Gonorrhea is a venereal infection that causes damage to the mucous membranes of organs lined with cylindrical epithelium: urethra, uterus, rectum, pharynx, conjunctiva of the eyes. It 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. With the defeat of the pharynx – inflammation of the throat and tonsils. Untreated gonorrhea in women and men causes inflammation in the pelvic organs, leading to infertility; gonorrhea during pregnancy leads to infection of the baby during childbirth.
Gonorrhea (gonorrhea) is a specific infectious and inflammatory process that mainly affects the genitourinary system, caused by gonococci (Neisseria gonorrhoeae). Gonorrhea is a sexually transmitted disease, as it is transmitted mainly through sexual intercourse. Gonococci quickly die in the external environment (when heated, dried, treated with antiseptics, in direct sunlight). Gonococci mainly affect the mucous membranes of organs with cylindrical and glandular epithelium. They can be located on the surface of cells and intracellularly (in leukocytes, trichomonads, epithelial cells), can form L-forms (not sensitive to the effects of drugs and antibodies).
At the site 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 conjunctival infection of the eye ( blenorrhea );
- gonococcal pharyngitis .
Gonorrhea from the lower parts of the genitourinary system (urethra, periuretal glands, cervical canal) can spread to the upper (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, in menopause), its development is possible.
Gonorrhea is more common among young people in their 20s and 30s, but can occur at any age. There is a very high risk of complications of gonorrhea – various genitourinary disorders (including sexual), infertility in men and women. Gonococci can enter the bloodstream 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 is noted.
With erased symptoms of gonorrhea, patients aggravate the course of their illness and spread the infection further without knowing it.
Gonorrhea is a highly contagious infection, in 99% of cases it is transmitted sexually. Infection with gonorrhea occurs in different forms of sexual intercourse: vaginal (normal and “incomplete”), anal, oral.
In women, after intercourse with a sick man, the probability of contracting gonorrhea is 50-80%. Men during 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 canal of the urethra, gonococci can be washed off with urine). The likelihood of a man getting gonorrhea is higher if a woman has menstruation, sexual intercourse is prolonged and has a violent end.
Sometimes there may be a contact pathway of infection of a child from a mother with gonorrhea during childbirth and household, indirect – through personal hygiene items (bed linen, a washcloth, a towel), usually in girls. The incubation (latent) period for gonorrhea can last from 1 day to 2 weeks, less often up to 1 month.
Infection with gonorrhea in a newborn baby
Gonococci cannot penetrate intact membranes during pregnancy, but premature rupture of these membranes leads to infection of the amniotic fluid and fetus. Infection with gonorrhea of a newborn can occur when it passes through the birth canal of a sick mother. At the same time, the conjunctiva of the eyes is affected, and the genitals in girls are also affected. Blindness in newborns in half of cases is caused by infection with gonorrhea.
Symptoms of gonorrhea
Based on the duration of the disease, fresh gonorrhea (from the moment of infection <2 months) and chronic gonorrhea (from the moment of infection> 2 months) are distinguished.
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 (with Trichomonas , chlamydia ) is often detected , which can change symptoms, lengthen the incubation period, and complicate the diagnosis and treatment of the disease. There are many asymptomatic and asymptomatic cases of gonorrhea.
Classic manifestations of the acute form of gonorrhea in women:
- purulent and serous-purulent vaginal discharge;
- hyperemia, edema and ulceration of the mucous membranes;
- frequent and painful urination, burning, itching;
- intermenstrual bleeding ;
- pain in the lower abdomen.
In more than half of cases, gonorrhea in women is either sluggish, asymptomatic, or does not appear at all. In this case, a late visit to a doctor is dangerous by the development of an ascending inflammatory process: gonorrhea affects the uterus, fallopian tubes, ovaries, peritoneum. The general condition may worsen, the temperature rises (up to 39 ° C), there is a violation of the menstrual cycle , diarrhea, nausea, vomiting.
Gonorrhea in girls has an acute course, manifested by edema and hyperemia of the mucous membrane of the vulva and the vestibule of the vagina, burning and itching of the genitals, the appearance of purulent discharge, pain during urination.
Gonorrhea in men occurs mainly in the form of acute urethritis :
- itching, burning, swelling of the urethra;
- profuse 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, and painful bowel movements occur.
Gonococcal pharyngitis can manifest itself as redness and sore throat, fever, but is more often asymptomatic. With gonococcal proctitis, there may be discharge from the rectum, pain in the anus, especially during bowel movements; although symptoms are usually mild.
Chronic gonorrhea has a protracted course with periodic exacerbations, manifested by adhesions in the small pelvis, decreased sex drive in men, menstrual irregularities 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 promoted by menstruation, surgical termination of pregnancy , diagnostic procedures ( curettage , biopsy , probing), and the introduction of intrauterine devices . Gonorrhea affects the uterus, fallopian tubes, ovarian tissue up to the occurrence of abscesses. This leads to a violation of the menstrual cycle, the occurrence of adhesions in the tubes, the development of infertility , 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 , impaired spermatogenesis, and a decrease in the ability of sperm to fertilize.
Gonorrhea can spread to the bladder, ureters and kidneys, pharynx and rectum, 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 instructions of a venereologist , 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 inoculation of the material on specific nutrient media to isolate a pure culture;
- ELISA and PCR diagnostics.
In microscopy of smears stained according to Gram and methylene blue, gonococci are identified by their typical bean-like shape and pairing, gram-negativeness 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 cultural method is more appropriate (its accuracy is 90-100%). The use of selective media (blood agar) with the addition of antibiotics makes it possible to accurately identify even a small number of gonococci and their sensitivity to drugs.
The material for research on gonorrhea is purulent discharge from the cervical canal (in women), urethra, lower rectum, oropharynx, conjunctiva of the eyes. For girls and women over 60, only the cultural method is used.
Gonorrhea often occurs as a mixed infection. Therefore, a patient with suspected gonorrhea is examined additionally for other STIs. Determination of antibodies to hepatitis B and C , to 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 mucous membrane of the cervical canal.
Examinations are carried out before the start of treatment for gonorrhea, again after 7-10 days after treatment, serological – after 3-6-9 months.
The doctor decides the need to use “provocations” for the diagnosis of gonorrhea in each case individually.
Treatment of gonorrhea
Independent treatment of gonorrhea is unacceptable , it is dangerous with the transition of the disease into a chronic form, and the development of irreversible damage to the body. All sexual partners of patients with gonorrhea symptoms who have had sexual intercourse 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. In the absence of clinical symptoms in a patient with gonorrhea, all sexual partners are examined and treated for the last 2 months. For the period of treatment of gonorrhea, alcohol, sexual relations are excluded, during the period of dispensary observation, sexual intercourse with the use of a condom is allowed.
Modern venereology is armed with effective antibacterial drugs that can successfully fight gonorrhea. In the treatment of gonorrhea, the duration of the disease, the symptoms, the location of the lesion, the absence or presence of complications, and concomitant infection are taken into account. In acute ascending type of gonorrhea, hospitalization, bed rest, and therapeutic measures are necessary. In the event of purulent abscesses ( salpingitis , pelvioperitonitis ), an emergency surgery is performed – laparoscopyor 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 causative agent of gonorrhea 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.
For children under 14 years of age, fluoroquinolones are contraindicated in the treatment of gonorrhea, tetracyclines, fluoroquinolones, aminoglycosides are contraindicated for pregnant women and nursing mothers. Prescribed antibiotics that do not affect the fetus (ceftriaxone, spectinomycin, erythromycin), carry out prophylactic treatment of newborns in mothers of patients with gonorrhea (ceftriaxone – intramuscularly, rinsing the eyes with silver nitrate solution or placing erythromycin ophthalmic ointment).
Treatment for gonorrhea can be adjusted if there is a mixed infection. In torpid, chronic and asymptomatic forms of gonorrhea, it is important to combine the main treatment with immunotherapy, local treatment and physiotherapy.
Local treatment of gonorrhea includes the introduction into the vagina, urethra, 1-2% solution of protorgol, 0.5% solution of silver nitrate, microclysters with chamomile infusion. Physiotherapy ( electrophoresis , UFO , UHF currents , magnetotherapy , laser therapy ) is used in the absence of an acute inflammatory process. Immunotherapy for gonorrhea is prescribed without exacerbation to increase the level of immune responses and is divided into specific (gonovacin) and nonspecific (pyrogenal, autohemotherapy , prodigiosan, levamiozole, methyluracil, glyceram, etc.). Children under 3 years of age do not receive immunotherapy. After antibiotic treatment, lacto- and bifidopreparations are prescribed (orally and intravaginally).
The successful result of the treatment of gonorrhea is the disappearance of the 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 follow-up examinations after the end of the treatment of gonorrhea, carried out with modern highly effective antibacterial drugs, is being disputed. One follow-up examination of the patient is recommended to determine the adequacy of this treatment for gonorrhea. Laboratory control is prescribed if clinical symptoms remain, there are relapses of the disease, and re-infection with gonorrhea is possible.
Prevention of gonorrhea
Prevention of gonorrhea, like other STDs, includes:
- personal prevention (exclusion of casual sexual intercourse, the use of condoms, adherence to the rules of personal hygiene);
- timely identification and treatment of patients with gonorrhea, especially in risk groups;
- professional examinations (for workers in children’s institutions, medical personnel, food workers);
- compulsory examination of pregnant women and pregnancy management.
In order to prevent gonorrhea, a solution of sodium sulfacil is instilled into the eyes of newborns immediately after birth.