Gonorrhea (clapper). Gonorrhea (gonococcal infection): infection, signs, diagnosis, how to treat, prevention

Gonorrhea refers to infectious and highly contagious diseases in which the mucous membranes of the urinary tract are affected, but infection of the oropharynx or rectum is also possible. Both men and women suffer from this disease.

The reasons

Gonorrhea is caused by the gonococcus (Neisseria gonorrhoeae), named after physician researcher Albert Neisser. The disease is transmitted only from a sick person to a person.

The main route of transmission of gonorrhea is sexual (genital), but infection is possible through anogenital and oral contact.

In addition, the vertical route of infection is known - during childbirth, a child becomes infected, passing through the birth canal of a sick mother.

The household route of transmission is not excluded, but its reliability has not been established, since the pathogen is unstable in the external environment.

Kinds

There are genital and extragenital (not sexual) gonorrhea. Genital gonorrhea is characterized by damage to the genitourinary organs.

The group of extragenital gonorrhea includes:

• gonorrhea of ​​anorectal localization (inflammation of the rectum),
• gonorrhea of ​​the bone and muscular systems (gonorrheal arthritis),
• gonorrheal lesion of the conjunctiva of the eyes (gonoblennorrhea),
• gonorrheal lesions of the pharynx (gonococcal pharyngitis).

The course of the disease is divided into fresh, chronic and latent gonorrhea.

Fresh gonorrhea is said to have been infected less than 2 months ago. Fresh gonorrhea is divided into acute, subacute and torpid (complaints are absent, but there are minor discharges).

If the infection occurred more than 2 months ago, chronic gonorrhea is diagnosed.

Latent or latent gonorrhea has no clinical manifestations.

Symptoms of gonorrhea in women and men

The first signs of the disease appear 2-14 days after infection (incubation period). But under some circumstances (for example, antibiotic treatment, the presence of good immunity), the first manifestations of the disease occur after 1-2 months.

Gonorrhea in men

The disease in men begins with a lesion of the urethra. Patients complain of a feeling of discomfort (burning and itching) that occurs during the process of urination. Also, urination becomes painful.

If you press on the head of the penis, a drop of pus appears. When the posterior urethra is involved in the process, urination becomes more frequent.

After intercourse, a bloody drop may appear.

On examination, hyperemia (redness) of the foreskin and head of the penis is noticeable.

Often the inguinal lymph nodes become inflamed, they increase and become painful.

In the case of an ascending infection, gonorrhea spreads to the prostate gland, affects the seminal vesicles and testicles. In this case, an increase in temperature is possible, aching pains in the lower abdomen appear and erection problems arise.

gonorrhea in women

More than half of infected women gonorrhea occurs without severe clinical manifestations.

At the very beginning of the disease, the urethra, vagina and cervical canal are involved in the process. Inflammation of the urethra occurs with pronounced signs: pale yellow discharge from the urethra appears, itching and burning sensation in this area, urination becomes painful.

With gonorrheal vaginitis and cervicitis, purulent, greenish leucorrhoea with an unpleasant odor, sometimes of a curdled consistency, is released from the genital tract. There is also a burning sensation and itching, soreness during intercourse.

In case of irritation with infected secretions of the vulva, it becomes inflamed, reddens and swells, itching in the perineum joins.

When viewed in the mirrors, there is hyperemia (redness) of the cervix and purulent discharge from the cervical canal.

If the infection rises higher, then the uterus and its appendages are affected.

Diagnostics

Gonorrhea in women must be differentiated from other sexually transmitted infections (trichomoniasis, candidiasis, bacterial vaginosis).

In men - with urethritis and prostatitis of another infectious or non-infectious etiology.

The diagnosis of gonorrhea is established on the basis of the patient's characteristic complaints and typical clinical signs established during the examination.

But to confirm the disease, it is necessary to conduct laboratory tests:

smear microscopy

To take smears, material (discharge) is taken from the urethra, cervical canal, vagina and anus. Before this, the doctor processes the listed anatomical structures with a swab dipped in saline. Before passing the analysis, it is necessary to refrain from urinating and stop taking antibacterial drugs for 4-5 days. All smears are taken in duplicate. The first batch of smears are stained with methylene blue, and the second batch is Gram stained.

Cultural method

The essence of the cultural (bacteriological) method is to sow secretions from the organs of the genitourinary tract on nutrient media. The conclusion is provided after 7 days, but gives a 100% result. In addition, this method allows you to determine the sensitivity of seeded gonococci to antibiotics.

Immune fluorescence reaction

The method consists in staining smears with special dyes, after which the gonococci glow under a microscope.

Linked immunosorbent assay

The essence of the method is to detect antibodies to the pathogen, and not smears are taken for analysis, but urine.

Polymerase chain reaction (PCR)

For PCR, smears from the anatomical structures of the genitourinary tract and urine can be used. The method is effective but expensive.

If chronic gonorrhea is diagnosed (repeated and ineffective treatment, negative results of bacterioscopic and bacteriological tests), provocative tests are performed, after which the pathogen is detected on the mucous membranes.

There are chemical, biological, thermal, alimentary and physiological provocations. For the most accurate result, a combined provocation is carried out (simultaneous holding of two or more samples). Smears after provocation are taken in a day, two and three.

*refer to the Federal Standard for the Diagnosis and Treatment of Gonorrhea, according to which this article was written.

gonorrhea treatment

Treatment of gonorrhea, as a rule, is carried out by a dermatovenereologist. But in some cases (for example, complicated gonorrhea), a gynecologist is involved in the treatment of a disease in women, and a urologist in men.

Uncomplicated gonorrhea is treated on an outpatient basis, all other cases are subject to hospitalization. Treatment is indicated for both sexual partners, regardless of test results. For the period of therapy, it is necessary to observe sexual rest, personal hygiene rules (mandatory washing of hands after using the toilet and taking a shower), refuse spicy food and alcohol.

Acute gonorrhea

Etiotropic treatment (elimination of the cause of the disease) consists in getting rid of gonococci and consists in prescribing antibacterial drugs.

With fresh gonorrhea are prescribed

• fluoroquinolone antibiotics (ciprofloxacin, abaktal, ofloxacin),
• cephalosporins (ceftriaxone, cefixime),
• macrolides (azithromycin, josamycin),
• tetracyclines (Unidox).

The course of treatment lasts 7, maximum 10 days. It is advisable to combine treatment with antibiotics that are active against chlamydia and ureaplasmas (since gonorrhea often occurs against their background).

Chronic form

Chronic gonorrhea is treated much longer.

First, gonovaccine is prescribed in courses of 6-8-10 intramuscular injections and drugs that stimulate nonspecific immunity (pyrogenal, ribonuclease) and only after that antibiotic therapy is carried out.

Gonorrhea- a sexual infection, about a quarter of a billion clinical cases are recorded annually. Despite modern methods of treatment, the disease is not fully controlled.: The causative agent of gonorrhea mutates, gradually acquiring resistance to the latest antibiotics.

Immunity to gonorrhea is not developed, the risk of getting sick again is approximately the same in women and men.

The disease belongs to the classics of venereology and has its own history. Ancient medical treatises ( Galen) mention "passive ejaculation" - gonorrhea, referring to the characteristic discharge from the penis. The Dutch and Germans preferred to rename gonorrhea to gonorrhea, associating the disease with travel and love affairs.

Toward the end of the 19th century, they were able to discover the causative agents of gonorrhea. They turned out to be diplococci - paired round-shaped bacteria resembling coffee beans. 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 to Neisseria. Since then, the causative agent of gonorrhea has received a sonorous name - Neisseria gonorrhoeae.

Infection transmission and prevalence

It has been proven that the predominant route of transmission of gonococcal infection is sexual contact. 50-70% of women get infected after the first contact, among men the infection rate is 25-50%.

It is recognized that gonorrhea is contracted equally during "everyday" sexual intercourse, and during oral or anal sex. The last two ways of infection are most frequent among homosexual and lesbian couples. There are no living gonococci on household items, in the water of pools or on bath accessories: Neisseria do not multiply outside the body and die, getting into the external environment, within 2-4 hours.

Transmission of gonococci by 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 with appropriate localizations of gonorrhea. Non-sexually, the child is infected during childbirth if the mother is sick or is a carrier of gonococci. In such cases, children in the period from 2 to 4 days of life develop neonatal blenorrhea, a specific inflammation of the conjunctiva.

The prevalence of gonorrhea does not depend on the degree of development of society or the economic well-being of countries. Statistics for the European Union revealed that the maximum incidence rate is observed in traditionally wealthy countries and states with a "Nordic" character. England (27.6) became the sad champion in terms of the number of cases per 100,000 population, Latvia (18.5) is in second place, Iceland (14.7) and Lithuania (11.7) take the honorable third position. It was also found that up to 60% of gonorrhea patients from the Netherlands and France were infected through homosexual contact, in Norway - up to 40%.

For many years, statistics do not change regarding the age of most patients with gonorrhea. Young people from 15 to 34 years old remain at risk, they account for up to 75% of all detected 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 environmental conditions. They die if the temperature is below 35 or more than 55 ° C, susceptible to drying and exposure to sunlight, to the effects of even weak antiseptics. In fresh purulent masses, live pathogens of gonorrhea are only preserved; they can reproduce comfortably inside cells - in the cytoplasm of leukocytes, in the epithelial layer of the mucous membranes of the genital organs, rectum, mouth and eyes.

Gonococci do not know how to move and are not able to form spores. However, with the help of the thinnest filaments-pills, they are fixed on the membrane of erythrocytes, spermatozoa and epithelial cells, due to which they move inside the body and end up outside it. Around Neisseria there is a semblance of capsules that protect against the effects of cellular enzymes. Therefore, leukocytes “attacking” gonococci cannot digest them, and erythrocytes and Trichomonas become a barrier that complicates the treatment of gonorrhea.

The phenomenon of resistance (resistance) to antibiotics is explained by the formation of L-forms of gonococci, which, if gonorrhea is not properly treated, lose some of the properties that are important for triggering the immune response. L-forms are difficult to treat: they do not give a vivid clinical picture of the disease, but are sexually transmitted and remain viable for a long time. Under favorable conditions (hypothermia, stress, colds, starvation), the infection is activated with the manifestation of signs of gonorrhea.

Forms of gonorrhea, incubation period

By duration, a fresh form of gonorrhea is distinguished, lasting no more than two months, and chronic, flowing more than 2 months. Chronic gonorrhea is also diagnosed if the statute of limitations for the disease has not been established. A classification based on the severity of the symptoms divides gonorrhea into acute, subacute and torpid - asymptomatic and asymptomatic variants, or carriage of gonococci.

Gonococci infect mainly the lower parts of the genitourinary system, which are covered with a cylindrical epithelium. it mucous membranes of the paraurethral glands and urethra - in men; urethra, cervical canal, fallopian tubes, Bartholin's glands - in women. The walls of the vagina are covered with stratified squamous epithelium, which is normally immune to gonococci. The development of gonorrheal occurs when the epithelium loosens during pregnancy, at puberty, or during menopause.

After ingenious-oral contacts, gonorrheal tonsillitis, stomatitis (erosions and ulcers in the mouth) or pharyngitis (sore throat) appear, after genital-anal contacts - proctitis, with infection of the mucous membrane of the eyes - gonorrheal conjunctivitis. The disease spreads beyond the mucous membranes, destroys tissues under the epithelium and provokes local inflammation. Without treatment, gonococci with lymph and blood are carried throughout the body, affecting the liver, joints, kidneys, and brain. Sepsis may develop.

skin-articular 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 may pass from the moment of infection with gonococci to the first symptoms. In the case of carriage, there are no signs of illness, but a person always poses a danger as a spreader of infection.

gonorrhea symptoms

purulent discharge is characteristic of both women and men

The onset of the disease is sometimes violent. The first signs of gonorrhea obtained by common sexual contact are abundant mucopurulent discharge resembling thick cream from the urethra (in men) and the cervical canal (in women). Redness, swelling around the urethra or cervical canal is visually determined. Locally, the temperature can rise to 38-39, there are signs of general intoxication - chills, muscle pain, thirst and weakness.

If the infection occurred orally, inflammation of the throat and palatine tonsils occurs - gonorrheal tonsillitis and pharyngitis, as well as inflammation of the mucous membrane in the mouth - stomatitis. First, local redness with uneven edges is formed, then erosion and a white coating characteristic of gonorrhea. Its thickness and prevalence are constantly increasing; without adequate treatment, stomatitis captures 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 of plaque with 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 localization - lower lip, gums, soft palate;
• The plaque does not disappear when treated with fungicidal preparations, but is sensitive to the effects of methylene blue (blue blue solution).

With anal infection with gonococci, proctitis develops, inflammation of the rectum. Rectal symptoms of gonorrhea: copious discharge from the anus, severe itching, burning and swelling of the tissues surrounding the anus. Complications - the formation of perianal abscesses (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 site does not pass through the liver, where the infection and tissue decay products could linger, but enters directly into the system of the inferior vena cava. The further path of infected blood is the heart and lungs, then the heart and aorta again, then the kidneys and all internal organs.

Gonorrhea of ​​the eyes is more common in newborns, the infection is transmitted during childbirth from an infected or sick mother with gonorrhea. It starts as a banal conjunctivitis - redness of the mucous membranes and swelling of the eyelids, but the inflammation quickly turns into a purulent one. The discharge becomes profuse, yellowish crusts form on the eyelids and eyelashes, the disease spreads to the cornea of ​​​​the eye. Without adequate treatment, a child can lose sight, so all newborns are given prophylaxis by instilling a solution of sodium sulfacyl into their eyes. Gonorrheal conjunctivitis, obtained during childbirth, manifests itself up to 4-5 days 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's glands often proceeds without subjective discomfort. Allocations are present, but a woman may not notice them or confuse them with, itching does not particularly bother or disappears after douching with a weak solution of potassium permanganate. Gradually, the disease passes into a carrier state or into a chronic form with mild exacerbations in the form of the same itching and scanty vaginal discharge. On examination by a gynecologist, swelling and redness of the cervical canal and the mouth of the urethra are noticeable, thick.

The main complications are purulent inflammation of the Bartholin glands, cervix and vagina. In these cases, the symptoms immediately become aggravated: the temperature rises sharply (39-40), there are pains in the perineum and lower abdomen, profuse purulent discharge. When one or two-sided swelling is determined in the region 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 perimetry (the outer shell of the uterus and the fiber around it), often the pelvic nerve plexus. The reasons are medical procedures: diagnostic curettage and abortion, probing of the uterus, cervical biopsy, the introduction 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.

Examination reveals purulent bloody discharge from the cervical canal; soft enlarged uterus and sharply painful on palpation; on ultrasound - edematous fallopian tubes and ovaries. The main complications are ovarian abscesses, peritonitis (inflammation of the peritoneum). In both cases, the picture of the "acute abdomen" is characteristic, when any pressure on its front wall causes a sharp pain. The woman takes the fetal position: she lies on her side, bends her knees and pulls them to 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 a little less.

Treatment is carried out only in a hospital, often it is necessary to remove the ovaries. If a pyometra (accumulation of pus in the uterus) is determined and the general condition of the patient is satisfactory, then the uterus is drained and treated with antibiotics. With the threat of sepsis and the ineffectiveness of the therapeutic approach, the organ is removed.

3) Chronic form

Chronic gonococcal inflammation is not symptomatic, but the consequences of an implicit disease are dangerous complications. The menstrual cycle is disturbed and adhesions develop in the small 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, septic abortion. Rarely enough, up to 4 months of pregnancy, gonococcal infection can proceed as (inflammation of the fallopian tubes). The development of gonorrheal vaginitis is characteristic, which usually does not occur outside of pregnancy and is associated with hormonal changes in the vaginal epithelium. Symptoms are similar to thrush, but standard drugs do not help. Danger for the child - intrauterine infection with gonococci, postpartum gonorrheal conjunctivitis, 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 contact., but often asymptomatic periods last up to 2-3 weeks. The scenario of 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, and aged men mostly suffer from asymptomatic variants of the disease, turning into chronic gonorrhea or carriage of gonococci.

1) Acute gonorrheal epididymitis - inflammation of the epididymis

The infection spreads from the urethra through the vas deferens. It begins with swelling of the testicles and such sharp pains in the scrotum that the man cannot actually move. Then there are pains in the lower back, go to the side of the abdomen and in the groin. The pain is stronger on the side where the inflammation is more intense. With an increase in edema, the epididymis increases 2-4 times in just a couple of hours; at the same time, pain increases during urination, 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 abscess of the epididymis and the transfer of infection to the testicle (). The normal functions of the appendages are reduced to the transport, preservation and maturation of spermatozoa. With inflammation, the ducts narrow or are completely blocked by adhesions, the result is infertility. With unilateral epididymitis - in 35% of cases, with bilateral - in 87%.

2) Gonorrheal prostatitis

Gonococci enter the prostate through the ducts that connect the gland to the urethra. Acute inflammation is characterized by pain in the lower back and lower abdomen, radiating to the scrotum and inguinal region. The prostate gland swells and can compress the urethra, making it difficult to urinate; mucus and blood appear in the urine. Chronic forms develop imperceptibly, but eventually 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 openings, fusion of the inner layers of the foreskin, erosions on the skin of the genital organs.

Gonorrheal epididymitis and prostatitis are diagnosed by a smear from the urethra, appropriate antibiotics and restoratives are prescribed. Purulent complications are treated in a hospital, chronic and subacute forms - on an outpatient basis., also with the use of antibiotics and further - physiotherapy. To reduce pain, it is proposed to put suspensions on the testicles, with urinary retention, drink a decoction of parsley and make local baths with chamomile or sage. Recommendations for the regimen: restriction of activity with a temporary renunciation of sexual activity, as well as cycling and horseback riding. Diet with restriction of fats and spices, without alcoholic beverages.

Diagnostics

The first point of the diagnostic algorithm - patient interview. The doctor finds out what exactly is worrying at the present time, when the problems started and what they can be associated with, whether there were such symptoms before.

Then proceeds to inspection, urological or gynecological, if necessary, assesses the condition of the genital organs by palpation (palpation). In women with an acute form of gonorrhea, hyperemia of the cervical canal is visible, liquid pus of a yellowish-milky color is released from it..In men, the discharge is in the form of a drop, the color is the same, an admixture of blood is possible. Chronic gonorrhea gives a more modest picture: there is little discharge, they appear after pressure on the mouth of the urethra.

smear for gonorrhea taken with a sterile loop or swab. If gonorrheal inflammation outside the genital organs is suspected, the material is obtained from the mucous membrane of the mouth and throat, from the anus, from the corners of the eyes. With standard localization of gonorrhea: in women - from the urethra, cervical canal, vagina and 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 performs a prostate massage through the rectum, and the patient holds a test tube near the mouth of the urethra. The procedure is unpleasant, but passes quickly. With normal inflammation, the prostatic secret contains only leukocytes and columnar epithelium, with gonorrhea - leukocytes, epithelium and gonococci, and Neisseria are inside the cells.

Cultural method

This is the sowing of material from the zone of inflammation on nutrient media, the isolation of gonococcal colonies and the determination of their sensitivity to antibiotics. It is used as the final diagnosis of gonorrhea for the appointment of a specific treatment.

Antibiotic susceptibility test: gonococci isolated from the 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 rounded transparent areas are visible only around the “confetti” with certain antibiotics. They are measured, with a diameter of 1-1.5 cm, the sensitivity of this 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 a long execution time; for the growth of colonies sequentially on two media, it takes from 7 to 10 days. Plus - the detection of gonorrhea in 95% of cases.

smear microscopy

The test material 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-purple diplococci, located mainly inside other cells. The technique is not complicated, but depends on the qualifications of the laboratory doctor, because its accuracy is only 30-70%. Microscopy is used to make a preliminary diagnosis.

Analyzes

Blood for general clinical research, for PCR and ELISA test.

1. General clinical analysis reveals signs of inflammation: leukocytosis, an increase in the number of lymphocytes, ESR, and possibly an increase in platelets.
2. , polymerase chain reaction. The method is highly sensitive, based on the determination of gonococcal DNA. It is used for preliminary diagnosis, it is often false-positive. Supplemented for confirmation.
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 is done quickly.

Hardware methods are used after treatment to assess the severity of the consequences of gonorrhea for 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.

Antibiotic treatment

The main principle: be sure to treat sexual partners in which gonococci were found using the cultural method. Acute and chronic gonorrhea require an etiotropic approach, that is, exposure to the cause of the disease.

For the entire period of treatment, sexual intercourse and alcohol are prohibited!

Therapy with oral antibiotics is always carried out against the background of hepatoprotectors(karsil) and probiotics(lineks, yogurt). Local remedies with eubiotics (intravaginally) - acylact, lacto- and bifidumbacterin. It will also be useful to prescribe antifungal drugs (fluconazole).

The temptation to heal yourself is better to stop immediately , since the antibiotic may not work and gonorrhea will become chronic, and drugs are increasingly causing allergies and its complication - anaphylactic shock - develops at lightning speed. And most importantly: only a doctor conducts a reliable diagnosis of gonorrhea, based on objective data.

Acute uncomplicated gonorrhea of ​​the lower genitourinary system is treated literally according to the instructions drawn up on the basis of official recommendations. Mostly prescribed for one of the following antibiotics:

• gonorrhea tablets, 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 they use (once, orally) ofloxacin (0.4 g) or cefozidime (0.5 g), kanamycin (2.0 g) intramuscularly, once. After treatment, it is necessary to control the sensitivity of gonococci to antibiotics.

Acute complicated gonorrhea of ​​the lower and upper parts of the genitourinary system is treated for a long time. The antibiotic is changed after a maximum of 7 days, or drugs are prescribed for long courses - until the symptoms disappear, plus another 48 hours.

1. Ceftriaxone 1.0 IM (intramuscularly) or iv (intravenously), 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 the symptoms disappear + 48 hours.

After stopping the acute manifestations of gonorrheal inflammation (the temperature should return to normal, the discharge is scarce or not detected, there are no acute pains, 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 regimens are expanded by adding azithromycin tablets (1.0 g once) or doxycycline (0.1 x 2.7 days each). Trichomoniasis can be treated with metronidazole, ornidazole, or tinidazole. associated with 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 in 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). Tetracycline drugs (doxycycline), sulfonamides (biseptol) and fluoroquinolones (ofloxacin) are categorically contraindicated. For complications of gonorrhea chorioamnionitis urgent hospitalization and antibiotics are indicated (ampicillin 0.5 intramuscularly 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 the treatment of the pregnant woman - the first control for gonococci, repeat it for three months in a row. A partner or husband is also treated, children must be examined.

Treatment of gonorrhea in children

Antibiotics of the same groups are prescribed that are used to treat pregnant women. Dosage is calculated by body weight: up to 45 kg - ceftriaxone 0.125 IM once or spectinomycin 40 mg per kilogram (not 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 body 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%, microclysters with chamomile infusion. It is prepared at the rate of 1 tbsp. a spoonful of dry chamomile for 1 cup of boiling water, leave for 2 hours, then strain through cheesecloth. All of these 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 phonopheresis 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, increase the susceptibility of cells to antibiotics. Gonococcal vaccine, autohemotherapy, drugs (pyrogenal) are used. They begin only after treatment of acute manifestations of gonorrhea and always against the background of antibiotics; in chronic gonorrhea or subacute course - before the start of a course of antibiotics.

Treatment for acute ascending infection

A prerequisite is hospitalization. In case of severe pain on the lower abdomen (for women) or the area of ​​​​the scrotum and penis, cold lotions or a rubber “heater” with ice are applied, if necessary, they are anesthetized with medication. Medicines are administered intravenously. Assign droppers with physical. glucose solution and novocaine, no-shpoy and insulin, antihistamines (suprastin, diphenhydramine). Inject gemodez, reopoliglyukin. The goal of infusion therapy is to reduce intoxication, reduce blood viscosity to prevent thrombosis and DIC, reduce smooth muscle spasm and relieve pain.

Acute inflammation of the fallopian tubes and / or ovaries on the first day is treated conservatively, 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. With the development of diffuse peritonitis, 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 see a doctor as soon as possible.

Treatment control

Gonorrhea cure criteria are used to evaluate the effectiveness of treatment.

• There are no symptoms of inflammation, gonococci are not detected in smears.
• After provoking, the symptoms of the disease do not return. The provocation can be physiological (menstruation), chemical (the urethra is lubricated with a solution of silver nitrate 1-2%, the cervical canal - 2-5%), biological (gonovaccine i / m), physical (locally - inductothermia) and food (acute, salty, alcohol) or a combination.
• Three times examination of smears from the urethra, cervical canal or anus, taken with an interval of a day. In women, during menstruation.
• Combined provocation, tank. examination of smears (threefold microscopy every other day, sowing).

If gonococci are not found, then gonorrhea is considered completely cured. It is recommended to do tests for, after 3 months. after the end of treatment.

home treatment

Home treatment is an addition to the main scheme 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 recovery period after an acute form.

1. Baths for the external genital organs and gargles for the throat, douching and microclysters with chamomile, sage, eucalyptus oil. Antiseptic, anti-inflammatory action.
2. A decoction of burdock, dill, parsley - diuretic, anti-inflammatory.
3. Tincture of ginseng, golden root - immunomodulatory.

Prevention of gonorrhea

Preventing infection with gonococci and blocking the spread of the disease are the main objectives of gonorrhea prevention. The risk of infection during sexual intercourse is reduced by the use of a condom and the subsequent use of chlorine-based antiseptics (miramitan). Washing with plain water and soap is ineffective, as are spermicides. The best way to maintain health is a reliable partner, preferably in the singular.

Safe sex with gonorrhea without a condom with a patient or a carrier of infection is possible, but such actions can hardly be called a full-fledged sexual intercourse. Experts include body massage, dry kissing, oral contact with the body except for the vulvar area, self-masturbation and individual sex toys.

Identification of patients with gonorrhea and carriers takes place during routine examinations, registration of medical books, during the registration of pregnant women. All sexual partners should be tested, if symptoms of gonorrhea appeared after contact within 30 days, and in the asymptomatic form - within 60 days before the diagnosis was made, if at least one of them showed signs of the disease. Examine mothers whose children are sick with gonorrhea, and girls, if gonorrhea has been found in parents or guardians.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is gonorrhea?

Gonorrhea is a common infectious venereal disease, which is caused by gonococci and is transmitted mainly through sexual contact. With gonorrhea, the mucous membranes of the genitourinary system are more often affected, much less often - the mucous membranes of the mouth, nose, throat, or rectum. Integuments at this pathology are surprised extremely seldom.

To date, gonorrhea is considered a rather serious social problem, as more and more people of working age fall ill with this pathology. Gonorrhea can occur in all age groups, but adolescents and young, able-bodied people between the ages of 18 and 30 are most at risk of infection. It is also worth noting that among adolescents, women are most often ill, while among the adult population - men.

The spread of gonorrhea can contribute to:

• An increase in the population at risk.
• Social cataclysms ( wars, natural disasters and others) associated with the deterioration of sanitary and hygienic living conditions.
• Promiscuous sexual contacts.
• Abuse of alcohol and drugs.
• Prostitution.

The causative agent of gonorrhea

The causative agent of the disease is Neisseria gonorrhea ( gonococcus). The cell wall of this microorganism consists of three layers. On the outer layer there are special filamentous processes ( drank) that promote the spread of infection. When entering the human body, bacteria with the help of pili are firmly attached to epithelial cells ( epithelium is a thin layer of rapidly renewing cells covering mucous membranes and other body surfaces).

After fixation on the cells of the epithelium, gonococci pass through the intercellular spaces under the epithelial tissue, which leads to the activation of the body's immune system and the development of the inflammatory process. cells of the immune system neutrophils) are delivered with blood flow to the site of infection and begin to actively absorb pathogens. However, gonococci engulfed by neutrophils usually do not die, and sometimes may even continue to multiply, supporting the inflammatory process. The resulting purulent masses are a lot of dead neutrophils, inside which are active ( contagious) gonococci. The resulting pus accumulates on the surface of the affected mucosa and can be discharged from the urogenital canal.

As the disease progresses, gonococcal infection spreads to new mucosal sites, affecting new organs ( prostate and seminal vesicles in men, uterus, fallopian tubes, or ovaries in women), leading to the development of complications. Also, gonococci can enter the lymphatic vessels and spread to distant organs with the lymph flow. Very rarely, gonococci can enter the bloodstream, leading to the development of severe purulent complications.

It should be noted that gonococci are highly resistant in the human body. Under the influence of unfavorable factors ( including the use of antibiotics) they can turn into the so-called L-forms, which are not able to multiply, but can survive for a long time in adverse conditions, and then reactivate. However, under environmental conditions ( outside the host) resistance of gonococci is reduced. They die when the fluid with which they were excreted from the body dries up ( pus, semen and so on). When heated to 41 - 55 degrees, they die almost instantly, as well as when they get into soapy or salt water. Also, gonococci are very sensitive to many antibiotics and antiseptics ( disinfectants).

Ways of getting gonorrhea

The source of infection with gonorrhea can be a sick person who may not even know that he is a carrier of gonococci ( gonorrhea can be latent or chronic).

Gonorrhea can be contracted:

• Sexually. The most common ( more than 95% of cases) the route of infection, in which gonococci pass from a sick person to a healthy person during an unprotected ( without using a condom) sexual contact. However, it is worth noting that sexual intimacy with an infected partner does not always lead to the development of the disease. After a single sexual contact with a sick woman, a man can get sick with a probability of 17 - 20%, while a woman who has contact with a sick man will become infected with a probability of 80%. This difference is due to the peculiarities of the anatomical structure of the male and female urethra ( urethra). In women, the urethra is shorter and wider, which facilitates the penetration and spread of infection, while the narrower and longer urethra reduces the risk of infection in men.
• Contact household way. Gonococci can pass from a sick person to a healthy person through various household items ( towels, sheets and other bedding, washcloths, underwear and so on). This route of gonorrhea spread occurs in less than 1% of cases, due to the low resistance of infectious agents in environmental conditions ( outside the host).
• vertical way. This route of transmission is characterized by infection of the newborn during passage through the birth canal of an infected mother. In this case, gonococcal infection can affect the mucous membrane of the eyes, mouth or genitals of the baby.

incubation period for gonorrhea

The incubation period is the period of time from the moment of penetration of infectious agents into the body until the first clinical signs of the disease appear. This time is necessary for the body's immune system to recognize the infectious agent and begin to react to it, that is, to produce special anti-infective antibodies, which is the direct cause of the development of an inflammatory reaction.

After infection with gonococcus, the incubation period lasts from 12 hours to several weeks ( extremely rare up to 3 months), which is due to the characteristics of the pathogen, the activity of the immune system and the general condition of the patient. On average, the first clinical signs of the disease in men appear after 3-4 days, and in women - 8-10 days after infection. A longer incubation period may occur in the elderly and in patients with AIDS ( acquired immunodeficiency syndrome), as their immune system reacts less actively to the introduction of foreign agents. At the same time, a shorter incubation period may be observed with a high initial dose of the pathogen.

It is worth noting that during the incubation period, no clinical or laboratory signs of gonorrhea are observed, however, an infected person may already be contagious to others. That is why the frequent change of sexual partners is one of the most important factors in the spread of gonococcal infection.

Forms of gonorrhea

In clinical practice, it is customary to classify gonorrhea depending on the time elapsed since infection, the rate of development and the severity of clinical manifestations. It is extremely important to timely and accurately determine the form of the disease, on which further diagnostic and therapeutic tactics depend.

Depending on the time since infection, there are:

• fresh gonorrhea;
• chronic gonorrhea;
• hidden ( latent, asymptomatic) gonorrhea.

fresh gonorrhea

Fresh gonorrhea is considered if no more than 2 months have passed since the onset of the first clinical signs of the disease. During this period, the body actively fights developing gonococci, which determines the clinical picture of the disease.

Fresh gonorrhea can occur:

• in acute form. In this case, the patient has pronounced manifestations of infection, which is due to the increased activity of the immune system against gonococcus. As a result of the progressive development of the inflammatory process, the epithelial cells of the affected mucosal area are destroyed, which can cause the formation of visible defects ( ulceration).
• In substandard form. With this form of gonorrhea, the activity of the infectious-inflammatory process is significantly reduced. As a result, the symptoms of the disease subside somewhat, become less pronounced, but are observed constantly throughout the entire period of the disease and continue to cause inconvenience to the patient.
• In torpid form. The torpid form is characterized by a sluggish, protracted course, in which the symptoms of the disease are extremely weakly expressed or absent altogether.

It is worth noting that although in most cases gonorrhea begins with an acute form, often the disease can debut in a subacute or torpid form. Such patients usually do not seek medical attention for a long time ( it can be embarrassing to go to the doctor, and the symptoms do not cause such pronounced inconvenience as in acute gonorrhea). However, it is worth remembering that with any form of the disease, a sick person is a distributor of infection, and complications that develop over time can cause serious harm to his health.

chronic gonorrhea

When the disease becomes chronic, the infectious agent ( gonococcus) ceases to play a decisive role in the appearance of clinical symptoms. At this stage in the development of pathology, certain changes are noted in the microorganism itself and in the immune system of a sick person, as a result of which it ceases to actively fight the infectious agent. At the same time, gonococci can stay in the affected tissues and cells for a long time, becoming activated when the body's defenses are weakened or when exposed to predisposing stress factors ( hypothermia, other infectious disease, surgery, and so on).

The chronic form of the disease is characterized by a sluggish, recurrent or even asymptomatic course ( in 95% of men 3 months after infection, it is difficult to detect any subjective symptoms). Obvious signs of the disease can be determined during an exacerbation of the disease, progress within a few days and disappear on their own, which greatly complicates the diagnostic process. At the same time, proliferative changes occur in the urethra itself, that is, there is an excessive growth of connective tissue, which can block the lumen of the urethra, making it difficult for the outflow of urine.

Hidden ( latent, asymptomatic) gonorrhea

The latent form of the disease is characterized by an almost asymptomatic course and is more common in women. In this case, the patient is infected, that is, he is a carrier and source of infection, however, for one reason or another, his immune system does not respond to a foreign microorganism, as a result of which the inflammatory process does not develop and subjective sensations ( symptoms) are missing.

It is worth noting that in men, even with a latent form of gonorrhea, certain non-specific signs can be observed ( adhesion of the lips of the urethra after a night's sleep, the appearance of a small amount of cloudy discharge from the urethra after a long walk, run or sex). However, these manifestations do not cause the patient absolutely no inconvenience and are extremely rarely a reason to see a doctor. The person continues to live a normal life, putting sexual partners or family members at risk of infection.

Symptoms and signs of gonorrhea

Symptoms of gonorrhea are due to the development of an infectious and inflammatory process at the site of infection, as well as the form of the disease and the gender of the patient.

Symptoms of gonorrhea in men

Fresh acute gonorrhea in men usually begins with acute urethritis ( inflammation of the mucous membrane of the urethra). Symptoms of the disease occur abruptly and progress rather quickly, which is usually the reason for going to the doctor.

Acute gonorrhea in men is manifested by:

• Inflammation of the urethra urethritis). First of all, the infectious-inflammatory process affects the mucous membrane of the anterior sections of the urethra ( anterior urethritis develops), and then can spread to its entire surface ( in this case we are talking about total urethritis). With the development of the inflammatory process, there is an expansion of blood vessels, an increase in blood flow and swelling of the mucous membrane. Outwardly, this is manifested by hyperemia ( redness) and swelling of the lips of the external opening of the urethra, discomfort during urination and other symptoms.
• Pain and itching. Pain and itching in the urethra are among the first symptoms of gonorrhea. Pain usually occurs in the morning after a night's sleep), at the beginning of urination and is cutting or burning in nature. Patients may also complain of pain during ejaculation ( ejaculation). The occurrence of pain is due to inflammation and swelling of the mucous membrane of the urethra. Also in the inflamed tissue changes ( rises) sensitivity of painful nerve endings, as a result of which a person feels pain when urinating.
• Discharge from the urethra. The second characteristic manifestation of gonorrhea is purulent discharge from the urethra ( thickish consistency, yellow, greenish or brown in color, with an unpleasant odor). They first appear in the morning during urination ( excreted in the first portions of urine). As the disease progresses, pus can be discharged from the urethra and outside of urination, soiling underwear and bedding, thereby causing significant inconvenience to the patient. With total urethritis at the end of urination, a small amount of blood may be released from the urethra, which is associated with the destruction of the mucous membrane of the urethra. There may also be hemospermia ( the appearance of blood in the semen).
• Violation of urination. Violation of urination in gonorrhea is also associated with inflammation of the urethra. As a result of swelling of the mucous membrane, the lumen of the urethra narrows, which can impede the outflow of urine. This can also be facilitated by the accumulation of pus in the lumen of the urethra. With total urethritis, the infectious-inflammatory process can spread to the posterior parts of the urethra, which will be manifested by frequent urge to urinate, during which a small amount of urine and / or pus will be released.
• An increase in temperature. Body temperature in gonorrhea may remain normal, however, in some cases, the development of acute gonorrheal urethritis is accompanied by an increase in temperature up to 37 - 38 degrees, and with the addition of purulent complications - up to 39 - 40 degrees. The reason for the increase in temperature is the release of special substances into the blood - pyrogens. Pyrogens are contained in many cells of the immune system and are released into the surrounding tissues during the development of the inflammatory process, affecting the thermoregulatory center in the brain and thereby increasing body temperature.

It is important to note that regardless of the form of urethritis ( front or total), after 3-5 days the severity of clinical manifestations subsides and the disease passes into a subacute or torpid form. The severity of hyperemia and soreness in the urethra decreases, the discharge acquires a mucous or mucopurulent character. The number of discharges is also significantly reduced.

Symptoms of gonorrhea in women

In most cases, gonorrhea in women occurs in a latent, asymptomatic form. Only 10 - 15% of women infected with gonococcus go to the doctor on their own because of certain manifestations of the disease. Much more often, women are recommended to undergo a diagnosis for the detection of gonococcus in the event that her husband or sexual partner has developed a clinic of fresh acute gonorrhea.

Gonorrhea in women can manifest itself:

• Profuse purulent or mucopurulent discharge from the urethra, worse in the morning after sleep.
• Inflammatory changes in the vestibule of the vagina ( redness, swelling and soreness of the mucous membrane).
• Itching, burning or soreness in the urethra, worse at the beginning of urination or during intercourse.
• An increase in body temperature to 37 - 38 degrees.

It should be noted that asymptomatic course does not reduce the likelihood of developing various complications. Moreover, in the absence of clinical signs of the disease, a woman may not see a doctor for a long time until other pelvic organs are affected. That is why it is extremely important when the first signs of gonorrhea appear, as well as when this pathology is detected in a sexual partner, consult a doctor and undergo a full examination.

Skin lesions in gonorrhea

Damage to the skin as a result of contact with gonococci is extremely rare. This is explained by the fact that for the development of the disease, the infectious agent must get on the skin in a living, active state, and as mentioned earlier, gonococci die quite quickly in environmental conditions. If infection has occurred, gonococci penetrate through damaged skin under the epidermis ( outer protective layer of the skin), causing the development of an inflammatory reaction at the site of implementation. This is manifested by the formation of small ( 0.5 - 2 cm in diameter), slightly painful ulcerations, the edges of which are hyperemic. These defects are located mainly in the region of the frenulum and skin of the penis, in the pubic region, on the inner surface of the thighs.

Eye damage in gonorrhea

Gonococcal eye disease usually develops when the pathogen is brought into the eyes with unwashed hands. Also, quite often, gonococcus can infect a newborn baby during its passage through the birth canal of an infected mother.

Clinically, eye damage in gonorrhea is manifested by gonococcal conjunctivitis ( inflammation of the conjunctiva, a thin transparent membrane that covers the outside of the eye). The incubation period usually lasts from 3 to 5 days, after which the person has the characteristic manifestations of the disease.

Gonococcal conjunctivitis may present with:

• severe redness of the conjunctiva;
• bleeding of the conjunctiva;
• severe swelling of the eyelids;
• suppuration from the eyes;
• increased lacrimation;
• photophobia.

In the absence of timely treatment, the inflammatory process can spread to the cornea, which can cause ulcers or even perforation.

Throat and mouth lesions in gonorrhea

Gonorrhea is usually asymptomatic. In most cases, on examination it is possible to detect hyperemia ( redness) and swelling of the mucous membrane of the pharynx and palatine tonsils ( tonsils), as well as the presence of a small amount of white or yellowish coating on them. Patients may complain of sore throat, enlargement and mild soreness in the region of regional lymph nodes ( submandibular, cervical).

Oral lesions in gonorrhea may present with gingivitis ( inflammation of the gums) or stomatitis ( inflammation of the oral mucosa) with the formation of painful ulcerations in the area of ​​​​introduction of the pathogen.

Symptoms of anal gonorrhea gonorrhea of ​​the rectum)

They talk about anal gonorrhea when gonococci affect the mucous membrane of the lower third of the rectum ( infection usually does not spread to higher parts of the intestine). Women and girls with acute gonorrhea are at risk of developing rectal gonorrhea. This is explained by the anatomical proximity of the urethra and anus in women, and therefore the pathogen can easily spread, especially if personal hygiene is not followed. Passive homosexuals are also at risk of developing anal gonorrhea, which is due to the peculiarities of sexual contacts among people in this group.

Anal gonorrhea can manifest itself:

• Itching and burning in the anus and rectum.
• Tenesmus. Tenesmus is a frequently repeated, severely painful false urge to defecate, during which a small amount of mucopurulent or stool is excreted ( or nothing at all).
• Constipation. Constipation can develop due to damage and destruction of the mucous membrane of the rectum.
• pathological secretions. Mucopurulent or purulent masses may be discharged from the rectum, as well as a small amount of fresh ( bright red or veined) blood ( usually with first stool).

Symptoms of gonorrhea in newborns and children

As mentioned earlier, newborn children become infected with gonococcus when passing through the birth canal of a sick mother. It is important to note that gonococcus can affect not only the eyes, but also other mucous membranes of the baby, which will lead to the development of characteristic clinical manifestations.

The incubation period for infection of a newborn lasts from 2 to 5 days, after which signs of damage to various organs begin to appear.

Gonococcal infection in newborns can manifest itself:

• eye injury ( neonatal ophthalmia);
• damage to the nasal mucosa ( rhinitis);
• damage to the urethra urethritis);
• damage to the mucous membrane of the vagina ( vaginitis);
• septic condition ( developing as a result of the penetration of pyogenic microorganisms into the blood).

Sick children become restless, sleep poorly, may refuse to eat. Mucous or purulent masses, sometimes with an admixture of blood, may be discharged from the urethra.

Methods for diagnosing gonorrhea

Diagnosing the acute form of gonorrhea is quite simple, it is enough to ask the patient in detail about the time of onset of the disease and about the main symptoms. At the same time, not a single dermatovenereologist ( doctor who treats and diagnoses gonorrhea) has no right to make this diagnosis on the basis of symptoms and clinical examination data alone. At the slightest suspicion of gonorrhea, the patient, as well as his sexual partner ( partners) must undergo a comprehensive examination and pass a series of tests in order to confirm the diagnosis.


Diagnosis of gonorrhea includes:

• smear for gonorrhea;
• methods of provocation of gonorrhea;
• seeding for gonorrhea;
• laboratory methods for diagnosing gonorrhea;
• instrumental methods.

smear for gonorrhea

smear for gonorrhea bacterioscopic examination) is one of the fastest and most reliable ways to detect gonococcus. The essence of the study is as follows. The patient is given a sampling of biomaterial, which may contain gonococci ( it can be discharge from the urethra or vagina, from the rectum, purulent plaque from the pharyngeal mucosa, and so on). After that, the resulting material is transferred to a special glass and stained with a special dye ( usually methylene blue). The dye penetrates the various structures of the gonococci and stains them, as a result of which they can be easily detected under a microscope.

It should be noted that this research method is effective only in the acute form of the disease, when the infectious agent is excreted from the urethra ( or other affected area) along with pus. In chronic gonorrhea, it is not always possible to isolate gonococcus using a conventional smear, and therefore additional studies are often prescribed.

Methods of provocation of gonorrhea

Provocation methods are used in the event that it was not possible to identify gonococcus and bacterioscopic examination failed ( this is usually observed in subacute or torpid form of the disease). The essence of provocative methods is that they stimulate the release of gonococci from the mucous membrane of the affected area. As a result, the probability that during the subsequent sampling of the material the pathogen will enter the smear and be detected by microscopy increases.

Provocation in gonorrhea can be:

• Biological. The essence of biological provocation is that the patient is injected intramuscularly with inactivated gonococcal vaccine. This preparation contains inactive gonococci, on the surface of which special antibodies have been preserved. These antibodies stimulate the immune system of the body, contributing to a more active absorption of gonococci by neutrophils ( cells of the immune system) and excreting them with pus. Also, biological stimulation can be intramuscular or rectal ( into the rectum) the introduction of the drug pyrogenal, which is an immunostimulant ( activates the body's immune system).
• Chemical. The essence of this method is the introduction into the urethra of various chemicals ( Lugol's solution, 0.5% silver nitrate solution).
• Mechanical. Mechanical provocation is carried out using a metal bougie ( tubes), which is inserted into the patient's urethra.
• Alimentary ( food). Its essence lies in the intake of spicy and / or salty foods, as well as alcohol.

To achieve maximum efficiency, it is recommended to carry out a combined provocation, that is, use several methods simultaneously. After performing the provocation, swabs should be taken from the alleged affected area within 3 days and examined bacterioscopically. It is also worth noting that in women it is recommended to take a smear on the 3rd - 5th day of the menstrual cycle, since menstruation also has a fairly effective provoking effect.

Seeding for gonorrhea

sowing ( bacteriological examination) is also included in the list of mandatory laboratory tests for suspected gonorrhea. The essence of the study is that the biomaterial obtained from the patient is transferred to special nutrient media on which gonococci grow best. If microscopic examination failed to identify the causative agent of the infection, even a small amount of gonococci will begin to actively divide during sowing ( multiply), as a result of which, after a while, several gonococcal colonies form on the nutrient medium. This will confirm the diagnosis and determine the type of pathogen, as well as establish antibiotics to which this pathogen is most sensitive.

It is important to remember that the sampling of material for bacteriological examination should be carried out before taking any antibacterial drugs. Otherwise, the antibiotic will begin to have a detrimental effect on gonococci, slowing down the process of their reproduction. As a result, even if the pathogen is present in the test material, colonies may not form during inoculation and the result will be false negative.

Laboratory methods for diagnosing gonorrhea

There are a number of laboratory tests that can detect the presence of gonococci in the test material, as well as assess the general condition of the patient.

In the diagnosis of gonorrhea can help:

• General blood analysis. A complete blood count is a routine research method that allows you to identify the presence of an infectious and inflammatory process in the body. The fact is that under normal conditions, the number of cells of the immune system ( leukocytes) is maintained at a constant level ( 4.0 - 9.0 x 10 9 / liter). When foreign agents enter the body, the immune system is activated and begins to synthesize a larger number of leukocytes, as a result of which their concentration in the blood will be higher than normal. Also, the presence of an acute inflammatory process in the body will be indicated by an increase in the erythrocyte sedimentation rate ( ESR), which is normally 10 mm per hour for men and 15 mm per hour for women. This is explained by the fact that with gonorrhea, the so-called proteins of the acute phase of inflammation are released into the bloodstream. They attach to the surface of erythrocytes red blood cells) and contribute to their sticking, as a result of which the latter more quickly settle to the bottom of the test tube during the study.
• General urine analysis. A urinalysis is not a specific test for gonorrhea, but it can detect signs of infection. The presence of a purulent-inflammatory process in the genitourinary tract will be indicated by an increased content of leukocytes and erythrocytes in the urine.
• Three glass Thompson test. This is a special urine test that is prescribed to men in order to determine the localization of the pathological process. For analysis, morning urine is taken ( the day before the examination, the patient should not take red vegetables and fruits, which can change the color of urine). The sampling of material into all three glasses is carried out with a single urination ( the patient urinates first into one, then into the second and then into the third glass, without interrupting the stream of urine), after which each sample is examined separately. If pus is found in the first sample, but is absent in the second and third, the pathological process is localized in the urethra. If there is pus in 2 servings, there is a high probability of damage to the posterior urethra, prostate gland and seminal vesicles.
• Direct immunofluorescence reaction. This study allows you to identify gonococci in the test material in a fairly short period of time. Moreover, the method of direct immunofluorescence is effective if, in addition to gonococci, many other microorganisms are present in the test material. The essence of the method is as follows. A smear is prepared from the obtained material, fixed on glass and stained with special dyes, and then treated with a special fluorescent antiserum. This antiserum contains antibodies that will interact ( unite) only with antigens present on the surface of gonococci. Also, special labels are attached to these antibodies, which glow when examined under a special microscope. If there is a gonococcal flora in the test material, the antibodies will combine with the antigens, causing the gonococci to glow, while other microorganisms remain "invisible".

PCR for gonorrhea

Polymerase chain reaction is a modern research method that allows to identify gonococci even at their low concentration in the test material. The principle of the method is based on the fact that every living organism on the planet ( including pathogenic microorganisms, including gonococci) has its own unique genetic information represented by a double strand of DNA ( deoxyribonucleic acid). During PCR, a special chemical process is launched, in which, using a set of enzymes, the desired DNA section is reproduced, and it will be reproduced only if it is present in the material under study.

With gonorrhea, a set of enzymes is added to the test material, which must find and "copy" the DNA of gonococci. If there is no gonococcal culture in the material at all, no reaction will occur. If there is one, the reaction will be repeated many times, resulting in the formation of several thousand copies of gonococcal DNA, which will confirm the diagnosis and determine the type of pathogen.

The advantages of PCR over other studies are:

• High accuracy- the method allows to detect gonococci even at their minimum concentration in the biomaterial.
• Specificity is the probability of an erroneous ( false positive) of the result is almost zero ( this is possible if safety rules are not observed in the laboratory, when DNA fragments from the environment can get into the test material).
• Speed ​​of execution- a positive result can be obtained within a few hours after taking the material from the patient.

Instrumental research methods

These methods are used not only for the diagnosis of gonorrhea itself, but also play an important role in identifying various complications of the disease.

To identify complications of gonorrhea, you can use:

• Urethroscopy. The essence of this method is to examine the mucous membrane of the genitourinary tract using a ureteroscope - a special device consisting of a long flexible tube with a camera at the end. During ureteroscopy, the doctor can assess the condition of the urethral mucosa, identify erosion, sources of bleeding, or places of pathological narrowing.
• Colposcopy. In this study, the doctor examines the mucous membrane of the entrance to the vagina using a special device - a colposcope, the optical system of which allows you to examine various parts of the mucous membrane under multiple magnification.
• Cervicoscopy. A method for examining the mucous membrane of the cervical canal using a hysteroscope, which is a long rigid tube with a powerful optical magnifying system.
• Diagnostic laparoscopy. The essence of this study is that tubes are inserted into the patient's abdominal cavity through small punctures in the anterior abdominal wall, at the ends of which there are video cameras. This allows you to visually examine the condition of the fallopian tubes and ovaries, assess their patency, and, if necessary, perform some medical manipulations.

Before use, you should consult with a specialist.

Gonorrhea is an infectious disease that is transmitted sexually. It is caused by gonococci of the genus Neisseria. The name of the disease literally means "semen flow". It does not reflect the essence of the disease, but it is firmly entrenched in medicine, displacing such terms as “clapper” and “blennorrhea”.

Gonorrhea has been known for centuries. But only in 1879, the German scientist Neisser discovered a microorganism that causes purulent inflammation of the urethra. Since that time, gonorrhea has been considered an independent disease.

Causes and mechanisms of the development of the disease

The causative agent of gonorrhea is called gonococcus. This bacterium is small (0.7 x 1.5 µm), oval in shape, stains well with aniline dyes. In the acute phase of the process, there are a lot of gonococci in the secreted pus and they are easy to detect with microscopy. In the chronic course of the disease, the discharge becomes insignificant, the pathogen is rarely isolated. To determine it, one has to resort to additional diagnostic methods.

Under adverse conditions, gonococci form the so-called L-forms, incapable of reproduction, but very resistant to damaging environmental factors. These forms penetrate deep into the mucous membrane, forming a focus of chronic infection.

Some of the gonococci produce penicillinase, an enzyme that sharply reduces the effect of penicillin antibiotics on them. As a result, drug resistance develops. This is one of the problems of modern venereology, a consequence of the irrational use of antibacterial drugs and self-medication.

Gonococci quickly die outside the human body under the influence of drying, heating, cooling, exposure to sunlight, antiseptics.

Infection with gonorrhea occurs when a woman has sexual contact with a sick man or a healthy carrier. Both ordinary and anal and oral sexual intercourse are dangerous. In this case, the rectum, tonsils, mucous membrane of the mouth and nose are affected.

Girls can become infected from their mother when using a common towel, linen. When entering the gonococcus in the eye, conjunctivitis develops.

With gonorrhea, cellular and humoral immunity is activated. However, these reactions do not protect against reinfection. Patients very often become infected repeatedly, both after recovery (reinfection) and while maintaining the gonococcus in the body (superinfection). This is largely due to the fact that gonococci change the reactivity of the body, and re-infection develops more easily and faster than the primary one.

There are cases of so-called familial gonorrhea, when the pathogen is present in both the husband and the wife, but does not cause serious clinical manifestations. When one of them comes into contact with "foreign" gonococci of another sexual partner, an acute picture of the disease occurs.

Gonorrhea in women occurs in the following variants:

• cervicitis (inflammation of the cervical canal);
• cystitis (inflammation of the bladder);
• urethritis (inflammation of the urethra);
• vulvovaginitis (inflammation of the vagina and vulva);
• inflammatory diseases of the pelvic organs -, proctitis.

Complications

Complications of gonorrhea include pelvioperitonitis (inflammation of the peritoneum), gonococcal infection of the musculoskeletal system (arthritis). Organs such as the heart, brain, lungs, and skin are rarely affected. Cases of disseminated (common) gonococcal infection have been described.

In women, the symptoms of gonorrhea are most often not expressed, so they rarely seek medical help. Diagnostic screening is required in high-risk patients (women who frequently change their sexual partner). It is necessary to tell such women how the disease is transmitted, why it is dangerous and how to treat gonorrhea.

Clinical picture

The mucous membranes of the genital tract are affected by the pathogen immediately, but the first signs of the disease appear only after the incubation period has passed. At this time, the patient may already be infectious for her sexual partner, without experiencing any discomfort. The incubation period for gonorrhea ranges from one day to three weeks.

Gonorrhea is divided into fresh (up to two months), chronic (more than 2 months) and latent (of unknown age, without symptoms). The fresh form can be acute, subacute and torpid.

Acute gonorrhea

It rarely occurs in women. It is accompanied by pain, itching, burning in the perineum, painful urination, fever. The vulva, vagina, urethra, and part of the rectum are usually affected. There is swelling and redness of the mucous membrane of these organs, mucopurulent discharge in a large volume, with an unpleasant odor. The mucous membrane is easily injured, it causes damage - erosion. Surrounding skin is irritated. The inguinal lymph nodes may be enlarged.

The cervix and cervical canal are involved in the inflammatory process. The urethra is affected, its channel expands, pus is released from it when pressed.

Subacute form

The subacute form is more often observed. All its signs are less pronounced than in acute. However, you can see a slight swelling and redness of the labia, urethra, vagina. There is a slight mucopurulent discharge from the cervical canal.

chronic gonorrhea

Most often diagnosed only during an exacerbation. With this form, the urethra is always affected, but urination disorders are slightly expressed. There is swelling and redness of the vaginal walls. Most often, the disease manifests itself only as white-yellow spots on the linen. The exacerbation is associated mainly with menstruation, while spotting can acquire an unpleasant odor. The same effect can be caused by an error in the diet - eating too fatty, spicy, salty foods or alcohol.

In many patients, damage to the rectum is detected. It is manifested by an admixture of blood and mucus in the feces.

One of the complications of gonorrhea is bartholinitis - inflammation of a large gland that opens on the eve of the vagina. This disease is manifested by the appearance of an enlarged painful formation in the vulva.

Often, the infection spreads upward with damage to the uterus, appendages and peritoneum. This may cause chills, fever, acute abdominal pain, vomiting.

In women, disseminated gonococcal infection occurs, in which pathogens enter the bloodstream. This is facilitated by a long course of the disease, menstruation, pregnancy, cervical injuries during instrumental interventions, including abortions.

There are two variants of disseminated gonococcal infection. The first proceeds as fulminant sepsis with chills, fever, sweating, severe general condition, skin and joint damage. In the second case, intoxication is mild, the main symptom of gonorrhea is gonococcal arthritis. However, even with this option, severe damage to the heart, brain and other organs is possible.

If gonorrhea is not treated, its complications can lead to a serious condition of a woman, cause infertility or even death with the development of fulminant sepsis. Therefore, if this disease is suspected, timely diagnosis should be carried out.

Diagnostics

Gonorrhea causes non-specific symptoms that are characteristic of other infectious processes. Therefore, the main role in its diagnosis belongs to the microscopic examination of a smear from the urethra, vagina or cervical canal.

How is a swab taken for gonorrhea?

All antibiotics are canceled 4-5 days before the study. Do not urinate 3 hours before the test. An analysis for gonorrhea is taken with a special spatula and a smear is made on a glass slide. The discharge is treated with special dyes, dried, fixed and examined under a microscope. With gonorrhea, one can see a specific symptom confirming the diagnosis - the arrangement of Gram-stained bean-shaped cells in pairs in the form of coffee beans. This symptom does not occur in all patients, but its presence allows us to speak with confidence about gonorrhea.

Cultural method

If the diagnosis is in doubt, the discharge is sown on special nutrient media. After cultivation, gonococci multiply on them and are much easier to differentiate from other infectious agents.

polymerase chain reaction

In addition to smear microscopy and the culture method, the determination of antibodies to gonococci in the blood is often used - polymerase chain reaction (PCR).

A rapid test shows the presence in the urine of a sick pathogen - gonococcus. However, its result is often not confirmed by other research methods. On the other hand, using only a rapid test, you may not detect the disease.

PCR is highly accurate. It allows you to detect antigens of gonococci in the discharge from the urethra or cervical canal. The disadvantage of this study is its high cost and the need for good laboratory equipment.

Other methods of laboratory diagnosis of gonorrhea (immunofluorescence reaction, enzyme immunoassay, Bordet-Gangu reaction, and others) are of secondary importance.

When the process is chronic, gonococci form stable forms that penetrate deep into the mucous membrane. To activate them, so-called provocative tests using chemicals, gonococcal vaccines, thermal, food provocations are used, and research is carried out on the days of menstruation.

Treatment

Treatment of gonorrhea that affects only the lower urinary tract (urethra, vagina and vulva, cervix) is carried out with a single injection of antibiotics, most often cephalosporins or fluoroquinolones.

Treatment of gonorrhea with ceftriaxone is one of the most common options. Ceftriaxone is an antibiotic from the group of cephalosporins, it is administered intramuscularly in a single dose of 250 mg. Effective pills for gonorrhea - Ciprofloxacin. Usually it is enough to take one tablet of 500 mg.

With simultaneous detection, Azithromycin is prescribed at a dose of 1000 mg once orally.

Amoxicillin and other penicillins are practically not used, since these drugs often have resistance (resistance) of gonococci.

It is necessary to take into account the possibility of a combination of gonorrhea with syphilis, chlamydia and other sexually transmitted diseases and select antibiotics that effectively act on all possible pathogens.

Treatment with antibiotics should be carried out only as prescribed by a doctor. Irrational antibiotic therapy leads to a chronic course of infection, contributes to the development of its complications and infection of sexual partners.

In chronic and latent forms of gonorrhea, before using antibiotics, a course of gonococcal vaccine is prescribed, which enhances immune responses and leaves microorganisms from a protected state. After 6-10 injections of the vaccine, antibiotic therapy is carried out according to the usual schemes.

Therapy of complications of the disease is carried out in a hospital. To do this, use courses of antibiotics for intramuscular or intravenous administration. If necessary, treatment is supplemented with immunostimulating agents, physiotherapeutic procedures, surgical intervention (for example, with bartholinitis).

Treatment of gonorrhea detected during pregnancy is necessary to exclude infection of the child during childbirth. To do this, use drugs that have a minimal harmful effect on the fetus: Ceftriaxone, Azithromycin, Levomycetin. Fluoroquinolones, in particular ciprofloxacin, are contraindicated. Treatment of gonorrhea in pregnant women should be carried out in a hospital.

10 days after completion of treatment, it is necessary to evaluate its effectiveness. To do this, repeat the smear analysis, make sure that there are no symptoms. Then the same study is carried out after the next menstrual cycle. This helps to ensure that there is no chronic form. If incomplete cure is suspected, a culture study is performed, the sensitivity of microbes to antibiotics is established, and the course of treatment is repeated.

The sexual partner of a woman with gonorrhea should be examined if she had contact with her within a month before the onset of symptoms of the disease. If the disease has a chronic or latent form, it is necessary to examine and, if necessary, treat all the partners of a woman in the last two months. If the patient cares for children, it is necessary to exclude the disease in them.

Ways to improve the effectiveness of treatment:

• strict implementation of doctor's prescriptions;
• refusal of sexual intercourse during treatment;
• examination of sexual partners;
• treatment of other sexually transmitted diseases.

Prevention of gonorrhea

Prevention of this unpleasant disease consists in observing sexual hygiene, using barrier contraceptives (condoms), and marital fidelity.

To prevent domestic infection of family members, do not use shared towels, linen and other hygiene items.

- a venereal infection that causes damage to the mucous membranes of organs lined with cylindrical epithelium: the 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 inflammatory processes in the pelvic organs, leading to infertility; gonorrhea during pregnancy leads to infection of the child during childbirth.

General information

(gonorrhea) 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 a cylindrical and glandular epithelium. They can be located on the surface of cells and intracellularly (in leukocytes, Trichomonas, epithelial cells), they 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 infection of the conjunctiva of the eyes (blennorrhea);
• 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 mucosa (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. The danger of complications of gonorrhea is very high - various genitourinary disorders (including sexual ones), 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 an infected mother with gonorrhea during childbirth is noted.

With the symptoms of gonorrhea 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 with different forms of sexual contact: vaginal (normal and "incomplete"), anal, oral.

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

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 (bedding, washcloths, towels), usually in girls. The incubation (hidden) 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 the 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 in girls, the genitals are also affected. Blindness in newborns in half of the cases is caused by infection with gonorrhea.

gonorrhea symptoms

Based on the duration of the disease, fresh gonorrhea is distinguished (from the moment of infection< 2 месяцев) и хроническую гонорею (с момента заражения >2 months).

Fresh gonorrhea can occur in acute, subacute, oligosymptomatic (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, as a mixed infection (with Trichomonas, Chlamydia) is often detected, which can change symptoms, lengthen the incubation period, and make it difficult to diagnose and treat the disease. There are many asymptomatic and asymptomatic cases of gonorrhea.

Classical 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.

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

With an ascending type of gonorrhea, the testicles, prostate, seminal vesicles are affected, the temperature rises, chills occur, painful defecation.

Gonococcal pharyngitis can be manifested by redness and sore throat, fever, but is more often asymptomatic. With gonococcal proctitis, there may be discharge from the rectum, soreness in the anus, especially during defecation; although the symptoms are usually mild.

Chronic gonorrhea has a protracted course with periodic exacerbations, manifested by adhesions in the pelvis, a decrease in sexual desire in men, menstrual cycle and reproductive function disorders 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), the introduction of intrauterine devices. Gonorrhea affects the uterus, fallopian tubes, ovarian tissue up to the occurrence of abscesses. This leads to disruption of the menstrual cycle, the occurrence of adhesions in the tubes, the development of infertility, ectopic pregnancy. If a woman with gonorrhea is pregnant, the likelihood of spontaneous miscarriage, premature birth, infection of the newborn and the development of septic conditions after childbirth is high. 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 violation of spermatogenesis, a decrease in the ability of spermatozoa to fertilize.

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

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

Diagnosis of gonorrhea

For the diagnosis of 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;
• bakposev material on specific nutrient media to isolate a pure culture;
• ELISA and PCR diagnostics.

AT microscopy of Gram-stained and methylene blue smears, gonococci are determined by the typical bean-shaped 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, a more appropriate method is culture (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. In girls and women after 60 years, 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 the determination of antibodies to hepatitis B and to HIV, serological reactions to syphilis, general and biochemical analysis of blood and urine, ultrasound of the pelvic organs, ureteroscopy, in women - colposcopy, cytology of the mucous membrane of the cervical canal.

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

The need to use "provocations" for the diagnosis of gonorrhea, the doctor decides in each case individually.

gonorrhea treatment

Self-treatment of gonorrhea is unacceptable, it is dangerous by the transition of the disease into 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. 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 contacts are allowed using a condom.

Modern venereology is armed with effective antibacterial drugs that can successfully fight gonorrhea. In the treatment of gonorrhea, the duration of the disease, symptoms, location of the lesion, the absence or presence of complications, concomitant infection are taken into account. With an acute ascending type of gonorrhea, hospitalization, bed rest, and therapeutic measures are necessary. In the event 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, while 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 disorders), amoxicillin, trimethoprim.

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

Gonorrhea treatment may 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 of 1-2% protorgol solution, 0.5% silver nitrate solution, microclysters with chamomile infusion. Physiotherapy (electrophoresis, UV radiation, 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 reactions and is divided into specific (gonovacin) and nonspecific (pyrogenal, autohemotherapy, prodigiosan, levamiosol, methyluracil, glyceram, etc.). Children under 3 years of age are not given immunotherapy. After treatment with antibiotics, lacto- and bifido drugs are prescribed (orally and intravaginally).

A 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).

At present, the need for various types of provocations and numerous follow-up examinations after the end of treatment of gonorrhea, carried out by 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 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 relations, use of condoms, observance of personal hygiene rules);
• timely detection and treatment of patients with gonorrhea, especially in risk groups;
• professional examinations (for employees of children's institutions, medical personnel, food workers);
• mandatory examination of pregnant women and management of pregnancy.

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