Gonorrhea: Symptoms and Treatment
- Causative agent
- Sources of infection and routes of transmission of gonorrhea
- Mechanism of development of the disease
- Forms of gonorrheal infection
- Symptoms of gonorrhea
- Diagnosis of gonorrhea
- Gonorrhea treatment
- Prevention of gonorrhea
Gonorrhea is a sexually transmitted sexually transmitted disease and occurs with a lesion of the cylindrical epithelium of the urogenital tract. Its extreme contagion is mentioned in the Old Testament and in the treatises of ancient Greek scholars. For the first time the term "gonorrhea" was used in the II century BC. Roman surgeon and philosopher Galen, who mistakenly called the discharge from the male urethra "seven-flow" (gonos - seed, rheos - flow).
For gonorrhea, there are no differences by gender and social status, and both a small child and an adult can become its victim. According to statistics from the World Health Organization, every year this insidious disease affects about a quarter of a billion people on the planet. This is explained by the fact that the causative agent of the disease is highly resistant to some medications, and the last role in the spread of infection is given to social reasons and behavioral factors (homosexuality flourishes, prostitution and the growth of promiscuous sex).
The risk group for the incidence of gonorrhea includes people aged 17 to 32 years old, sexually active adolescents, as well as people who have several sexual partners and who do not use personal protective equipment.
The causative agent of the disease is gonococcus Neisser, discovered in 1879. This is an obligate extracellular and intracellular parasite, reaching a length of 1.5 microns, not having mobility and not forming a spore. Under the lens of a microscope, it is a paired diplococcus, shaped like coffee beans or beans, facing each other with their concave surfaces and separated by a narrow slit-like opening. Gonococcus propagation occurs through indirect division perpendicular to the gap located between the paired cocci.
для свежей гонореи характерно внутриклеточное расположение гонококков, а для хронической – внеклеточное. Note: for fresh gonorrhea, the intracellular location of gonococci is typical, and for chronic gonorrhea - extracellular.
Gonococcus is a specific pyogenic parasite that can penetrate not only into leukocytes, but also into larger bacterial cells. His body is surrounded by an outer three-layer membrane containing various structural proteins. In turn, the membrane is protected by a dense multi-layered capsule. On the outside of the gonococcus are thin tubular microscopic threads (drank). With their help, the pathogen adheres to the epithelial cells of the mucous membrane of the urogenital tract.
Under the influence of unfavorable conditions for it, gonococcus can form L-forms (fall into a state of suspended animation). Thus, he is able to survive the treatment process, and later cause a relapse of the disease.
Sources of infection and routes of transmission of gonorrhea
Most often, gonorrheal infection is transmitted sexually (with genital contact). In this case, the source of infection is a sick person suffering from an asymptomatic or mild form of gonorrhea.
Penetrating into the male body, gonococcal flora causes inflammation of the urethral mucosa. In the female body, the infection affects the urethra, the eve of the vagina and the cervical canal, and in young girls the vulva and vagina.
In passive homosexuals, the rectum often becomes the source of infection (in girls and women, such a lesion develops as a result of leaks from infected genital organs).
With oral-genital contacts, gonococcal infection is capable of affecting the mucous membrane of the mouth, tonsils and pharynx. Some experts argue that pharyngeal gonorrhea can develop even as a result of a kiss, and young children sometimes become infected with rhinitis or stomatitis of gonococcal etiology through dirty hands.
When gonococci are brought from the genitals into the eyes, gonococcal damage to the eyes develops, and if a pregnant woman suffers from gonorrhea, the child is threatened with gonorrheal conjunctivitis during childbirth.
Due to contact with infected amniotic fluid, intrauterine infection of the fetus may occur, as well as some specialists allow for intrauterine hematogenous infection (gonococcemia).
Mechanism of development of the disease
Depending on the place of initial introduction of gonococcal infection, it is customary to distinguish the following types of gonorrhea:
- Genital (urogenital gonorrhea);
- Extragenital (gonorrheal damage to the eyes, pharynx and rectum);
- Disseminated, or metastatic (complicated gonorrhea).
After the penetration of a gonococcal infection into the organism of its new host, the parasite almost instantly with the help of pili (attachment zones) is firmly attached to epithelial cells, and after 1-2 days it is possible to detect the pathogen in the process of laboratory research. The incomplete phagocytosis characteristic of a gonococcal lesion leads to the fact that viable microorganisms move into the subepithelial layer where they form their colonies, and, causing destruction of the epithelium, penetrate into the lymphatic blood vessels of the genital organs. As a result, phagocytes rush to the place of their accumulation, which causes secretions in the urethra (exudate containing a large amount of the pathogen), and in the layer located under the epithelium - infiltration, which can persist for a long time even after the death of the parasite. Often there is a replacement of infiltration with scar tissue, after which strictures are formed (narrowing of the urethra).
Forms of gonorrheal infection
In medical practice, gonorrhea is divided into acute and chronic. The acute form includes clinical cases that last no more than two months. Pathological process, which takes more than two months, is diagnosed as chronic gonorrhea. According to experts, the only morphological criterion for the transition from acute to chronic is the formation of deep foci of infiltration in the urethra and the formation of fibrous tissue.
It should be emphasized that asymptomatic gonorrhea sometimes occurs in the practice of venereologists. This is a pathological process that does not cause an inflammatory reaction to the mucous membrane. In some cases, asymptomatic pathology is nothing more than a disease with a prolonged incubation period, at the end of which there are characteristic clinical signs.
Symptoms of gonorrhea
Signs of gonorrhea in women
This pathology is characterized by multifocal and mild symptoms (this is due to the anatomical features of the female urogenital tract). Thus, often in the process of examining a woman, a gonorrheal lesion that does not accompany subjective sensations can be found simultaneously in several locations.
Clinicians distinguish between two clinical types of "female" gonorrhea:
Rising gonorrhea (defeat of the upper urinary tract). In this case, a woman can be diagnosed with gonococcal salpingitis, endometritis, oophoritis, and pelvioperitonitis.
The most characteristic signs of the disease of the lower part of the urogenital system include hyperemia and swelling of the urethra, itching and burning in the vagina, painful urination, as well as thick mucopurulent discharge from the cervical canal.
With the development of ascending gonorrhea, patients complain of pain in the lower abdomen, nausea, vomiting, fever up to 39 degrees, painful urination and irregular menstruation. Also, diarrhea can sometimes develop.
It should be emphasized that, due to abortions, sensing of the uterus and other gynecological procedures, the infection can spread beyond the internal shed of the uterus.
Signs of gonorrhea in men
When "male" gonorrhea, there is a predominant lesion of the urethra (urethritis). At the same time, patients complain of severe cutting pains that occur during urination and the appearance of purulent discharges, which can vary in degree of intensity.
Depending on the severity of the signs of the disease, urethritis can be acute, subacute and torpid.
In the acute form, swelling and hyperemia of the urethral sponges are noted, throughout the day greenish-yellow purulent discharges from the urethral canal, and during urination, cramps and burning appear.
For anterior acute gonorrheal urethritis, pain is characteristic at the beginning of urination, and if the entire urethra is affected (acute total urethritis), pain arises at the end of urine discharge. In the second case, increased urge to urinate, painful emissions and erections may also be observed. With pronounced gonorrhea inflammation in the purulent secretions there are admixtures of blood, as well as hemospermia develops (blood in seminal fluid).
Without appropriate treatment, acute urethritis can go into a subacute stage, in which there is no swelling or hyperemia of the urethral sponges. Pain during urination, as well as purulent or serous-purulent discharge at this stage of the disease are minor and most often occur only after a night's sleep.
A torpid urethritis with even less severe clinical signs may follow the subacute stage. At this stage, scanty discharge occurs only in the morning or when pressed on the urethra.
It should be emphasized that in the absence of adequate treatment, the adnexal and periurethral glands are affected, which leads to the development of multiple complications. The most common of these is prostatitis. This disease develops when the gonococcal infection of the posterior urethra is damaged and can occur both in acute and in chronic form.
Often, prostatitis is accompanied by inflammation of the seminal vesicles (vesiculitis), inflammation of the epididymis (epididymitis), balanoposthitis and phimosis (lengthening or narrowing of the foreskin).
Signs of extragenital gonorrhea
Pharyngitis and proctitis belong to extragenital forms of infection, that is, outside the genital area. Gonorrheal proctitis is a pathological condition that develops in girls and women as a result of the leakage of purulent discharge from the vagina into the anus, or it becomes the cause of anal sex.
In acute gonorrhea, patients complain of pain during stool, as well as burning and itching in the anus. Sometimes in the formation of cracks to the fecal masses may be mixed with blood. There is hyperemia in the anus, and accumulations of pus are found in the skin folds.
Gonococcal tonsillitis and pharyngitis, resulting from oral-genital contacts, can only be detected by bacteriological examination, since they do not have characteristic differential signs.
Disseminated gonococcal infection
Such a pathological condition occurs when the pathogen from the primary source of infection penetrates the bloodstream. Often gonococci in the blood under the influence of factors of natural immunity die, but in some cases they begin to multiply there, and with the blood flow into various tissues and organs, causing damage to the liver, joints, brain membranes, skin and endocardium.
It should be emphasized that the spread of the pathogen does not depend on the virulence of the microorganism, nor on the nature of the primary focus. As a rule, this occurs in immunodeficient states, a long-term unrecognized infection, inadequate treatment, as well as during pregnancy, due to instrumental manipulations or due to sexual contact, which provoked injury to the mucous membrane.
In clinical practice, there are 2 forms of disseminated gonococcal infection: mild and severe. The mild form of the disease is characterized by articular syndrome, and when severe, the patient develops sepsis, accompanied by hepatitis, pericarditis or meningitis.
This is one of the manifestations of gonorrheal infection, which is most common in newborns (gonococcal ophthalmia, iridocyclitis, gonococcal conjunctivitis). In this case, the infection occurs intrauterinely, or when passing through the infected birth canal of the mother. With intrauterine infection, signs of the disease appear already on the first day of a child’s life.
For gonococcal conjunctivitis, hyperemia and eyelid edema, copious purulent discharge from the eyes and photophobia. If untreated, the infectious process spreads to the cornea. As a result, there is swelling, clouding, ulceration and infiltration of the cornea.
Diagnosis of gonorrhea
Diagnosis of the disease is based on the history of the patient's sexual life and the presence of pathogenetic signs of the inflammatory process.
Mandatory in representatives of both sexes is investigated discharge from the genitals. At the same time, women can be assigned to the study of Bartholin gland discharge, paraurethral ducts, vaginal walls and cervix. In some cases, men are shown to investigate the secretion of the prostate gland and seminal vesicles, the washing water of the rectum, as well as the examination of the lacunae and glands of the urethra.
The diagnosis of "gonorrhea" is established only in the case when the pathogen is detected in the test discharge. For this, several methods are used in laboratory practice:
. 1. Bacterioscopy . Today it is the most common method, involving the study of two smears of discharge, one of which (for orientation microscopy) is painted with methylene blue, and the other (allowing to finally identify the pathogen) - by Gram. If typical forms of gonococcus are detected in both smears, the analysis is considered positive.
. 2. Cultural method . Unfortunately, due to its variability, the pathogen can not always be detected by bacterioscopic examination. Therefore, in the diagnosis of asymptomatic forms of gonococcal infection, a culture method is carried out. This technique, involving the use of nutrient media, is the “gold standard” in identifying Neisser’s gonococcus.
. 3. PCR diagnostics . This method is based on the detection of a pathogen in biological material.
. 4. Transcriptional amplification reaction . This is a relatively new technique with a higher sensitivity than PCR and other amplification methods. With its help, it is possible to identify a live pathogen even in a very small amount of material, which allows you to monitor the results of the treatment.
Experts urge not to try to cure gonorrhea on their own, as often such rash actions are fraught with the transition of the disease into a chronic form. It should be noted that when a gonococcal infection is detected in a patient, all sexual partners who have had contact with him for two months are subjected to examination and treatment. During this period, any sexual contact is strictly prohibited, and the intake of alcoholic beverages and the consumption of fatty, spicy and smoked food are contraindicated.
Treatment of gonorrhea involves the use of antibacterial drugs. Over the past decades, gonococcus has acquired resistance to the antibiotic of the penicillin series, in connection with which, at the present stage, other groups of antibacterial drugs of bacterioscopic and bactericidal action have been prescribed to patients.
With fresh acute gonorrhea, it is often sufficient etiotropic therapy that affects the cause of the disease, but with the development of a complicated, latent and chronic form of gonorrheal infection, patients are given complex treatment after first determining the sensitivity of the pathogen to a particular antibacterial drug.
беременным женщинам, кормящим матерям и детям до 14 лет противопоказаны фторхинолоны и аминогликозиды, поэтому такой группе пациентов патогенетическая терапия назначается сугубо индивидуально. Note: pregnant women, nursing mothers and children under 14 years old are not suitable for fluoroquinolones and aminoglycosides, therefore, for such a group of patients, pathogenetic therapy is prescribed purely individually.
If a pregnant woman is sick with gonorrhea, immediately after the birth of the child he is given prophylactic treatment.
In mixed forms of infection, the main treatment is combined with immunotherapy, physiotherapy and local procedures.
Prevention of gonorrhea
- The use of personal protective equipment;
- Compliance with the rules of personal hygiene;
- Use after accidental unprotected sexual intercourse special antiseptics (chlorhexidine, Miramistina, etc.)
- Regular diagnosis of STDs in individuals who frequently change sexual partners.
- Mandatory medical examinations of workers in the field of nutrition, children's and medical institutions.
- Mandatory screening for gonorrhea of pregnant women.
- Sanitary-educational work of narrow-profile specialists among the population.