Gonorrhea: symptoms and treatment
- Pathogen of the disease
- Sources of infection and ways of transmission of gonorrhea
- Mechanism of disease development
- Forms of gonorrhea infection
- Symptoms of gonorrhea
- Diagnosis of gonorrhea
- Treatment of gonorrhea
- Prevention of gonorrhea
Gonorrhea is a sexually transmitted disease that occurs with the defeat of the cylindrical epithelium of the urogenital tract. About his extreme infectiousness is mentioned even in the Old Testament and in the treatises of ancient Greek scientists. 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 "seed" (gonos - a seed, rheos - a leak).
For gonorrhea, there is no difference in gender and social status, as well as a minor child and an adult can become a victim. According to the statistics of the World Health Organization, this insidious disease affects about a quarter of a billion of the world's population every year. This is due to the fact that the causative agent of the disease is highly resistant to certain medicinal preparations, and social reasons and behavioral factors (prosperity of homosexuality, prostitution and the growth of promiscuity) are far from the last role in the spread of infection.
The risk group for gonorrhea incidence includes people aged 17 to 32 years, sexually active adolescents, as well as people who have multiple sexual partners and do not use individual protective equipment.
Pathogen of the disease
The causative agent of the disease is the gonococcus Neisser, discovered in 1879. This is an obligate extracellular and intracellular parasite, reaching a length of 1.5 μm, not having mobility and not forming a spore. Under the lens of the microscope, it is a pair of diplococcus, in shape resembling coffee beans or beans, facing each other with their concave surfaces and separated by a narrow slit-shaped hole. Reproduction of the gonococcus occurs by indirect division perpendicular to the gap located between the pair cocci.
для свежей гонореи характерно внутриклеточное расположение гонококков, а для хронической – внеклеточное. Note: for the fresh gonorrhea, the intracellular location of the gonococci is characteristic, and for the chronic - the extracellular.
Gonococcus is a specific pyogenic human parasite that can penetrate not only into leukocytes, but also into larger bacterial cells. Its body is surrounded by an outer three-layer membrane containing various structural proteins. In turn, the membrane is protected by a dense multilayer capsule. On the outside of the gonococcus are located thin tubular microscopic filaments (saws). With their help, the pathogen sticks to the epithelial cells of the mucous membrane of the urogenital tract.
Under the influence of unfavorable conditions, the gonococcus can form L-forms (fall into a state of suspended animation). Thus, he is able to survive in the process of treatment, and later cause a relapse of the disease.
Sources of infection and ways of transmission of gonorrhea
Most often, gonorrheal infection is transmitted sexually (with genital contacts). 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 mucous membrane of the urethra. In the female body, the infection affects the urethra, vestibule and cervical canal, and in young girls - vulva and vagina.
In passive homosexuals, the focus of infection is often the rectum (in girls and women, such damage develops due to leakage of secretions from infected genitalia).
With oral-genital contacts, gonococcal infection can affect the mucous membrane of the mouth, tonsils and pharynx. Some experts argue that gonorrhea of the pharynx can develop even as a result of a kiss, and in young children, infection with rhinitis or stomatitis of gonococcal etiology through dirty hands sometimes occurs.
With the introduction of gonococci from the genital organs, gonococcal damage to the eyes develops in the eyes, and if the pregnant woman suffers from gonorrhea, gonorrheal conjunctivitis threatens the baby.
Due to contact with contaminated amniotic fluid, intrauterine infection of the fetus may occur, and some specialists admit intrauterine hematogenous infection (gonococcemia).
Mechanism of disease development
Depending on the place of initial introduction of gonococcal infection, it is common to distinguish the following types of gonorrhea:
- Genital (gonorrhea of urogenital organs);
- Extragenital (gonorrheal lesions of the eyes, pharynx and rectum);
- Disseminated, or metastatic (complicated gonorrhea).
After the penetration of gonococcal infection into the organism of its new host, the parasite is almost instantly attached to the epithelial cells by means of pylae (attachment zones), and within 1-2 days of the pathogen it can be detected in the laboratory. The incomplete phagocytosis characteristic of gonococcal lesions leads to the fact that viable microorganisms move to the subepithelial layer, where they form their colonies, and, causing the destruction of the epithelium, penetrate into the lymphatic blood vessels of the genital organs. As a consequence, phagocytes rush to the place of their accumulation, which causes discharge in the urethra (exudate containing a large number of pathogens), and in the layer located beneath the epithelium - an infiltrate that can last for a long time even after the parasite has died. Often, the replacement of infiltration with scar tissue, followed by the formation of strictures (narrowing of the urethra).
Forms of gonorrhea infection
In medical practice, gonorrhea is divided into acute and chronic. To acute form include clinical cases, which last no more than two months. The pathological process, which lasts for more than two months, is diagnosed as chronic gonorrhea. According to experts, the only morphological criterion for the transition of the acute form to chronic is the formation in the urethra of deep foci of infiltration and the formation of fibrous tissue.
It should be emphasized that in the practice of venereologists sometimes there is asymptomatic gonorrhea. This is a pathological process that does not cause an inflammatory reaction to the mucosa. 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
For this pathology is characterized by multifacetedness and mild symptomatology (this is due to the anatomical features of the female urogenital tract). So, often in the process of examining a woman, a gonorrheal lesion that does not accompany subjective sensations can be detected simultaneously in several localizations.
Clinicians distinguish two clinical varieties of "female" gonorrhea:
Ascending gonorrhea (defeat of the upper part of the genito-urinary tract). In this case, a woman can be diagnosed with gonococcal salpingitis, endometritis, oophoritis and pelvicperitonitis.
The most characteristic signs of the lower part of the urogenital system include hyperemia and edema of the urethra, itching and burning in the vagina, painful urination, and thick mucopurulent discharge from the cervical canal.
With the development of ascending gonorrhea, the patients complain of pain in the lower abdomen, nausea, vomiting, fever of 39 degrees, painful urination and menstrual irregularity. Sometimes diarrhea can develop.
It should be emphasized that due to abortions, uterine cavity probing and other gynecological procedures, the infection can spread beyond the inner throat of the uterus.
Signs of gonorrhea in men
In "male" gonorrhea, the urethritis (urethritis) is predominantly affected. At the same time, patients complain of severe cutting pains caused by urination and the appearance of purulent discharge, which can vary in intensity.
Depending on the severity of the signs of the disease, urethritis is acute, subacute and torpid.
In acute form, there is edema and hyperemia of the urethral sponges; during the whole day, greenish-yellow purulent discharge drips from the urethral canal, and when urinating, resists and burning occur.
For anterior acute gonorrheal urethritis pain is typical at the beginning of urination, and when the entire urethra is affected (acute total urethritis), painful sensations occur at the end of urine excretion. In the second case, there may also be frequent urge to urinate, painful pollutions and erections. With pronounced gonorrheal inflammation in purulent discharge, blood impurities are observed, and hemospermia (blood in the seminal fluid) also develops.
Without appropriate treatment, acute urethritis can pass into the subacute stage, in which there is no edema and hyperemia of the urethral sponges. Pain during urination, as well as purulent or serous-purulent discharge at this stage of the disease are insignificant and are most often observed only after a night's sleep.
A subacute stage may be followed by torpid urethritis with even less pronounced clinical signs. At this stage, scant excretions occur only in the morning or when pressing on the urethra.
It should be emphasized that in the absence of adequate treatment subordinate 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 affected and can occur both in acute and chronic forms.
Often, prostatitis accompanies inflammation of the seminal vesicles (vesiculitis), inflammation of the epididymis (epididymitis), balanoposthitis and phimosis (lengthening or narrowing of the foreskin).
Signs of extragenital gonorrhea
Extragenital forms of infection, that is, outside the genital area, include pharyngitis and proctitis. Gonorrheal proctitis is a pathological condition that develops in girls and women due to the leakage of purulent vaginal discharge into the anus, or causes anal intercourse.
With acute gonorrhea proctitis, patients complain of pain during defecation, as well as burning and itching in the anus. Sometimes, when forming cracks, blood can be admixed with the blood masses. There is a hyperemia in the anus, and in the folds of the skin there are accumulations of pus.
Gonococcal tonsillitis and pharyngitis due to oral-genital contacts can be detected only by bacteriological examination, since they do not have characteristic differential signs.
Disseminated gonococcal infection
This pathological condition occurs when the pathogen from the primary focus of infection enters the bloodstream. Often in the blood gonococcus under the influence of natural immunity factors die, but in some cases they begin to multiply there, and along with the blood flow they enter various tissues and organs, causing damage to the liver, joints, meninges, skin and endocardium.
It should be emphasized that the spread of the pathogen does not depend on either the virulence of the microorganism or the nature of the primary focus. Typically, this occurs with immunodeficient conditions, a long-term unrecognized infection, inadequate treatment, as well as in pregnancy, due to instrumental manipulation or due to sexual contacts that provoked mucosal trauma.
In clinical practice, there are 2 forms of disseminated gonococcal infection: mild and severe. For the mild form of the disease, articular syndrome is characteristic, and in severe cases the patient develops sepsis, accompanied by hepatitis, pericarditis or meningitis.
This is one of the manifestations of gonorrheal infection, which is most often found in newborns (gonococcal ophthalmia, iridocyclitis, gonococcal conjunctivitis). In this case, the infection occurs in utero, or when passing through the infected mother's birth canal. When prenatal infection signs of the disease occur already on the first day of life of the child.
For gonococcal conjunctivitis, the characters are hyperemia and edema of the eyelids, abundant purulent discharge from the eyes and photophobia. In the absence of treatment, the infectious process spreads to the cornea of the eye. As a consequence, there is edema, clouding, ulceration and infiltration of the cornea.
Diagnosis of gonorrhea
The diagnosis of the disease is based on the history of the patient's sexual history and the presence of pathogenetic signs of the inflammatory process.
In a mandatory manner, the representatives of both sexes are examined for separation from the genital organs. At the same time, women can be assigned to study the separated Bartholin gland, paraurethral ducts, vaginal walls and cervix. In some cases, men are shown a study of the secretion of the prostate and seminal vesicles, rinsing water of the rectum, and examination of the lacunae and glands of the urethra.
The diagnosis of "gonorrhea" is established only in the case when the investigator is found the pathogen. For this, several methods are used in laboratory practice:
. 1. Bacterioscopy . To date, this is the most common method, involving the study of two smears of the discharge, one of which (for orientation microscopy) is painted with methylene blue, and the other (allowing to finally identify the pathogen) - according to Gramm. If you identify typical forms of gonococcus in both smears, the analysis is considered positive.
. 2. The culture method . Unfortunately, due to its variability, the causative agent can not always be detected by a 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 the detection of the gonococcus Neisser.
. 3. PCR diagnostics . This method is based on the identification of the pathogen in the biological material.
. 4. Reaction of transcriptional amplification . This is a relatively new technique with higher sensitivity than PCR and other amplification methods. With its help you can identify a living pathogen even in a very small amount of material, which allows you to monitor the results of the treatment.
Treatment of gonorrhea
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 if a patient has a gonococcal infection, all sexual partners who have been in contact with him for two months are examined and treated. During this period, any sexual intercourse is strictly forbidden, and drinking alcohol and consuming 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, and in connection with this, at the present stage, other groups of antibacterial preparations of bacterioscopic and bactericidal activity have been prescribed for patients.
When fresh acute gonorrhea is often enough etiotropic therapy affecting the cause of the disease, but with the development of complicated, latent and chronic forms of gonorrheal infection, patients are prescribed complex treatment after preliminary determination of the sensitivity of the pathogen to one or another 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: fluoroquinolones and aminoglycosides are contraindicated in pregnant women, breastfeeding mothers and children under 14 years of age, therefore, this pathogenetic therapy group is assigned exclusively to individual patients.
If a pregnant woman is sick with gonorrhea, immediately after the birth of the child, he is given preventive treatment.
With mixed forms of infection, the basic treatment is combined with immunotherapy, physiotherapy and local procedures.
Prevention of gonorrhea
- Use of personal protective equipment;
- Compliance with personal hygiene;
- The use after a special unprotected sexual contact of special antiseptics (chlorhexidine, miramistin, etc.)
- Regular diagnosis of STD in people who frequently change their sexual partners.
- Obligatory professional examinations of workers in the field of nutrition, children's and medical institutions.
- Mandatory examination for gonorrhea in pregnant women.
- Sanitary-educational work of narrow-profile specialists among the population.