Gonorrhea is a sexually transmitted infection caused by gonococci. Causative agents – Neisseria gonorrhea.
-Promiscuous sex life;
-Rare use of barrier methods of contraception (condoms);
-Newborns – infection of the mother’s birth canal;
-Children – attempted sexual assault by an infected person;
-The presence of a focus of gonococcal infection in the body – for example, carrying the infection into the eye by hand;
-For inflammatory diseases of the pelvic organs – the use of an intrauterine device.
Risk groups: prostitutes and their clients, businessmen, tourists, drug addicts, etc.
Ways of infection with gonorrhea: more often sexual, less often household (through personal hygiene items). Newborns become infected when passing through the birth canal of a sick mother.
Manifestations of gonorrhea
Symptoms in women
The incubation period is from 1 day to 1 month (on average, 2-5 days). Gonorrhea affects the genitourinary organs, urethra, cervix, rectum, eyes. The vagina and pharynx are involved in the process only under special conditions (trauma, hormonal changes, immune disorders). Gonococci are able to penetrate the bloodstream, but only in exceptional cases can they spread throughout the body with the formation of gonococcal metastases in various organs or with the development of sepsis.
Gonococcal infection has no characteristic manifestations that distinguish it from other infections and is very often combined with chlamydial (in 30-60% of cases), Trichomonas, ureaplasma and other infections.
Gonorrhea in women is characterized by multifocal and in 75-85% of cases asymptomatic. In the acute stage, patients complain of pain during urination, in the chronic stage, there are no complaints, pain in the lower abdomen, and menstrual irregularities may disturb. In the acute stage – an increase in body temperature.
Symptoms in men
Gonorrhea in men occurs in the form of urethritis.
Anterior acute (fresh) urethritis: pain during urination, profuse purulent discharge, redness and swelling of the sponges of the urethra.
Subacute urethritis: pain during urination decreases, there is a small serous-mucous, mainly morning discharge, reddening of the urethral sponges.
Torpid urethritis is asymptomatic; note the scanty discharge or sticking of the urethral sponges in the morning, often not noticed at all by the patients; when the process spreads to the posterior urethra, frequent urge to urinate and increased painfulness are added
Gonorrhea prostatitis is more often chronic, less often acute. A feeling of heaviness in the perineum, weakening of erection, premature ejaculation are noted. In the acute stage – fever, urinary disorders.
Gonorrhea in children
Gonoblenorrhea – gonococci enter the conjunctiva of the eyes when passing through the birth canal of a sick mother. Gonorrheal vulvovaginitis in girls occurs when a sick mother passes through the birth canal or uses common hygiene items. At an older age, infection often occurs as a result of lecherous actions of adults.
Gonorrheal proctitis – damage to the lower third of the rectum; observed in women and girls with gonorrhea, as well as in homosexual men. Subjective sensations are often absent, only sometimes itching, burning, slight pain during bowel movements are noted.
Oropharyngeal gonorrhea is manifested by damage to the tonsils and pharynx: redness and swelling, sometimes a purulent plaque appears on the tonsils
Gonorrhea of the eyes in adults is recorded if personal hygiene is not observed: edema of the eyelids, redness of the conjunctiva, suppuration, photophobia.
In men, swabs are taken from the urethra and rectum, in women – from the urethra, vagina and rectum
Culture is mandatory in women due to the low detection rate of gonococci on smear staining and in children with suspected sexual abuse
In case of negative results of bacteriological research, in case of suspicion of gonorrheal infection, provocative tests are necessary (lead to a temporary weakening of the immune defense and active reproduction of gonococci). The chemical method of provocation is the lubrication of the mucous membrane of the cervical canal with a 2-5% solution or the urethra with a 1-2% solution of silver nitrate. The biological method of provocation is the intramuscular injection of 500 million microbial bodies of the gonovaccine or 20 μg of pyrogenal. Thermal method – daily diathermy or inductothermy of the genitals for 3 days. Physiological method – smears are taken during menstruation. The food method is the intake of spicy and salty foods. Physical method – massage of the urethra
Antibiotics, even in small doses, affect research results.
Treatment of gonorrhea
The same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to heal yourself – consult your doctor.
- examination of all patients for the presence of syphilis and HIV infection.
- examination and treatment of sexual partners.
- or benzylpenicillin intramuscularly with the sensitivity of the pathogen.
Alternative drugs for gonorrhea:
- once azithromycin 1 g inside,
- spectinomycin 2 g intramuscularly,
- norfloxacin 800 mg orally,
- ciprofloxacin 500 mg,
- combination of cefuroxime 1 g, cefotaxime 1 g intramuscularly.
Due to the fact that gonococcal infection is often combined with chlamydia, one of the above drugs is prescribed simultaneously with doxycycline 100 mg orally 2 times a day for 7 days (pregnant women – with erythromycin 500 mg orally 4 times a day for 7 days).
With complicated gonorrhea of the lower urinary tract, with gonorrhea of the upper urinary tract and pelvic organs, with gonococcal proctitis, pharyngitis and disseminated gonococcal infection:
- ceftriaxone 1 g intramuscularly or intravenously 1 time per day.
- pregnant women – erythromycin, benzylpenicillin (sodium salt) or some cephalosporins.
Chemotherapy for gonorrhea is stopped no earlier than 24-48 hours after the disappearance of the manifestations of the disease.
With gonorrheal conjunctivitis:
- ceftriaxone 125-250 mg intramuscularly once,
or topically every 2 hours – gentamicin
Topical treatment for gonorrhea
For men – washing the urethra with a solution of potassium permanganate (1: 10000), nitrofural (1: 5000), instillation of 0.25-0.5% silver nitrate solution, tamponade according to Vashkevich, bougienage
For women: with urethritis – instillation of 0.25-0.5% silver nitrate solution; with cervicitis – vaginal baths, lubrication of the cervical canal with 1% Lugol’s solution with glycerin, 2% silver nitrate solution; with vulvitis – sessile baths with a solution of potassium permanganate (1: 8,000), chamomile infusion.
In 7-10 days after the end of treatment, a combined provocation is carried out, and after 24-48-72 hours, material for research is taken. The provocation and clinical examination is repeated after 1 month.