucous membrane of the urethra, cervical canal, uterus, fallopian tubes, ovaries, periurethral glands and peritoneum. In men, the urethral area is most often affected. In rare cases, when the local immunity of the vagina is reduced, the vaginal epithelium may be damaged by gonorrhea.

Gonorrhea of ​​the anal and rectal area is diagnosed as gonococcal proctitis. The rectal mucosa is affected. This type of gonorrhea is more often diagnosed in gay men and during genital-anal contact in traditional couples.

With gonococcal pharyngitis, redness of the throat, formation of purulent plaque, and enlarged lymph nodes are observed. Can be transmitted through genital-oral contact. In some cases, infection occurs through the use of dishes from infected people. It is most often transmitted through oral contact with patients.

Gonorrhea of ​​the skeletal and muscular system is also called gonoarthritis. It affects the joints, which leads to impaired mobility and pain. Develops with untreated chronic gonorrhea.

Gonococcal eye infection is called blenorrhea and affects the conjunctiva of the eyes. It is often diagnosed in newborns - on the second or third day after birth, if the mother is sick or is a carrier of gonorrhea. It is very rarely transmitted through sexual contact.

According to the duration and severity of the disease, fresh and chronic forms of gonorrhea are distinguished:

• with fresh gonorrhea, infection occurred less than 2 months ago;
• with chronic gonorrhea, infection occurred more than 2 months ago.

Fresh gonorrhea is further divided into acute (with pronounced symptoms), subacute (with less pronounced symptoms) and torpid (with minimal symptoms).

With chronic gonorrhea, the symptoms of infection are less pronounced than with acute gonorrhea, but the likelihood of complications is high.

In rare cases, a person can become a carrier of gonococci, but not get sick. Gonorrhea carriage can only be determined through laboratory testing. This is a dangerous option, since a person is a source of infection for a sexual partner and people around him. With a decrease in immunity, symptoms of gonorrhea may also appear in the carrier.

How does gonorrhea manifest?

The onset of symptoms after infection does not occur immediately. The incubation period for gonorrhea can last from 1 to 14 days. The duration of the incubation period depends on the method of infection, the location of the gonococci and the immune status of the patient.

The clinical picture is different for men and women. Symptoms also differ for different types of gonorrhea.

Fresh gonorrhea of ​​the genitourinary organs in women has the following symptoms:

• purulent vaginal discharge;
• frequent urination, accompanied by itching, burning and pain;
• intermenstrual bleeding;
• disruption of the female cycle;
• pain in the abdomen, in its lower part;
• the appearance of ulcers on the genital mucosa;
• discoloration and swelling of the genital mucosa;
• temperature rise above 39 degrees;
• indigestion - nausea, vomiting, diarrhea, abdominal pain.

The clinical picture of gonorrhea in women may change if other sexually transmitted infections are associated with gonorrhea.

Fresh gonorrhea of ​​the genitourinary organs in men has the following symptoms:

• narrowing of the urethra caused by swelling of the urethral mucosa;
• burning and itching in the genitourinary canal;
• purulent discharge from the urethra;
• frequent urination, accompanied by pain and burning;
• fever and chills.

Chronic gonorrhea of ​​the genitourinary organs manifests itself as follows:

• in men and women, adhesions appear in the pelvis, which can cause infertility;
• in men, libido decreases, erectile dysfunction is observed, including impotence;
• In women, the menstrual cycle is disrupted, there is severe inflammation of the internal organs of the intimate sphere, and fertility (the ability to conceive and bear a child) decreases.

Gonorrhea of ​​the anal and rectal area in men and women is accompanied by:

• painful bowel movements;
• itching, swelling and burning in the anus;
• fever;
• purulent discharge from the anus;
• ulcers of the rectum and anus;
• proliferation of polyps in the rectum (with chronic rectal gonorrhea).

Blennorea has the following symptoms:

• inflammation, swelling and redness of the conjunctiva;
• purulent discharge from the eyes;
• ulcers on the mucous membranes of the eyes;
• inflammation of the cornea of ​​the eyes;
• appearance of a cataract (rare);
• blindness (without treatment or with congenital blennorrhea).

When infected during childbirth, bilateral blenorrhea is usually diagnosed. In other cases, unilateral inflammation is possible.

Diagnostics

Diagnosis of gonorrhea is carried out by different specialists. Gonorrhea of ​​the genital tract in women is dealt with by a gynecologist, and in men by a urologist. A proctologist diagnoses rectal gonorrhea. An otolaryngologist deals with gonococcal pharyngitis. Blenorrhea is treated by an ophthalmologist, gonorrheal meningitis is treated by a neurologist. An infectious disease specialist is also involved in the diagnosis and treatment of gonorrhea. It may be necessary to consult an immunologist.

It is almost impossible to detect gonorrhea by visual examination, since it often occurs without pronounced symptoms, so laboratory diagnosis is necessary. For analysis, they take secretions from the genitals, anus, eyes, and make a smear from the mucous membrane of the throat. Next, the biological material is examined under a microscope, bacterial culture is carried out, and PCR diagnostics are performed.

Gonorrhea is often accompanied by other STDs, so additional testing is carried out for various infections and viruses. In women, cytology of the cervical canal mucosa is performed; in men, urethroscopy is performed.

Diagnosis of gonorrhea is carried out several times. This is necessary to track progress in treatment. After completion of treatment, a follow-up examination with collection of material for laboratory testing is indicated.

Sexual partners of the infected person should also be screened for gonorrhea, even if they have no symptoms. This is a delicate issue, but you cannot hide the fact of diagnosing the disease from your partner.

Treatment

Gonorrhea should be treated by a doctor, otherwise complications may develop. In adults, uncomplicated gonorrhea is treated at home; children are treated in a hospital under the supervision of several specialists. The prognosis for the treatment of this disease is usually positive. The difficulty in treating this disease is that gonococci often form strains that are resistant to antibiotics - this causes difficulties in selecting adequate treatment. Untreated gonorrhea always becomes chronic.

During treatment for gonorrhea, sexual activity is prohibited to avoid re-infecting each other. Alcohol, active sports training, and hypothermia are prohibited.

Antibiotics play a vital role in the treatment of gonorrhea. They are prescribed orally, intramuscularly, in the form of vaginal or rectal suppositories, in the form of ointments, solutions and creams.

Treatment of gonorrhea is carried out comprehensively. Along with other therapeutic methods, physiotherapy is also used - electrophoresis, UHF, magnetic therapy. Immunotherapy speeds up treatment and helps the body fight infection.

In case of acute purulent gonococcal process in the peritoneum or uterus, surgical treatment is necessary. The doctor opens the area of ​​the abscess, removes purulent masses and dead tissue, and treats the tissue with antimicrobial agents.

Without adequate treatment, gonorrhea can cause numerous complications:

• infertility;
• impotence;
• ectopic pregnancy in women;
• blood infection with gonococci with their subsequent spread throughout the tissues.

How to prevent gonorrhea

Prevention of gonorrhea - a healthy lifestyle, maintaining good hygiene and avoiding promiscuity. You should use only your own hygiene items - sponge, towel, toothbrush. You should not sit on toilets in public places; after visiting the restroom, you should wash your hands with soap or treat them with a disinfectant solution. During sexual intercourse, it is advisable to use barrier contraception.

When planning a pregnancy, be sure to be screened for gonorrhea. This will keep the baby and mother healthy. Perhaps the worst consequence of gonorrhea is the infection of children, because this often leads to irreversible blindness.

In Russia, regular screening for gonorrhea is mandatory for workers in the fields of education, medicine, and public catering. Medical examinations are carried out annually and the results of the examinations are recorded in the personal medical record.

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.

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 (gonova vaccine intramuscularly), 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

Even in the enlightened 21st century, when everyone knows everything about sexually transmitted infections and contraceptive methods, gonorrhea is the most common sexually transmitted disease. In many ways, the problem is caused by infection in women, since their disease is often asymptomatic. A woman leads a normal life for months, changing sexual partners, and not suspecting that she has “rewarded” each of them with her infection.

The causative agent of the disease is the bacterium gonococcus, which in its prevalence is second only to chlamydia (the causative agent of chlamydia). Gonococcus can enter a woman’s body in the following ways:

• sexual- the most common route of infection. Possible with unprotected vaginal and anal sex, the lowest risks are with oral sex. In the vast majority of cases, a woman becomes ill during sexual intercourse. The source of infection most often is the vagina and urethra. It can also be the rectum (for anal intercourse) and the oral cavity (for oral intercourse). Moreover, with oral contact there is less chance of getting sick, since saliva has an antibacterial effect and kills most gonococcal bacteria.
• from an infected mother to the fetus. Infection occurs when a fetus passes through an infected birth canal.
• domestic– a rather rare route of transmission of the pathogen. As a rule, it is carried out through a washcloth, bed linen, dirty linen and other items used by an infected person. The possibility of becoming infected with gonorrhea through household means (through hygiene products, dishes, etc.) is almost excluded, since gonococcus is not able to live outside the human body and quickly dies. However, there is a possibility of transmission of the disease from an adult to a child if they sleep in the same bed with a clear violation of hygiene standards.

Gonorrhea is classified according to duration - fresh (the disease lasts no more than 60 days) and chronic. The latter can be asymptomatic, hidden, subacute. Gonococci cannot remain content in the affected area for long and tend to spread. So gradually, from the vagina, the bacterium “conquers” the uterus, ovaries, and fallopian tubes.

Types of gonorrhea in women

The causative agent of gonorrhea is gonococcus bacteria, which have a tendency to spread. Clinicians distinguish two types of gonorrhea: fresh and chronic ascending.

Acute

Acute gonorrhea – infection time is two months. This type is divided into several forms: acute, subacute and sluggish (torpid) - oligosymptomatic or asymptomatic.

Chronic

Chronic gonorrhea is a period of infection of more than 2 months or of unknown duration. May cause endometriosis of the uterus, fallopian tubes and pelvic peritoneum, as well as inflammation of the ovaries.

Hidden

Latent and asymptomatic – occurs without any symptoms. Most often it is discovered accidentally during laboratory diagnostics.

In addition, gonococcal carriage is possible; this is a form of infection in which the pathogen is present in the human body, but no manifestations of the disease are detected.

First signs and incubation period

The incubation period of the disease lasts from several days to 3 weeks. Symptoms appear no earlier than 5 days after infection. How quickly the disease spreads and makes itself known depends on the patient’s age, concomitant diseases, and immunity. When the body’s protective functions are depleted, the first signs may appear within two days after infection. In pregnant women, gonorrhea spreads especially quickly, which is associated with increased blood flow to the genitals and decreased body immunity. The danger also lies in the fact that expectant mothers show almost no signs of infection.

Female gonorrhea in the first stage often occurs without symptoms. But in most cases, women still have subtle signs of gonorrhea. They are often attributed to the onset of thrush and other non-dangerous sexual disorders, which is why treatment does not begin on time, and the disease moves to the next stage. The symptoms of the disease depend on where the virus enters the body.

When visiting a doctor, women complain of pain in the urethra and a sudden burning sensation. Often there is a frequent urge to urinate, and over time, specific vaginal discharge. As a rule, their appearance is accompanied by:

• Discomfort in the vagina.
• Burning.
• Itching.
• Pain of varying degrees in the lower abdomen.

Rarely, in the acute stage of the disease, symptoms such as:

• Sore throat.
• Temperature increase.

During the examination, the gynecologist notes minor damage to the mucous surface of the uterus, as well as hyperemia (swelling) around the opening of the urethra. In addition, purulent discharge is visible from the lumen of the cervix.

To confirm the disease, the doctor prescribes a series of laboratory tests on material taken from the genitals.

In the video in this article, the doctor shares information about the signs of gonorrhea, including in women.

Main symptoms

After contracting this infection, characteristic discharge appears - this is the first and classic symptom of this disease. Most often they have a thick consistency, yellow or white color, and have an unpleasant pungent odor. In most cases, women mistake such manifestations for thrush or colpitis and begin self-medication, which significantly erases the clinical picture of a sexually transmitted disease.

In addition, gonorrhea in women has the following manifestations:

• Inflammation of the uterus and appendages. The infection spreads higher, and the endometrium and appendages are affected. There is nagging or sharp pain in the lower abdomen, purulent discharge with blood, and rarely, intoxication (malaise, loss of appetite, etc.).
• Cervicitis - in addition to discharge, a woman is bothered by itching and severe burning in the vaginal area. Upon examination, hyperemia (edema) of the cervix is ​​noticeable, which becomes scarlet in color. These symptoms indicate the presence of gonorrheal cervicitis.
• Urethritis, cystitis, pyelonephritis. These diseases are caused by infection of the urethra caused by gonorrheal urethritis. Patients complain of frequent, painful urination. As the bacterial infection progresses, the bladder and kidneys are involved.

Gonorrheal vaginitis

Characterized by the following symptoms:

• frequent urge to go to the toilet;
• discomfort and pain when urinating;
• spotting not associated with menstruation;
• pain in the lower abdomen;
• purulent vaginal discharge.

Some women experience all of these symptoms at the same time, but it is more likely that only one of them will appear. If appropriate treatment is not started at this stage, the disease will progress to the chronic stage. Often the disease is understood higher and spreads to the uterus with appendages, while the symptoms intensify, the pain in the lower abdomen intensifies. Additionally, body temperature rises (up to 39 degrees Celsius), general signs of intoxication appear - aches, nausea, fatigue.

Gonorrheal pharyngitis and stomatitis

When infected through the oral route, the following symptoms appear:

• inflammation of the gums;
• small purulent wounds on the oral mucosa;
• sore throat;
• increased salivation;
• redness and enlargement of the tonsils;
• pustular lesions on the tonsils.

Due to the similarity of symptoms, gonorrheal pharyngitis is often confused with tonsillitis and therefore inappropriate treatment is prescribed. Therefore, when diagnosing a disease, it is important to take a smear to determine the pathogen. With strong immunity, gonorrhoea occurs with smoothed symptoms. The patient only has a slight sore throat and slight hoarseness.

Gonorrheal proctitis

Develops if the infection enters through the rectum. This happens during unprotected anal sex, but penetration of the pathogen is also possible during classical sexual intercourse, since the vagina is located in close proximity to the anus. The symptoms of gonorrheal proctitis are subtle, making it very difficult to identify the disease.

Warning signs:

• itching in the anus;
• purulent mucous discharge from the rectum;
• streaks of blood in the stool;
• discomfort and pain during bowel movements.

There may be a false urge to go to the toilet (tenesmus), accompanied by pain. A visual examination shows that the anus is red and its folds are covered with purulent discharge.

Gonococcal conjunctivitis

This form usually occurs in infants when the disease is transmitted to them from an infected mother during childbirth. In this case, gonorrhea manifests itself very noticeably: the eyelids swell greatly, pus is released abundantly, which makes it impossible to unstick the eyelids without special washing. At the same time, the mucous membrane of the eyes is very irritated. In the most advanced cases, it is possible that the disease may spread to the cornea, causing it to become cloudy and vision to deteriorate.

Chronic gonorrhea

If the disease lasts more than two months, then it is said to be in a chronic stage. In this case, the symptoms become less obvious, the signs are mild. Occasionally, the disease manifests itself as nagging pain in the lower back or lower abdomen, and foul-smelling vaginal discharge. If the disease has spread to the uterus, the menstrual cycle is disrupted and intermenstrual bleeding appears. At the same time, periods become more abundant and last 1-2 days longer.

Against the background of chronic gonorrhea, other diseases of the genital area often worsen. For example, thrush, urethritis, endometritis. Typically, gonococci are located on the cylindrical epithelium and rarely affect the vaginal mucosa. However, pregnant women and girls may develop vulvovaginitis.

Complications of gonorrhea in women

What is dangerous about gonorrhea is not so much its unpleasant symptoms, but the high risk of complications that develop in most cases in the absence of adequate treatment. Most often, among diseases developing against the background of gonorrhea, women are diagnosed with:

• bartholinitis - damage to the Bartholin glands located in the vestibule of the vagina;
• infertility - associated with developed tubal obstruction and endometrial damage;
• a sharp decrease in libido and, as a result, a drop in the quality of sexual life;
• problems with bearing a child and complications after childbirth - there is a high risk of miscarriage, premature birth, delayed fetal development, there is a possibility of the child dying in the first days of life, as well as the appearance of purulent-septic diseases;
• infection of a child - development of gonococcal conjunctivitis, inflammation of the inner ear, infection of the genital tract in girls, etc.;
• penetration of the gonorrhea into the blood and spread of the disease throughout the body, which leads to infection of the joints, skin, internal organs, and brain.

In the most advanced cases, pelvioperitonitis or purulent peritonitis develops, caused by multiple adhesions in the abdominal cavity. Sometimes this leads to acute intestinal obstruction and requires immediate surgical intervention.

Diagnostics

The vaginal form of gonorrhea is usually diagnosed by a venereologist or gynecologist during a routine examination. In this case, materials are taken for analysis from the vagina, urethra, rectum - depending on the location of the outbreak. Smears are examined under a microscope and examined by PCR and PIF. There are special rapid tests that can help you identify this disease at home.

The diagnosis of gonorrhea is confirmed only after a series of studies:

• Microscopy of smears from the vagina, urethra and cervical canal.
• RSC is a serological method. The study of venous blood is the most effective method for diagnosing this disease in a chronic form.
• Culture method. Sowing in a special nutrient medium the discharge taken from the urethra and cervix.
• ELISA – examination of the patient’s urine.
• RIF – coloring of a smear from the cervix with special dyes.
• PCR – examination of smears and urine.

If the diagnosis is confirmed, the attending physician prescribes complex therapy.

In chronic forms of gonorrhea, it is not possible to detect the pathogen in scrapings. But if this disease is suspected, various provocations are arranged (chemical, mechanical, biological, nutritional, etc.), after which several smears are taken in succession with an interval of 24 hours.

As soon as a woman finds out that she has gonorrhea, she must stop all sexual contact with her partners. Avoidance of this rule is perceived as maliciously infecting other people.

If the gonorrhea is localized outside the genitourinary system, then it is identified by other specialists - an ophthalmologist for gonococcal conjunctivitis, a dentist or otolaryngologist for damage to the oral cavity. After gonorrhea is detected in one of the family members, all members of his household are sent for diagnosis. In addition, a woman must notify all sexual partners with whom she has had recent contact about her diagnosis.

Treatment of gonorrhea in women

Therapy is selected depending on the stage and location of the infection. Treatment is based on drug antibacterial therapy. If gonorrhea is accompanied by other sexually transmitted diseases, then the course of treatment is expanded. The duration of treatment depends on the form of the disease. Acute gonorrhea can be treated with a single dose of medication. With an ascending infection, the course of treatment is delayed for 5-7 days. Chronic gonorrhea takes even longer to treat. In this case, drugs that improve immunity are prescribed, as well as washing the affected area with antiseptics. Autohemotherapy sessions effectively activate the protective functions of a woman’s body.

Acute gonorrhea is the easiest to treat. The course of therapy includes a single dose or administration of an antibacterial drug:

• Sumamed 2 g (Azitrox, Ecomed, Azicide, Z-factor, Hemomycin).
• Gentamicin 2.0 g – intramuscularly.
• Ciprofloxacin 0.5 g or Cefixime 0.4 g – orally.

Ascending acute gonorrhea is treated with the following drugs:

• Ceftriaxone – once a day for a week.
• Ofloxacin - twice a day for 7 days.
• Ciprofloxacin - twice a day for 7 days.

Therapy for the chronic form of gonorrhea is usually supplemented with immune stimulants and an effective gonococcal vaccine (Methyluracil, Prodigiozan, Pyrogenal are used).

In advanced cases and complications, one cannot do without surgical treatment, in which abscesses are opened, wounds are washed and drained, appendages are removed, and the abdominal cavity is sanitized - all depending on the stage of the disease.

Expert opinion

Lyuvanova Arina Viktorovna, specializes in female venereal diseases

During the period of therapy, a woman infected with gonorrhea is prohibited from having sexual intercourse and drinking alcoholic beverages. During treatment, bacteriological control is carried out. The onset of recovery is determined by the results of scrapings and smears in which no gonococcus bacteria are observed.

Unprotected coitus: how not to get sick

If you have had sexual intercourse with an unverified partner, then simple manipulations will help you avoid the development of gonorrhoea:

• immediately after sexual intercourse, urinate - preferably several times (urine washes away the gonorrhea pathogen);
• thoroughly wash the external genitalia and thighs with soap, rinse your mouth with an antiseptic solution if there has been oral contact;
• Inject Betadine solution into the urethra and vagina
  Miramistin from a special bottle with a urological attachment - this should be done as early as possible (within two hours after sexual intercourse);
• treat the skin of the labia and inner thighs with an antiseptic (Miramistin or a light pink solution of potassium permanganate is good).

Miramistin is a unique development of Soviet pharmacists, which reduces the likelihood of contracting gonorrhea and some other STDs by 10 times.