Gonorrhea etiology pathogenesis clinical diagnosis. Gonorrhea in women. Clinic (symptoms), diagnosis and treatment of gonorrhea. Medicines to treat gonorrhea

Definition. Gonorrhea is an infectious disease caused by gonococci, which is usually transmitted sexually and usually affects the mucous membranes of the genitourinary organs, and sometimes the mucous membranes of the oral cavity, pharynx (with orogenital contact) and rectum (with homosexual contact).

Etiology and pathogenesis. The causative agent of gonorrhea Neisseria go-norrhoeae- Gram-negative diplococcus, which is an aerobe or facultative anaerobe. He looks like two

"coffee beans" folded with their concave sides facing each other. Gonococcus has dimensions of 1.25 µm in length and 0.7 µm in width, a three-layered outer wall, a cytoplasmic membrane, a cytoplasm containing a nuclear vacuole and ribosomes. In some strains (30-40%), microorganisms are surrounded on the outside by a polysaccharide capsule, which protects them from phagocytosis by leukocytes. This explains the incompleteness of phagocytosis and the phenomenon of endocytobiosis, characteristic of gonorrhea. In addition, gonococci are capable of forming L-forms, which have pronounced multiresistance to antibiotics.

The route of transmission of infection is usually sexual, and with a single contact with a partner, the infectivity is about 30%. Extrasexual infection can occur in girls when they wash their genitals with sponges contaminated with the secretions of mothers with gonorrhea, when they share a chamber pot, bed, etc. Gonococci affect the mucous membranes of the urethra, vagina, rectum, oral cavity, and conjunctiva , which is observed, for example, in a fetus passing through the birth canal of a sick mother, or in a patient with gonorrhea as a result of infection of the eyes with contaminated hands. The lesions they cause are acute purulent in nature, leading to a chronic inflammatory reaction of tissues resulting in fibrosis.

The incubation period is usually 3-5 days, but can range from one day to 3 weeks or more. Immunity is not formed during gonorrhea, so reinfections, including multiple ones, are possible.

Clinical picture. Gonorrhea manifests itself in fresh and chronic forms. The disease is no more than 2 months old - this is fresh gonorrhea, which can be acute, subacute and torpid (sluggish, asymptomatic). With a longer course of the disease, a diagnosis of chronic gonorrhea is made.

Attention should be paid to the great difficulties in detecting gonococci in patients with chronic gonorrhea. This is possible only after repeated research, with the help of provocations, and sometimes only in crops.

Gonorrhea in men. Fresh gonorrhea is characterized, first of all, by inflammation of the urethra - fresh gonorrheal urethritis. Acute urethritis is characterized by cutting pain during urination, swelling and hyperemia of the sponges of the external opening of the urethra, and copious purulent discharge. Inflammatory process or limited to the anterior part of the urethra

(anterior urethritis), or extends to its posterior part (total urethritis). Anterior urethritis is characterized by pain at the beginning of urination, while total urethritis is characterized by pain at the end of it. Patients with total urethritis also suffer from frequent uncontrollable urge to urinate. In subacute urethritis, all these symptoms are less pronounced, and the manifestations of torpid urethritis are limited to scanty mucopurulent or mucous discharge (sometimes only in the morning or when squeezing out), sticking of sponges in the morning, sensations of itching or tickling when urinating. Sometimes with torpid gonorrhea there are no clinical symptoms.

In order to establish the localization of the inflammatory process in the urethra, a two-glass urine sample is used. The patient releases urine alternately into two glasses. In acute anterior urethritis, the pus is washed away with urine into the first glass, so the urine in the second glass will be clear. With total acute urethritis, the urine will be cloudy in both glasses. In patients with torpid urethritis, the urine is only slightly cloudy (opalescent) or transparent, but with purulent threads and flakes settling to the bottom: in the first glass - with anterior urethritis, in both - with total urethritis.

Chronic gonorrheal urethritis Its clinical picture resembles fresh torpid. However, it is characterized by the following features:

1) development in the urethra of infiltrates, granulations, strictures, inflammation of the glands, epithelial metaplasia and other lesions detected by urethroscopy, bouginage, urethrography;

2) periodic exacerbation of the inflammatory process with the appearance of symptoms of acute or subacute urethritis;

3) the occurrence of complications such as inflammation of the prostate gland (prostatitis), epididymis (epididymitis), seminal vesicles (vesiculitis), bladder (cystitis), renal pelvis and kidneys (pyelitis and pyelonephritis), etc.

Gonorrhea in women. In most women, unlike men, gonorrhea occurs without subjective symptoms, but affects almost all parts of the genitourinary system, as well as the rectum. Distinguish gonorrhea of ​​the lower genitourinary system(urethritis, paraurethritis, vulvitis, vestibulitis, bartholinitis, colpitis, cervicitis and endocervicitis) and ascending gonorrhea- endometritis, salpingitis, oophoritis, pelvioperitonitis.

Acute urethritis is characterized by purulent discharge from the urethra; some patients complain of pain (pain) during urination. In chronic urethritis, it is possible to detect scanty serous-purulent discharge only after massage of the urethra, which can be felt in the form of a dense cord. Just as often as urethritis, inflammation of the cervix (cervicitis and endocervicitis) occurs in patients with gonorrhea.

Diagnostics gonorrhea is based on anamnesis data, a characteristic clinical picture, confirmed by mandatory laboratory tests, for which they use both the discharge of the urethra, paraurethral ducts, cervical canal, vaginal walls, large gland of the vestibule of the vagina, and the secretion of the seminal vesicles, prostate gland, lacunae and glands of the urethra. These laboratory tests include:

1) microscopic detection of gonococcus with typical morphological and tinctorial properties (gram-negative diplococci, located in pairs and intracellularly);

2) isolation of a pure culture of gonococcus (culture method);

3) immunofluorescent and immunohistochemical methods for detecting gonococcal antigen or its nucleic acid.

Differential diagnosis carried out with other inflammatory diseases of the genitourinary system, accompanied by damage to its mucous membranes.

Treatment Gonorrhea is carried out according to the order? 415 of the Ministry of Health of the Russian Federation “On approval of the protocol for the management of patients with “Gonococcal infection” (M., 2003) and includes the use of antibiotics, immunostimulating and symptomatic agents, physiotherapeutic and surgical methods of treatment. Mandatory means general therapy are antibiotics. Currently, the most effective drugs are cephalosporins, fluoroquinolones, and aminocyclone (spectinomycin). This is due to the fact that certain strains of gonococci produce penicillinase or β-lactamase, which ensure the resistance of the latter to penicillin and its derivatives.

When treating acute localized gonococcal infection, one of the proposed drugs is used:

ceftriaxone- 250 mg once intramuscularly; ciprofloxacin- 500 mg once orally;

ofloxacin- 400 mg once orally;

spectinomycin- 2.0 g once intramuscularly;

benzylpenicillin sodium and potassium salts- initial dose of 600,000 units intramuscularly, subsequent doses of 400,000 units every 3 hours, for a course of treatment of 3,400,000 units.

When treating gonococcal infections with systemic manifestations, the following antibiotic regimens are used:

ceftriaxone- 1.0 intramuscularly or intravenously every 24 hours;

cefotaxime- 1.0 intravenously every 8 hours; spectinomycin- 2.0 g intramuscularly every 12 hours; ciprofloxacin- 500 mg intravenously every 12 hours.

Intravenous or intramuscular therapy with one of these drugs should continue for at least 7 days.

It is possible to use another treatment algorithm: the initiated therapy with one of the above drugs is continued for 24-48 hours, and when clinical symptoms resolve, they switch to oral therapy with one of the following antibiotics:

ciprofloxacin- 500 mg orally every 12 hours; ofloxacin- 400 mg orally every 12 hours.

Treatment is carried out for 14 days; extension of the duration of therapy must be strictly reasoned.

The choice of drugs is carried out taking into account anamnestic data (allergic reactions, individual intolerance to drugs and the study of gonococcus sensitivity to antibiotics, the patient’s age, etc.).

If, after 10-12 days after the end of antibiotic therapy and the exclusion of gonococci, inflammatory phenomena (discharge from the urethra, threads in the urine, etc.) persist, then these phenomena should be considered as post-gonorrheal. The patient should be examined and treatment should begin in accordance with the etiological and topical diagnosis.

In case of failure following antibiotic therapy, clinical improvement is short-lived and, as a rule, early relapses of the disease occur. 35 days (and sometimes later, within one month) after the administration of the antibiotic, discharge from the urethra intensifies and gonococci can be detected again. For late relapses

VVs, which are less common, are characterized by a sluggish, asymptomatic clinical course. Most often, relapses occur as a result of unrecognized concomitant trichomoniasis, since, captured by trichomonas, gonococci due to endocytobiosis can maintain vital activity inside them, weakly responding to antibiotics. In cases of concomitant trichomoniasis or suspicion of it, 5-nitro-imidazole preparations (metronidazole, tinidazole, ornidazole (“Tiberal”)) should be prescribed in parallel with antibiotics. "Tiberal" is used 0.5 g 2 times a day for 5 days.

In case of acute uncomplicated relapse of gonorrhea, an antibiotic from a different, previously unused group (tetracyclines, macrolides, aminoglycosides, rifamycins, cephalosporins, etc.) should be used. In patients with a sluggish, asymptomatic relapse, antibiotic therapy should be carried out only after local treatment.

The gonococcal vaccine is used as a specific immunotherapy, and nonspecific immunotherapy includes the use of pyrogenal, prodigiosan, levamisole, methyluracil, potassium orotate, and thymus preparations. In addition, biogenic stimulants are used (aloe extract, FIBS, vitreous).

From physiotherapeutic methods use reinfusion of one's own blood irradiated with laser light, as well as means used for the symptomatic treatment of complications (orchiepididymitis, prostatitis, adnexitis, etc.) - diathermy, inductothermy, phonophoresis, paraffin and ozokerite therapy, mud therapy.

Local treatments for gonorrhea are: daily rinsing of the urethra with solutions of potassium permanganate (1: 10,000), furacillin (1: 5000) or ethacridine lactate (1: 1000); vaginal douching with a solution of potassium permanganate (1: 8000) or chamomile infusion (1 tablespoon per 2 glasses of water); instillation of the urethra with a 0.25% solution of silver nitrate or 1-2% solution of protargol; bougienage of the urethra with metal and elastic bougies.

For indolent (torpid) and chronic forms of gonorrhea, treatment should be comprehensive. When treating such patients, the administration of an antibiotic should be preceded by immunotherapy and local treatment. Suspected sources of infection and those who had sexual contact with patients with gono-

rhea, persons in whom gonococci are not detected must be treated according to chronic gonorrhea regimens.

Criteria for elegance. The establishment of clinical-microbiological criteria for the cure of gonorrhea is determined using clinical, bacterioscopic and bacteriological studies and is carried out 2-14 days after the end of treatment (subsequent studies are carried out according to indications). If the source of infection has been identified and the test results for gonorrhea are negative, patients are not subject to further observation. If the source of infection is unknown, a repeat serological examination for syphilis is recommended after 3 months, for HIV, hepatitis B and C - after 3 and 6 months. The bacteriological research method should be used not only for the primary diagnosis of gonorrhea, but also for monitoring cure. Bacteriological examination is necessary in the following cases:

1) when gram-negative diplococci are detected in smears suspicious for gonococci;

2) in the presence of a suspicious history and clinical picture of the disease against the background of negative results of a bacterioscopic examination for gonorrhea;

3) to diagnose and establish its cure in patients who, despite the absence of gonococci, remain inflammatory.

Anterior urethroscopy allows us to establish only the nature of inflammatory changes after the disappearance of gonococci in acute clinical manifestations of gonorrhea, which is important for prescribing appropriate local treatment. However, it is not possible to determine the gonorrheal etiology of these changes using urethroscopy.

The criteria for cure of acute complicated and chronic gonorrhea are:

1) persistent absence of gonococci (during bacterioscopic examination and culture) in urethral discharge, scrapings and urine threads;

2) no changes during palpation of the prostate and seminal vesicles, normal content (5-10 per field of view) of leukocytes in their secretion with a significant content of lipoid grains;

3) complete absence or presence of mildly expressed inflammatory changes in the urethra during urethroscopic examination.

The patient should be informed about the need to use a condom during sexual intercourse until complete recovery. All sexual partners of patients with symptoms are subject to mandatory examination and treatment if they have had sexual contact with patients in the last 14 days, or the last sexual partner is examined and treated if there was earlier contact. If a patient with gonorrhea has no symptoms, all sexual partners over the past 60 days are subject to examination and treatment. At the initial appointment, it is necessary to convince the patient to conduct tests for other sexually transmitted infections (syphilis, chlamydia, trichomoniasis, as well as HIV, viral hepatitis B and C). In order to prevent concomitant chlamydial infection if it is impossible to diagnose chlamydia, it is advisable to accompany all treatment regimens for gonococcal infection with the prescription of anti-chlamydial drugs.

– a sexually transmitted infection that causes damage to the mucous membranes of organs lined with columnar epithelium: urethra, uterus, rectum, pharynx, conjunctiva of the eyes. Belongs to the group of sexually transmitted infections (STIs), the causative agent is gonococcus. It is characterized by mucous and purulent discharge from the urethra or vagina, pain and discomfort during urination, itching and discharge from the anus. If the pharynx is affected - inflammation of the throat and tonsils. Untreated gonorrhea in women and men causes inflammatory processes in the pelvic organs, leading to infertility; Gonorrhea during pregnancy leads to infection of the child during childbirth.

General information

(grip) is a specific infectious and inflammatory process that mainly affects the genitourinary system, the causative agent of which is gonococci (Neisseria gonorrhoeae). Gonorrhea is a sexually transmitted disease, as it is transmitted mainly through sexual contact. Gonococci quickly die in the external environment (when heated, dried, treated with antiseptics, under direct sunlight). Gonococci mainly affect the mucous membranes of organs with columnar and glandular epithelium. They can be located on the surface of cells and intracellularly (in leukocytes, trichomonas, epithelial cells), and can form L-forms (insensitive to the effects of drugs and antibodies).

Based on the location of the lesion, several types of gonococcal infection are distinguished:

• gonorrhea of ​​the genitourinary organs;
• gonorrhea of ​​the anorectal region (gonococcal proctitis);
• gonorrhea of ​​the musculoskeletal system (gonarthritis);
• gonococcal infection of the conjunctiva of the eyes (blenorrhea);
• gonococcal pharyngitis.

Gonorrhea from the lower parts of the genitourinary system (urethra, periuretal glands, cervical canal) can spread to the upper parts (uterus and appendages, peritoneum). Gonorrheal vaginitis almost never occurs, since the squamous epithelium of the vaginal mucosa is resistant to the effects of gonococci. But with some changes in the mucous membrane (in girls, in women during pregnancy, during menopause), its development is possible.

Gonorrhea is more common among young people 20 to 30 years old, but can occur at any age. There is a very high risk of complications from gonorrhea - various genitourinary disorders (including sexual ones), infertility in men and women. Gonococci can penetrate the blood and, circulating throughout the body, cause joint damage, sometimes gonorrheal endocarditis and meningitis, bacteremia, and severe septic conditions. Infection of the fetus from a mother infected with gonorrhea during childbirth has been observed.

When the symptoms of gonorrhea are erased, patients aggravate the course of their illness and spread the infection further, without knowing it.

Gonorrhea infection

Gonorrhea is a highly contagious infection, in 99% it is transmitted sexually. Infection with gonorrhea occurs through different forms of sexual contact: vaginal (regular and “incomplete”), anal, oral.

In women, after sexual intercourse with a sick man, the probability of contracting gonorrhea is 50-80%. Men who have sexual contact with a woman with gonorrhea do not always become infected - in 30-40% of cases. This is due to some anatomical and functional features of the genitourinary system in men (a narrow urethral canal, gonococci can be washed away with urine.) The likelihood of a man becoming infected with gonorrhea is higher if a woman has menstruation, sexual intercourse is prolonged and has a violent ending.

Sometimes there may be a contact route of infection of a child from a mother with gonorrhea during childbirth and household, indirect - through personal hygiene items (bed linen, washcloth, towel), usually in girls.

The incubation (latent) period for gonorrhea can last from 1 day to 2 weeks, less often up to 1 month.

Gonorrhea infection of a newborn baby

Gonococci cannot penetrate intact membranes during pregnancy, but premature rupture of these membranes leads to infection of the amniotic fluid and the fetus. Infection of a newborn with gonorrhea can occur when it passes through the birth canal of a sick mother. The conjunctiva of the eyes is affected, and in girls the genitals are also affected. Half of the cases of blindness in newborns are caused by infection with gonorrhea.

Gonorrhea symptoms

Based on the duration of the disease, fresh gonorrhea is distinguished (2 months from the moment of infection).

Fresh gonorrhea can occur in acute, subacute, asymptomatic (torpid) forms. There is gonococcal carriage, which is not subjectively manifested, although the causative agent of gonorrhea is present in the body.

Currently, gonorrhea does not always have typical clinical symptoms, since a mixed infection is often detected (with trichomonas, chlamydia), which can change symptoms, lengthen the incubation period, and complicate the diagnosis and treatment of the disease. There are many oligosymptomatic and asymptomatic cases of gonorrhea.

Classic manifestations of acute gonorrhea in women:

• purulent and serous-purulent vaginal discharge;
• hyperemia, swelling and ulceration of the mucous membranes;
• frequent and painful urination, burning, itching;
• intermenstrual bleeding;
• pain in the lower abdomen.

• itching, burning, swelling of the urethra;
• copious purulent, serous-purulent discharge;
• frequent painful, sometimes difficult urination.

With the ascending type of gonorrhea, the testicles, prostate, seminal vesicles are affected, the temperature rises, chills occur, and painful bowel movements occur.

Gonococcal pharyngitis can manifest itself as redness and pain in the throat, increased body temperature, but more often it is asymptomatic. With gonococcal proctitis, discharge from the rectum and pain in the anal area, especially during defecation, may be observed; although usually the symptoms are mild.

Chronic gonorrhea has a protracted course with periodic exacerbations, manifested by adhesions in the pelvis, decreased libido in men, and disturbances in the menstrual cycle and reproductive function in women.

Complications of gonorrhea

Asymptomatic cases of gonorrhea are rarely detected at an early stage, which contributes to the further spread of the disease and gives a high percentage of complications.

The ascending type of infection in women with gonorrhea is facilitated by menstruation, surgical termination of pregnancy, diagnostic procedures (curettage, biopsy, probing), and the introduction of intrauterine devices. Gonorrhea affects the uterus, fallopian tubes, and ovarian tissue until abscesses occur. This leads to disruption of the menstrual cycle, the occurrence of adhesions in the tubes, the development of infertility, and ectopic pregnancy. If a woman with gonorrhea is pregnant, there is a high probability of spontaneous miscarriage, premature birth, infection of the newborn and the development of septic conditions after childbirth. When newborns are infected with gonorrhea, they develop inflammation of the conjunctiva of the eyes, which can lead to blindness.

A serious complication of gonorrhea in men is gonococcal epididymitis, a disorder of spermatogenesis, and a decrease in the ability of sperm to fertilize.

Gonorrhea can spread to the bladder, ureters and kidneys, pharynx and rectum, and affect the lymph glands, joints, and other internal organs.

You can avoid unwanted complications of gonorrhea if you start treatment in a timely manner, strictly follow the venereologist’s prescriptions, and lead a healthy lifestyle.

Diagnosis of gonorrhea

To diagnose gonorrhea, the presence of clinical symptoms in a patient is not enough; it is necessary to identify the causative agent of the disease using laboratory methods:

• examination of smears with material under a microscope;
• bacterial seeding of material on specific nutrient media to isolate a pure culture;
• ELISA and PCR diagnostics.

IN microscopy of smears stained with Gram and methylene blue, gonococci are determined by their typical bean-shaped shape and pairing, gram-negativity and intracellular position. The causative agent of gonorrhea cannot always be detected by this method due to its variability.

When diagnosing asymptomatic forms of gonorrhea, as well as in children and pregnant women, the more appropriate method is cultural (its accuracy is 90-100%). The use of selective media (blood agar) with the addition of antibiotics makes it possible to accurately detect even a small number of gonococci and their sensitivity to drugs.

The material for testing for gonorrhea is purulent discharge from the cervical canal (in women), urethra, lower rectum, oropharynx, and conjunctiva of the eyes. For girls and women over 60 years of age, only the cultural method is used.

Gonorrhea often occurs as a mixed infection. Therefore, a patient with suspected gonorrhea is additionally examined for other STIs. They carry out determination of antibodies to hepatitis B and HIV, serological reactions to syphilis, general and biochemical analysis of blood and urine, ultrasound of the pelvic organs, urethroscopy, in women - colposcopy, cytology of the cervical canal mucosa.

Examinations are carried out before the start of treatment for gonorrhea, again 7-10 days after treatment, serological examinations - after 3-6-9 months.

The doctor decides the need to use “provocations” to diagnose gonorrhea in each case individually.

Treatment of gonorrhea

Self-treatment of gonorrhea is unacceptable; it is dangerous due to the transition of the disease to a chronic form and the development of irreversible damage to the body. All sexual partners of patients with symptoms of gonorrhea who have had sexual contact with them in the last 14 days, or the last sexual partner if contact occurred earlier than this period, are subject to examination and treatment. If there are no clinical symptoms in a patient with gonorrhea, all sexual partners over the past 2 months are examined and treated. During the period of treatment of gonorrhea, alcohol and sexual relations are excluded; during the period of clinical observation, sexual contacts using a condom are allowed.

Modern venereology is armed with effective antibacterial drugs that can successfully fight gonorrhea. When treating gonorrhea, the duration of the disease, symptoms, location of the lesion, absence or presence of complications, and concomitant infection are taken into account. In case of acute ascending type of gonorrhea, hospitalization, bed rest, and therapeutic measures are necessary. In case of purulent abscesses (salpingitis, pelvioperitonitis), emergency surgery is performed - laparoscopy or laparotomy. The main place in the treatment of gonorrhea is given to antibiotic therapy, taking into account the resistance of some strains of gonococci to antibiotics (for example, penicillins). If the antibiotic used is ineffective, another drug is prescribed, taking into account the sensitivity of the gonorrhea pathogen to it.

Gonorrhea of ​​the genitourinary system is treated with the following antibiotics: ceftriaxone, azithromycin, cefixime, ciprofloxacin, spectinomycin. Alternative treatment regimens for gonorrhea include the use of ofloxacin, cefozidime, kanamycin (in the absence of hearing diseases), amoxicillin, trimethoprim.

Fluoroquinolones are contraindicated in the treatment of gonorrhea for children under 14 years of age; tetracyclines, fluoroquinolones, and aminoglycosides are contraindicated for pregnant women and nursing mothers. Antibiotics that do not affect the fetus are prescribed (ceftriaxone, spectinomycin, erythromycin), and prophylactic treatment is carried out for newborns of mothers with gonorrhea (ceftriaxone - intramuscularly, washing the eyes with a solution of silver nitrate or applying erythromycin ophthalmic ointment).

Treatment of gonorrhea can be adjusted if there is a mixed infection. For torpid, chronic and asymptomatic forms of gonorrhea, it is important to combine primary treatment with immunotherapy, local treatment and physiotherapy.

Local treatment of gonorrhea includes the introduction into the vagina, urethra of 1-2% protorgol solution, 0.5% silver nitrate solution, microenemas with chamomile infusion. Physiotherapy (electrophoresis, ultraviolet irradiation, UHF currents, magnetotherapy, laser therapy) is used in the absence of an acute inflammatory process. Immunotherapy for gonorrhea is prescribed outside of exacerbation to increase the level of immune reactions and is divided into specific (gonovacin) and nonspecific (pyrogenal, autohemotherapy, prodigiosan, levamiosole, methyluracil, glyceram, etc.). Immunotherapy is not given to children under 3 years of age. After treatment with antibiotics, lacto- and bifid drugs are prescribed (orally and intravaginally).

A successful result of treatment for gonorrhea is the disappearance of symptoms of the disease and the absence of the pathogen according to the results of laboratory tests (7-10 days after the end of treatment).

Currently, the need for various types of provocations and numerous control examinations after the end of treatment for gonorrhea, carried out with modern highly effective antibacterial drugs, is disputed. One follow-up examination of the patient is recommended to determine the adequacy of this treatment for gonorrhea. Laboratory monitoring is prescribed if clinical symptoms remain, there are relapses of the disease, or re-infection with gonorrhea is possible.

Gonorrhea prevention

Prevention of gonorrhea, like other STDs, includes:

• personal prevention (exclusion of casual sex, use of condoms, compliance with personal hygiene rules);
• timely identification and treatment of patients with gonorrhea, especially in risk groups;
• medical examinations (for employees of child care institutions, medical personnel, food workers);
• mandatory examination of pregnant women and pregnancy management.

To prevent gonorrhea, a solution of sodium sulfacyl is instilled into the eyes of newborns immediately after birth.

The fact that many women are asymptomatic significantly complicates the diagnosis of gonorrhea, prevention and treatment of infection, and also leads to the development of complications.

Diagnosis of gonorrhea in women

In women, gonorrhea is detected by bacteriological examination of vaginal contents. The basis for diagnosis is the presence of gonococcus in the smear.

Consequences of gonorrhea in women

If this dangerous infection is not treated promptly, the following complications are possible:

• menstrual disorder
• pain in joints, eyes
• pelvic pain
• infection of the fetus during passage through the birth canal
• infertility
• ectopic pregnancy

To avoid such problems, it is best to carry out regular gonorrhea prevention. If you discover symptoms of the disease, you should immediately consult a doctor. If gonorrhea is treated on time, in the early stages, it will not cause any additional complications.

Treatment of gonorrhea in women

The main treatment for gonorrhea is antibiotic therapy. Antibiotics affect gram-negative flora, which includes gonococcus. At the final stage of treatment, drugs are prescribed that help restore the microflora. An important condition is abstinence from alcohol and sexual intercourse. A woman is considered cured only when a control bacteriological study does not detect gonococci in a smear or scraping.

The period of development of the disease from the entry of pathogenic gonococcus bacteria to the appearance of the first signs of the disease ranges from 2 days to 2 weeks. The first signs indicating infection begin to appear, as a rule, after 3 days. Bacteria multiply well in the mucous membranes - the uterus, urethra, rectum and fallopian tubes and vaginal walls.

Among the most well-known symptoms indicating gonorrhea are the following:

• pain and burning when urinating with purulent discharge with frequent urge to urinate;
• unpleasant odor and inflammation during urination.

At the same time, there are often cases of absence of these and other symptoms indicating illness.

The disease can be difficult to diagnose at an early stage due to changes in symptoms that become different from their classic forms due to mixed infections (often a whole bunch of different sexually transmitted diseases with forms such as chlamydia, etc.). At the same time, both the treatment of the disease and its diagnosis become more complicated. In practice, there are many variations of this disease with very different symptoms.

Common symptoms are: increased temperature (more than 38 degrees), a feeling of constant weakness, menstrual irregularities, indigestion, and nausea.

Gonorrhea looks like this

Incubation period

On average, the incubation period of this disease is 3 days. Fluctuations can range from 2 to 5 days in men and from 2 to 10 days in women.

Types of gonorrhea

Speaking about the types of the disease, we can distinguish its chronic and fresh forms. When the disease lasts less than two months, then we are talking about its fresh form. It can be divided into the following types: torpid, acute and subacute. When the disease lasts for more than two months, it becomes chronic. It is characterized by its slow and unnoticeable course. But this process does not exclude the occurrence of exacerbations.

Gonorrhea can have several forms and varieties, depending on the location of the area affected:

• genitourinary (the most common type of gonorrhea, more commonly known as gonorrhea);
• anal-rectal (proctitis);
• throat (pharyngitis);
• ocular (blennorrhea - ocular conjunctivitis);
• musculoskeletal (gonarthritis).

Now we can say that the disease is acquiring new features: the number of diseases without symptoms is increasing, when pathogens and inflammatory processes are detected in the patient, but at the same time, he has no complaints. This form is called gonococcal carriage. For example, women who have an asymptomatic and torpid form of gonorrhea may not know about their disease and continue to be sexually active, thereby spreading the infection.

Most often, along with gonorrhea, the patient also has concomitant diseases: colibacillary infection, trichomoniasis and staphylococcus.

Ways of infection with gonorrhea

The main route of transmission of gonococcal infection is sexual. Infection occurs from a sick person through unprotected vaginal, anal and oral contact. It is possible for a child's eyes to become infected during natural childbirth, as they pass through the birth canal. Infection with gonorrhea in everyday life is extremely unlikely; this is due to the instability of gonococci in the external environment, outside the human body. Although the literature describes cases of domestic infection through common household items, in particular through towels.

Gonorrhea is a serious infection with a high rate of infectivity, which is transmitted sexually in 99% of cases. And only 1%, infection can occur through domestic means (personal belongings of the infected person), or during childbirth. Infection with gonorrhea can occur during any type of intimate relationship.

Chances of contracting gonorrhea

As practice shows, approximately 70% of women become infected with gonorrhea if they have had sexual contact with a man who is its carrier. In men, this figure is lower - up to 40% (causative agents of the disease can be washed away while a man goes to the toilet). This happens due to the male structural features of the genitourinary system. Men will be more likely to become infected during sexual contact with a woman during menstruation or during prolonged sexual intercourse, as well as when it is intensively completed.

The period of illness with gonorrhea, when there are no symptoms, can be from one day to two weeks.

Gonorrhea treatment anonymously

Treatment of gonorrhea depends on the stage of the disease, the presence of complications and concomitant diseases.

Treatment of acute gonorrhea, as a rule, is not difficult for an experienced venereologist. If you consult a doctor in a timely manner, at the first symptoms of gonorrhea, treatment of acute gonorrhea occurs quickly and without complications. Antibacterial drugs are usually taken for several days. According to statistics, in 30% of cases, gonococcal infection is combined with chlamydial infection. Therefore, antichlamydial drugs are added to the course of treatment for gonorrhea. Effective treatment of gonorrhea involves the use of antibacterial drugs, the timing of which depends on the stage of the disease. In case of acute gonorrhea, treatment takes an average of 5 days, the first signs of gonorrhea disappear a day after the start of treatment for gonorrhea, in the treatment of chronic gonorrhea, the first symptoms of gonorrhea also disappear on the first day of treatment for gonorrhea, the entire course of treatment for gonorrhea lasts from 10 days or more. Treatment tactics for men and women differ slightly in drug doses.

Prices for gonorrhea treatment in our clinic

The cost of treatment consists of the antibacterial drugs and related medications necessary to treat gonorrhea. Today, both imported and domestic drugs are widely represented on the market, the use of which can significantly reduce the cost of treating gonorrhea.

Important! Treatment of sexually transmitted infections (STIs) should be carried out strictly under the supervision of a doctor. Uncontrolled use of antibiotics can lead to under-treatment of the infection, its transition to a chronic form, complications, which in the case of gonococcal infection can lead to infertility.

Our doctors

Treatment of gonorrhea in men and women

The first signs of gonorrhea in men are pain and pain in the urethra when urinating and purulent discharge from the urethra. If you consult a doctor in a timely manner for treatment of gonorrhea in men Gonorrhea symptoms do not have time to fully develop and treatment takes several days.

If a man does not immediately consult a doctor, there is a risk of the disease developing into chronic gonorrhea. The symptoms of chronic gonorrhea in men are not as pronounced as the symptoms of acute gonorrhea, but chronic gonorrhea is dangerous due to its complications for the prostate gland. Treatment of chronic gonorrhea in men, as mentioned above, is a longer process; complex treatment of the symptoms of gonorrhea and its possible complications is required.

The first signs of gonorrhea in women are difficult to recognize immediately. The discharge may be scanty, so a woman may not pay attention to the first symptoms of gonorrhea and mistake them for normal vaginal discharge. Therefore, women, as a rule, consult a doctor not at the stage of the first signs of gonorrhea, but at a later stage. In this regard treatment of gonorrhea in women requires longer-term use of antibacterial drugs to treat all symptoms and manifestations of gonorrhea. For women, drug doses are higher.

In addition to antibiotics, immunomodulatory drugs, urethral lavage (urethral instillation), and physiotherapy can be used to treat complicated forms. Effective treatment of chronic gonorrhea in women will prevent the development of such a formidable complication of gonorrhea as female infertility.

Gonorrhea in men usually manifests itself as severe urethritis:

• burning, swelling and itching of the urethra;
• the appearance of discharge with pus;
• When urinating there is a feeling of pain, it often becomes difficult.

In the acute form, women are often diagnosed with the following symptoms:

• pain in the lower abdomen;
• swelling, formation of ulcers and swelling of the mucous membranes of internal organs;
• pain when urinating with burning and itching;
• purulent discharge and extramenstrual bleeding.

In 50% of cases, the development of gonorrhea in women is mild and has virtually no symptoms, or they are very mild. Therefore, visiting a specialist occurs late, and this threatens more serious complications.

In girls, the disease occurs in an acute form. Its main manifestations are swelling and hyperemia in the vagina, itching and burning in the genitals, pain when urinating, and the presence of discharge with pus.

Surgical treatment of gonorrhea

When a person is diagnosed with purulent abscesses, their immediate removal is required using laparotomy or laparoscopy.

Antibiotic therapy

The main method of treating gonorrhea is the use of antibiotics, which are prescribed depending on the location of the lesion and the age of the patient. It should not be ignored that some varieties of gonococci are resistant to medications, in particular to penicillin. When there is no noticeable effect from the prescribed drug, it should be replaced with another.

If the infection occurs in a pregnant woman, then drugs are prescribed that will be harmless to the fetus, such as spectinomycin, erythromycin, ceftriaxone. For newborns, preventive treatment should be carried out; for this, ceftriaxone is administered intramuscularly, and erythromycin ointment or silver nitrate solution is used for the eyes.

When concomitant infections are also observed, treatment may be slightly different. When the disease is in a chronic form, or there are no pronounced symptoms, the treatment is combined with physiotherapy, as well as immunotherapy.

Local treatment

In this case, we are talking about introducing a mixture of silver nitrate and protargol solutions into the vagina and\or urethra, and douching with a chamomile solution is also carried out.

Immunotherapy

It is necessary to strengthen the immune system, but it may be prescribed if no contraindications are identified. It cannot be performed under the age of three years. Treatment may include gonovaccination (specific) or prodigiosan (nonspecific), and autohemotherapy may be prescribed.

Physiotherapy

This treatment consists of UV irradiation and electrophoresis. Laser and magnetic therapy can be carried out when there is no acute inflammatory focus. Along with taking antibiotics, it is necessary to take bifid drugs, not only orally, but also intravaginally.

The end of treatment occurs when the symptoms of the disease completely disappear and laboratory tests do not show the presence of the pathogen.

When treatment has reached its final stage using modern antibiotics, a follow-up examination by a specialist is required. He, in turn, draws conclusions about the effectiveness of the treatment.

If symptoms of the disease were detected during the examination, and there is a possibility of contracting gonorrhea again, then laboratory monitoring is required.

Treatment of chronic gonorrhea

The disease is considered chronic if it continues for more than two months after infection. Most often, the chronic stage can be noted in those patients in whom the disease proceeded without symptoms. When the disease is acute, it is no longer possible to postpone an appointment with a specialist, since the symptoms are very unpleasant.

The chronic form of the disease is different in that foci of infection will spread from the lining of the urethra, rectum or oral cavity to other organs. Gonorrhea also affects the uterus, prostate gland, bladder, and pharynx. And if timely and correct treatment is not carried out, the disease will spread throughout the body.

Almost all human organs can be affected, from the kidneys, heart, and ending with the nervous system. The final stage of the disease is considered to be the occurrence of sepsis (in both women and men), but this phenomenon is observed quite rarely.

Complications of gonorrhea in men and women

The disease is difficult to recognize in the earliest stages, especially when it is asymptomatic. The infection will continue to develop and complications may arise.

Complications of gonorrhea in men. For men, complications of the disease can lead to impaired sperm production, deterioration of sperm function, and gonococcal epididymitis. Bacteria can multiply in the bladder, rectum, kidneys, and sometimes joints and other internal organs of a man are affected.

To prevent unpleasant consequences from gonorrhea, men should begin immediate treatment, strictly follow all doctor's orders and lead a healthy lifestyle.

The most common inflammation of the epididymis is epididymitis. Testicular tissue may also be involved in the inflammatory process, which then results in orchiepididymitis. This condition is characterized by an increase in the size of the testicle and/or epididymis, and fairly severe pain in the scrotum. If this situation is left to chance, purulent melting of the testicle may develop, which will inevitably lead to infertility. Also complication of gonorrhea in men may be prostatitis.

Complications of gonorrhea in women. The presence of ascending gonorrhea in women can occur upon the onset of menstruation immediately after infection, as well as during various procedures and surgical interventions (for example, abortion or insertion of a device inside the vagina).

With a genitourinary infection, the uterus, ovaries, and fallopian tubes will be affected; in advanced situations, abscesses may appear. Infection with gonococci can lead to the appearance of adhesions in the tubes, problems in the menstrual cycle, ectopic pregnancy, or even infertility.

If a pregnant woman is infected with gonorrhea, then this can be fraught with miscarriage, premature birth, and subsequent infection of the child, and the presence of postpartum complications.

Diseases of the uterus and uterine appendages of an inflammatory nature - the main complication of gonorrhea in women, which in turn can lead to female infertility.

Infection of a newborn during childbirth

During pregnancy, the membranes of the fetus are protected, so penetration of the gonococcus is impossible. But when their untimely rupture occurs, the amniotic fluid, and directly, the fetus itself, becomes infected. Also, infection can occur during the passage of the child through the birth canal if the mother is infected.

Foci of pathogens can settle in the eyes or on the genitals of girls. In 50% of cases, blindness in infants occurs due to infection with gonorrhea.

Diagnosis of gonorrhea

To accurately determine whether a patient has gonorrhea, the presence of symptoms alone is not the main indicator. In addition, it is necessary to conduct laboratory tests to determine the presence of gonococci in the body. To do this:

• Analysis of smears that are collected from the surface of the mucosa.
• Taking bacterial culture.
• ELISA diagnostics and PCR.

When analyzing smears under a microscope, which are stained with Gram and also with methylene blue, gonococcus can be determined by the shape of the bean and its pairing, by its intracellular location and the presence of a negative Gram reaction.

When diagnosing the presence of gonorrhea in pregnant women or children, it is best to use a method based on culture isolation (the accuracy of such diagnosis is over 90%). In addition, the method of selective environment with antibiotics is used. When using it, it is possible to determine the presence of gonorrhea, even with a small number of gonococci that are sensitive to specific antibiotics.

The presence of pus discharge from the urethra, urinary canal, rectum or eyes may indicate that a person has gonorrhea. Such secretions can be used for analysis to detect the presence of gonococci.

Very often, gonorrhea can occur in combination with other infections that are transmitted to a person during intimate contact. Therefore, the patient should be examined for concomitant diseases.

During diagnosis, tests are performed for AIDS, hepatitis, syphilis, a pelvic ultrasound is performed, and general urine and blood tests are taken. Women are recommended to undergo colposcopy, as well as cytology in the cervical canal.

Gonorrhea prevention

In order not to become infected with gonorrhea, or to avoid its spread, you should follow some rules:

• Maintain hygiene, use condoms during intimacy, and avoid sexual contact with casual partners.
• Timely detection of the disease at its inception stage, and immediate contact with a specialist.
• Conducting regular professional examinations for doctors, catering staff and children's institutions.
• If you have had casual sexual contact without a condom with a casual partner, to prevent possible infection with gonorrhea or other sexually transmitted diseases, you need to take medication to prevent casual sex.

All pregnant women should undergo regular examination by a gynecologist. For newborn babies, sodium sulfate solution is immediately injected into the eyes if there is a risk of infection of the baby during childbirth.

If your sexual partner is diagnosed with gonorrhea and treated, you should definitely be examined by a venereologist and also undergo treatment to avoid re-infection.

The venereologists of the “Honest Clinic” have extensive experience in the diagnosis, prevention and treatment of sexually transmitted infections (STIs), and will professionally and, if you wish, absolutely anonymously help in solving your “delicate” problem.