Gonorrhea in men

Content:

• What is the causative agent of gonorrhea?
• How does the infection occur?
• Types of gonorrhea
• Symptoms of gonorrhea in men
• Diagnostics
• Treatment of gonorrhea in men
• Prevention
• Conclusion

Gonorrhea is an acute or chronic infectious disease that is transmitted mainly through sexual contact and is currently one of the most common in the world: more than 62 million people suffer from it every year.

In recent years, there has been an increase in the incidence of gonorrhea in almost all age groups, including adolescents and the elderly.

What is the causative agent of gonorrhea?

The causative agent of gonorrhea was discovered in 1789 by A. Neisser, and in 1885 it was isolated in pure culture by Bumm. It is Neisser's gonococcus, which is a diplococcus and is shaped like a coffee bean with a characteristic groove in the middle between the two halves. Under the microscope, these halves are almost the same in acute gonorrhea, but may have different sizes in the chronic form.

If an infected person took antibiotic treatment in insufficient doses or irregularly, then gonococci can change their shape, becoming large spherical, resembling the size of an erythrocyte, as well as small, pulverized. Among the gonococci there are many individual species - strains, including those that have become resistant to treatment with various drugs, and today this gonorrhea is practically incurable, accounting for about 20% of all infections.

Gonococcus lives predominantly on the mucous membranes of the urinary organs, however, it can be found in the prostate secretion, seminal vesicles, oral cavity, on the mucous membrane of the eyes, rectum or spread to other places (the so-called extragenital forms of gonorrhea). The pathogen does not penetrate into the cells of the mucous membrane, but remains on the surface or in the intercellular space. If the gonococcus got into the blood, then it dies there quickly enough.

Also, the gonococcus is often absorbed by leukocytes, but in most cases it does not die, but continues to live inside it. Similarly, he lives in Trichomonas, which makes him practically insensitive to treatment: antibiotics used to treat gonorrhea cannot get into Trichomonas, and what is detrimental to the latter does not affect gonococci at all. This determines the possibility of recurrence of the disease.

Outside the body, gonorrhea pathogens are unstable and die as the secret dries out. On wet sponges, towels can maintain their viability during the day and lead to infection. Heating to 41–50 ° C leads to their death within 6 hours, and at 39 ° C - after 12 hours. However, in the body, fever, even at 41 ° C, causes only some weakening of their viability and temporary cessation of purulent secretions. The optimum temperature for maximum reproduction of diplococcus is 36.5–37 ° C.

After suffering gonorrhea, persistent immunity is not maintained, so gonorrhea can be infected many times in a row.

How does the infection occur?

The source of infection is exclusively a person suffering from gonorrhea, including her poor symptom, chronic forms or not at all noticing any signs of such.

The most famous transmission routes are:

• sexual intercourse (for example, vaginal, rectal, oral);
• during childbirth from mother to child (the development of eye lesions in the newborn - vagina);
• through general hygiene items and things contaminated with secretions that contain the pathogen (towels, bed linen, etc.).

The possibility of transmitting gonorrhea with passionate kisses is not excluded.

The period from the moment of infection to the onset of the first signs of the disease averages 3-5 days, but can vary from 1 day to 3 weeks.

After the urinary organs enter the mucous membrane, the gonococci multiply rapidly and cause inflammation, accompanied by purulent secretions. Later on, scars are formed in these places, leading to a narrowing of the urethra. If such scarring occurs in the appendages of the male testicles, then they become impassable for spermatozoa, and the man becomes infertile.

Most often in men, gonococcus affects the urethra, and in homosexuals it also affects the rectum, pharynx, tonsils, oral mucosa. Gonorrheal conjunctivitis in men can develop in cases where the pathogen was accidentally carried by the hands of the genitals by the patient himself.

If gonococcus enters the bloodstream, it dies very quickly there, releasing toxin that causes loss of appetite, damage to the joints, tendons, and nervous system (other researchers dispute this: they consider these symptoms to be a manifestation of the local action of gonococcus in these organs). Untreated gonorrhea often acquires a chronic course, aggravated by taking alcohol, spicy foods, as well as sexual intercourse or sexual arousal.

The most common among men are the following groups:

• unmarried
• having a lot of casual sex,
• alcohol abusers
• having a certain social setting.  

Types of gonorrhea

By the time since infection:

1. Fresh gonorrhea (duration of flow - up to 2 months).
2. Chronic gonorrhea (disease duration over 2 months).

According to the intensity of the disease:

1. Acute gonorrhea - signs of inflammation are pronounced.
2. Subacute - symptoms of the disease erased.
3. Torpid (sluggish) - subjective symptoms are absent, but gonococcus is detected by laboratory methods.
4. Latent (carriage) - the symptoms of gonorrhea are absent, the pathogen can be isolated by laboratory methods with difficulty.

Localization men distinguish gonococcal:

1. Urethritis - inflammation of the urethra (urethra).
2. Balanitis ( balanoposthitis ) - gonococcal affection of the penis head and the inner leaf of the foreskin.
3. Epididymitis - gonorrhea of ​​testicular appendages.
4. Orchitis is an inflammation of the testicle.
5. Prostatitis - gonorrhea of ​​the prostate gland.
6. Vesiculitis - gonorrheal defeat of the seminal vesicles.
7. Some other forms.
8. Extragenital Gonorrhea:

- proctitis,

- pharyngitis , tonsillitis ,

- conjunctivitis (adult disease),

- arthritis - gonococcal joint damage,

- endocarditis - inflammation of the inner lining of the heart,

- peritonitis, meningitis, sepsis, etc. - in men can occur only with a strong decrease in immunity and changes in the bactericidal properties of the blood.

Often gonorrhea occurs in conjunction with other infections, which masks its manifestations, for example, with:

• chlamydia
• mycoplasmosis
• syphilis
• ureaplasmosis,
• trichomoniasis
• viral diseases.  

Symptoms of gonorrhea in men

There are practically no latent and sluggish forms of symptoms, so below we will look at acute and subacute forms of the disease.

Gonorrheal urethritis

Acute form

Local symptoms of acute gonorrheal urethritis when examining the penis:

• pain on palpation of the urethra (in this way the doctor can reveal small painful lesions of the size of a millet grain, which are the inflamed glands of the mucous membrane);
• swelling and redness (hyperemia) of the urethral opening sponges;
• frequent addition of balanoposthitis with the subsequent development of phimosis;
• involuntary release of droplets of yellow-green pus from the opening of the urethra, which leads to a constant dirty linen;
• the appearance of erosions on the head of the penis;
• in some cases, there is a semi-registered state of the penis with blood in the discharge from the urethra.

If, in acute gonorrheal urethritis, one begins to urinate in one glass and finish in the other (the so-called two-glass test), then the first one will have urine that is cloudy with admixture of pus, and the second is light, transparent.

The general condition of the patient usually does not suffer, the temperature does not rise.

Regardless of whether treatment is applied or not, the signs of urethritis gradually subside, the amount of discharge decreases. Then, without adequate therapy, gonorrhea gradually becomes subacute, and then - in the chronic form. In some cases, there is a spontaneous cure.

Subacute form

Often, gonorrheal urethritis occurs precisely in subacute form and is characterized by more blurred symptoms:

• head and foreskin remain of normal color;
• purulent discharge less abundant (usually observed after a night's sleep or just a long break in urination);
• pus spots on underwear;
• whitish urethral discharge;
• with palpation pain is much less than with the acute form;
• general condition does not suffer.

When dvuhstakannoy sample: in the first glass there is a cloudy, opalescent urine and pus threads, in the second - transparent.

Balanoposthitis and phimosis, paraphimosis with gonorrhea

It is found as a complication of acute urethritis, when another infection joins the gonococcus that is released from the external urethral orifice, causing inflammation of the internal sheet of the foreskin, as well as the head of the penis.

Symptoms of balanoposthitis:

• itch
• burning,
• rez,
• pain,
• discomfort in the penis head,
• increased sensitivity during intercourse,
• irritation,
• dryness,
• all sorts of specks, bumps, erosion on the mucous head,
• unpleasant smell of discharge.

Balanoposthitis can show one or more symptoms in any combination. In advanced cases, balanoposthitis may increase the inguinal lymph nodes, increase body temperature.

If, as a result of inflammation, scars are formed between the sheets of the foreskin, then phimosis develops - the impossibility of moving the foreskin backwards from the penis head. In cases where it was possible to move the foreskin away, paraphimosis can occur - pinching of the head of the penis and the inability to correct it back.

Cavernite

Cavernitis is an inflammation in the penis of the corpus cavernosum and is manifested by pain and possible penile curvature during erection, as well as difficulty urinating.

Urethrocystitis

Main symptoms:

• frequent urination;
• periodic imperative urges;
• sharp pains due to spasm of the sphincter of the bladder;
• the presence of blood at the end of urination.  

Colliculitis

Colliculitis is an inflammation of the seminal tubercle, and it is often a complication of gonorrheal urethrocystitis. Manifested by increased painful erections, emissions, as well as the presence of blood in the seminal fluid.

Epididymitis

It is characterized by inflammation of the epididymis, pain in the groin area, fever up to 40 ° C, chills, general weakness, headache. To the touch, the epididymis is enlarged, of a dense consistency, painful. The skin of the scrotum is hyperemic, tense. If scars form as a result of gonococcal inflammation, then a complication such as infertility will occur.

Deferentitis, funiculitis

In fact, it is a gonorrheal inflammation localized in the vas deferens or spermatic cord. It occurs with simultaneous lesions of the epididymis. It is manifested by soreness, increase, swelling (it is palpated, as a dense and painful cord).

Orhit

Gonorrheal inflammation of the testicle is quite rare, manifested by severe pain in the scrotum, its swelling, fever, deterioration of the general condition.

Prostatitis

Gonorrheal prostatitis can occur in acute and chronic forms, and there are 3 types:

• catarrhal
• parenchymal,
• follicular.  

Catarrhal

When catarrhal gonorrhea prostate inflamed lobules of the prostate, there are frequent urge to urinate, burning or mild itching in the perineum, weak pressure in the anus. Urine is transparent, there are single threads or flakes of pus. In a smear of prostatic juice - gonococci.

Follicular

Excretory ducts of the prostatic glands are blocked, insulated follicles are formed, which are filled with pus. Patients have a sensation of heat in the perineum, pain at the end of urination. A doctor during palpation examination through the rectum will notice an enlarged prostate, as well as individual spherical painful seals.

Parenchymal

In this case, the muscle-elastic stroma of the prostate is involved in the process of gonorrheal inflammation, in which separate purulent cavities are formed with the subsequent formation of one large abscess.

Symptoms:

• urinary retention or difficulty urinating;
• feeling of pressure in the anus;
• pain during stool;
• Irradiation of pain in the penis, pelvis, sacrum;
• enlarged prostate by palpation through the rectum.  

Chronic prostatitis

It has less pronounced symptoms, but over time there are:

• weakening of erection;
• reduced orgasm;
• premature ejaculation.

Also, periodically, such patients complain of decreased performance, rapid fatigability, irritability.

Vesiculitis

Vesiculitis is an inflammation of the seminal vesicles and is often combined with epididymitis or prostatitis.

Symptoms:

• in the urethra: itching, pain, discharge;
• hyperexcitability;
• blood and soreness at the end of urination;
• frequent wet dreams;
• painful ejaculation;
• pus or blood in semen;
• pain on palpation of the seminal vesicles.  

Extragenital forms

Gonorrheal proctitis

Proctitis of this type usually proceeds in disguise or it is manifested by slight itching in the anus, as well as pain during a bowel movement.

Gonorrheal pharyngitis and tonsillitis

It develops after unprotected oral sex. It manifests a slight soreness when swallowing or is generally asymptomatic. However, even in this situation, such a person can infect his sexual partner during oral sex.

Adults

Gonorrheal conjunctivitis is characterized by purulent discharge from the palpebral fissure, lacrimation. Launched and untreated can lead to total or partial blindness.

Other forms

Gonorrhea can manifest as joint pain (arthritis), damage to the liver, kidneys, and heart, but this is extremely rare, as is meningitis, sepsis.

Diagnostics

If classic cases of acute gonorrhea usually do not cause difficulties, then if you suspect a chronic or latent form, you need to carry out a laboratory and instrumental examination with the utmost care and comprehensiveness.

Currently, for the diagnosis of gonorrhea are used:

• rapid tests
• smear microscopy and bacteriological culture,
• REEF,
• ELISA
• PCR,
• provocative tests
• other methods.

Express Test

This diagnostic is suitable for quick determination of the presence of gonococci at home in case of an emergency. As a rule, outwardly such a test resembles a test for determining pregnancy (the same 1 and 2 strips).

The mechanism of action of the test is based on the method of counter electrophoresis, when at the merging of the corresponding antibodies and gonococcus staining of the second strip occurs.

When using this test, one should remember that it can give a false positive result in the presence of microorganisms similar to gonococcus, as well as a false negative if gonococci are too small.

Smear microscopy

Examination of the smear under a microscope in case of detection of gonococci confirms the diagnosis.

On the eve of 4-5 days abolish antibiotics. For the study carried out the sampling of material from the discharge of the urethra, prostatic juice, semen, rectum, mucous membranes of the mouth in 2 copies. In the case of taking a smear from the urethra on the eve of the material intake should refrain from urinating for 3-4 hours.

The first smear is usually stained with brilliant green or methylene blue to detect cocci in general. Then the second smear is dyed Gram, as a result of which the gonococci turn bright pink.

This diagnostic method allows you to detect gonococci in 40-86% of cases due to the fact that some subspecies of gonococci are not painted as it should. Also a great role in the diagnosis of gonorrhea in this way is played by the qualifications and experience of the laboratory assistant.

If gonococcus is detected by this method, then the diagnosis of gonorrhea is considered confirmed.

Bacteriological method

It is a culture of discharge from mucous membranes on special media that are suitable for the growth of gonococcus. The indisputable advantage of this method is the absence of false-positive results, its sensitivity is close to 98%.

The disadvantage of bacposev is a long waiting time for results, however, in the case of chronic persistent gonorrhea, this method is one of the most reliable.

REEF

The reaction of immune fluorescence should be carried out in the presence of high-quality reagents, a special fluorescent microscope and appropriate training of medical staff.

For RIF, a smear is taken in almost the same way as for conventional microscopic examination, but then stained with special dyes containing gonococcal antibodies. These antibodies, with attached dye molecules, bind to antigens on the surface of the Neisser diplococci and form immune complexes, which are detected under a microscope as luminous circles.

This method allows you to identify gonorrhea in cases where it occurs in conjunction with other infections or if the disease is at an early stage. Существенный недостаток РИФ — относительная его дороговизна, что ограничивает его применение.

ИФА

Иммуноферментный анализ также не относится к числу рутинных методов, выполняемых каждой лабораторией, так как требует высокой квалификации персонала и качественных реактивов.

ИФА позволяет выявить устойчивые формы возбудителя, однако в связи с тем, что он не способен отличить мертвые гонококки от живых, его ценность несколько снижается, и он используется большей степенью в качестве вспомогательного метода.

Механизм действия ИФА основан на выявлении антител в моче пациента.

Серологический метод

Based on the reaction of complement fixation, which in the case of a diagnostic study of gonorrhea is known as the Borde-Zhang reaction. Used when there is a need to identify chronic gonorrhea, not detected by the bacteriological method.

Molecular genetic diagnosis

Although polymerase and ligase chain reaction are expensive, they are highly accurate methods of detecting gonorrhea, including in the case of latent or sluggish flow. Can identify the causative agent of gonorrhea in combination in the same sample with chlamydia. The duration of the reactions ranges from 3-4 to 7-8 hours.

Provocative tests

If the gonococcus as a result of inadequate or incomplete treatment undergoes a series of transformations and becomes able to penetrate deeply, even to the muscle layer, then the gonococcus on ordinary smears will not be detected.

Provocative tests force the gonococcus back to the mucous membranes and become accessible to standard methods of examination (for example, microscopic examination, bacteriological seeding).

Today there are various options for provocative tests.

Chemical provocation

The urethra is smeared with a 1-2% solution of silver nitrate, the rectum with a 1% solution of Lugol. After 24, 48, 72 hours take the appropriate scraping smear. On the third day they spend bacteriological seeding.

Biological provocation

The patient is administered gonococcal vaccine alone or in combination with pyrogenal. Smears and backdoors are done at the same intervals as during chemical provocation.

Thermal provocation

As a provocation, diathermy is used for 3 days according to the following scheme, starting from 30 minutes and increasing in subsequent days by 10 minutes. Induction is also prescribed as a provocation for 3 days, 15–20 minutes daily.

Swabs are done every day an hour after the procedure.

Physiological provocation

In men, it is not carried out, as it is based on the menstrual cycle.

Alimentary provocation

In this case, aggravation of gonorrhea will cause: alcohol in combination with salty, spicy and spicy foods. Smears are taken in the same way as in chemical provocation.

Combined provocation

During the day several provocative tests are carried out. Bacteriological seeding is done 3 days later, and smears are taken a day, two after 72 hours after the provocation.

Treatment of gonorrhea in men

In order to avoid chronization of the process and the development of infertility, only a doctor (dermatovenereologist) should deal with the treatment of gonorrhea, and the use of antibacterial drugs should be carefully observed and not interrupted. Otherwise, the risk of acquiring such a form of gonorrhea that is resistant to most types of modern drugs and, therefore, will become incurable sharply increases.

The following are the most common groups of drugs that should not be considered as a guide to self-medication in any way:

• Penicillin,
• Ekmonovotsillin,
• Bicillin-1,3,
• Phenoxymethylpenicillin,
• Streptomycin,
• Norsulfazol,
• Ceftriaxone and other antibacterial agents.

Locally prescribed instillation in the urethra of antibacterial drugs, and rectally - microclysters. For severe pain, analgesics are used.

Immunomodulators (for example, pyrogenal, methyluracil) are most often prescribed for chronic gonorrhea. Also to activate the protective forces used vaccine therapy gonococcal vaccine.

After completion of the course of treatment, 1–1.5 weeks later, the patient is re-examined. If the tests are negative, then resort to provocative tests, combining chemical, biological, alimentary methods among themselves.

If the tests are also negative in this case, then after a month they are repeated again. In the case of re-receiving negative results and the absence of signs of inflammation, the patient is considered cured.

Prevention

Prevention of gonorrhea, as well as other diseases that are transmitted sexually, is as follows:

1. Loyalty of sexual partners to each other. The exclusion of any kind of sex "on the side."
2. For occasional sexual intercourse, the use of condoms is mandatory.
3. After intercourse:

• mandatory urination,
• washing with genital soap,
• introduction of protargol or miramistina into the urethra.  

Conclusion

Despite the seeming simplicity in treatment, gonorrhea is gradually turning into a disease that is difficult to treat as gonococcus becomes resistant to antibiotics. For this reason, it is necessary to take a very serious approach to the choice of a sexual partner, since the latter, due to the presence of latent and weak-symptom forms, may not even be aware of his illness. The best way out is to have a permanent sexual partner and mutual loyalty in marriage.

• Gonorrhea: Symptoms and Treatment
• Male secretions
• Ureaplasma in men
• Trichomoniasis in men
• Chlamydia in men
• Cystitis in men