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 Gonorrhea causes, symptoms and treatment

Gonorrhea is a common infectious disease that is mainly transmitted sexually and leads to damage to the mucous membranes of the genital organs and the urethra. Gonorrhea refers to venereal diseases, and is caused by gonococci, which, in addition to the genital organs, can affect the pharynx, larynx, eyes, joints, and rectum.

Gonorrhea causes, symptoms and treatment

What is gonorrhea

- Gonorrhea belongs to sexually transmitted infections (STIs), and in terms of prevalence it ranks third after trichomoniasis and chlamydia, - says the head of the department of dermatovenereology and cosmetology of the SSMU. V.I. Razumovsky Andrey Bakulev. - Most often, infection occurs during sexual intercourse, when the mucous membranes of the urinary tract are affected. The entrance gate in men is the urethra. Although occasionally gonococci cause inflammation on the tonsils, skin, joints, conjunctiva, and anal area.

Types of gonorrhea

The typology of this venereal disease is carried out under the influence of such factors as:

the duration of the disease;1. 

the location of the concentration of infection;2. 

the reaction of the body to the penetration of the causative agent of the disease into it.3. 

According to the symptoms and duration of the disease, gonococcal infection is divided into chronic (sluggish inflammation of the urinary organs with a duration of more than 8 weeks) and fresh (lasting up to 8 weeks, has 3 forms - acute, subacute and torpid). Also, there is the concept of “latent gonorrhea”. This condition occurs in female patients. With latent gonorrhea, smears and cultures for gonococci do not reveal problems, there are no pronounced symptoms of infection, and the woman is a clear source of infection with a sexually transmitted infection.

According to the focus of infection, gonorrhea is divided into:

infection concentrated in the lower parts of the reproductive and urinary systems;1. 

ascending infection (the endometrium of the uterus, appendages, urinary canal, peritoneum is affected) - such2.  gonorrhea develops extremely rarely, but it is difficult and has dangerous complications.

SYMPTOMS OF GONORRHEA IN WOMEN

Gonorrhea can manifest itself in different ways. Its symptoms are nonspecific and do not allow an accurate diagnosis. In addition, in almost half of the cases in women, they are absent for a long time or do not appear at all.

SYMPTOMS OF GONORRHEA IN WOMEN

Signs of gonorrhea may include:

• white, pale yellow, or greenish vaginal discharge;

• redness of the vulva and vaginal opening;

• itching, burning;

• intermenstrual bleeding;

• discomfort when urinating;

• pain during intercourse;

• lower abdominal pain;

• an increase in local temperature;

• increase in body temperature .

Symptoms of gonorrhea in men

In men, the first signs of the disease usually appear 2 to 5 days after infection. It can be:

Symptoms of gonorrhea in men

mucopurulent or purulent discharge from the urethra;

itching / burning in the urethra;

pain when urinating (dysuria);

frequent urination and urgent urge to urinate;

pain during sexual intercourse (dyspareunia);

pain in the perineum radiating to the rectum.

Gonorrhea in men manifests itself in fresh and chronic forms. The disease, lasting more than 2 months, becomes chronic. Fresh gonorrhea is characterized by inflammation of the urethra - fresh gonorrheal urethritis. Acute urethritis is manifested by cutting pains during urination, redness and swelling of the mucous membrane of the external opening of the urethra, abundant purulent discharge. The subacute form suggests all the same, but the symptoms are less pronounced. In the torpid course of gonorrhea in men, clinical symptoms are sometimes absent or limited to meager mucopurulent or mucous secretions, itching or tickling during urination.

With primary inflammation of the anus, complaints of discomfort in the anus, purulent discharge, and defecation disorders are characteristic. The skin in the anus is swollen and irritated.

Inflammation of the mucous membrane of the mouth, tonsils, pharynx may develop after orogenital contacts. The mucous membrane of the pharynx and tonsils is bright red, painful, swollen, with a purulent coating.

Inflammation of the mucous membrane of the eyes begins rapidly with swelling of the eyelids, conjunctival hyperemia, hemorrhages and purulent discharge. A characteristic symptom is blepharospasm. Visual disturbances are possible.

Unlike many other types of STIs, gonorrhea risk factors do not include weak immunity, bad habits, and other lifestyle habits. It has been confirmed that upon contact with an infection, infection occurs even with strong immunity and the absence of other diseases.

Ways of infection with gonorrhea

Gonorrhea is transmitted through sexual contact. You can get the infection from an infected partner during classic, oral, or anal sex. It should be borne in mind that in some cases the disease can progress slowly and remain undiagnosed. To reduce the risk of infection, contact contraceptives are always recommended, but they do not provide 100% protection.

Oxford Medical specialists say it's theoretically possible to get infected when visiting public saunas, baths or swimming pools, as well as using shared towels and other things. However, such cases do not occur in practice. It has been established that gonococcus die very quickly in the external environment.

Another way to get gonorrhea is from mother to child. The bacteria can reach the baby during fetal development or pass through the birth canal. In such cases, the disease is diagnosed shortly after birth.

Gonococcus is a gram-negative microorganism that lives in leukocytes or on the surface of the epithelium. Infection with it occurs during vaginal, anal or oral sex. Gonococcus can cause gonorrheal tonsillitis, pharyngitis, stomatitis - with oral-genital, and gonorrheal proctitis - with anal-genital sexual intercourse.

Transmission of the infection by household means is also not excluded. The risk group for domestic infection is girls from 2 to 8 years old. Also, gonococcal infection can be transmitted from mother to child during delivery. With this route of infection, gonococcus causes neonatal conjunctivitis in newborns (the condition of gonorrheal conjunctivitis when the pathogen enters the mucous membrane of the eye can occur not only in children).

With improper treatment or its complete absence, as well as with a protracted chronic course of the disease, there is a polymorphism of the pathogen, the appearance of new L-forms that are insensitive to the drug. Long-term persistence of the pathogen in the body complicates both diagnosis and treatment.

At the same time, gonococci are quite sensitive microorganisms that die quickly:

when heated above 56 degrees Celsius;1. 

after the biomaterial has dried (but in pus they can remain virulent for up to 24 hours);20. 

exposed to direct sunlight;3. 

in contact with antiseptics;

when exposed to a solution of silver nitrate at a concentration of 1:6000 (after 60 seconds).4. 

Pathogenesis

After the gonococcus has got on the mucous membrane of any organ lined with a single-layer squamous epithelium, it is fixed on the epithelial cells. The endotoxin released after the death of the pathogen causes degenerative and destructive transformations of epithelial cells. Then there is a proliferation of connective tissue. With a progressive process, the tissue is scarred, which leads to the development of obstruction of the fallopian tubes and narrowing of the urethra.

Gonorrhea is dangerous because the human body does not have an immune response to its pathogen. And in combination with the high antigenic variability of Neisseria gonorrhoeae, the lack of an immune response leads to the possibility of multiple infection and complications.

Clinical picture during infection

The first symptoms of the disease may appear 3-4 days after infection. At the same time, the duration of the incubation period depends on various factors, but on average it is 2-3 weeks.

If you suspect that you might have contracted gonorrhea, you should keep in mind that the clinical manifestations of the disease are not always pronounced. In some individuals, the disease proceeds without clear symptoms and its detection is possible only through appropriate studies (lower genitourinary gonorrhea can occur without noticeable symptoms). However, there are common symptoms, in which in any case it will not be superfluous to consult a doctor.

Complications of gonorrhea

 Complications of gonorrhea A common complication of infection is the addition of a secondary type of STD. Severe forms of gonorrhea are accompanied by the spread of pathogens throughout the body and their settlement on tissues lined with single-layer squamous epithelium. Also among the complications of gonorrhea:

Inflammatory processes in the prostate.1. 

Endometritis.2. 

Inflammation of the seminal vesicles.3. 

Infection of the fallopian tubes and ovaries.4. 

damage to the testicular appendages;5. 

Infection of the anus and rectal mucosa.6. 

Penetration of the pathogen into the abdominal cavity and other diseases.7. 

The most serious consequences of the disease are infertility (in both men and women), miscarriage and ectopic pregnancy.8. 

DIAGNOSIS OF GONORRHEA IN WOMEN

During the consultation, the gynecologist listens to the patient's complaints and examines the medical history. This helps the specialist to draw up a clinical picture of the disease and determine what examinations need to be carried out to make an accurate diagnosis.

During the appointment, the doctor also conducts:

• gynecological examination;

• collection of smears and scrapings from the urethra, vagina and cervix.

Laboratory diagnostics can confirm or exclude the diagnosis. Analyzes are done in several ways. Most often carried out:

• analysis by polymerase chain reaction (PCR) - allows you to identify the DNA of bacteria in the sample, due to which it is considered the most accurate diagnostic method;

• bacteriological seeding - the sample is placed on a nutrient medium and left for a while, after which they look at which cultures have sprouted, and, if necessary, check their sensitivity to different groups of antibiotics;

• bacterioscopic analysis with Gram stain - the sensitivity and specificity of the method reaches 90-100% in the study of discharge from the urethra, but drops to 30-50% in the diagnosis of genital specimens.

As an additional diagnosis, a woman may be prescribed tests for other STIs, since a combination of several infections is often detected, as well as general blood and urine tests, ultrasound of the pelvic organs, and, if necessary, other examinations. They are necessary to assess the stage of the disease and its spread, to exclude the development of complications.

For diagnostics carried out for preventive purposes, usually only analysis of urogenital secretions is carried out.

Diagnosis of gonorrhea in men

In men, the diagnosis of gonorrhea is based on the characteristic clinical picture, anamnesis, and is confirmed by laboratory tests. It is used as secretions from the urethra, adjacent ducts, the secret of the seminal vesicles, the prostate gland. Indication for treatment is the presence of gonococci in the contents of the test.

In order to determine the localization of the inflammatory process in the urethra, a two-glass urine sample is sometimes prescribed.

Differential diagnosis of gonorrhea in men should be made with other infections of the genitourinary system.

Diagnostics

The diagnosis of gonorrhea is no different from establishing the presence of any other disease in the human body. In order to know for sure whether there is a problem, you need to undergo examinations according to the appropriate protocol. To determine gonorrhea, a patient is interviewed for complaints, a visual examination of the organs and laboratory tests. It is the results of the tests that are the decisive argument in the diagnosis. Although, in some cases, for example, to exclude damage to the myometrium, endometrium and fallopian tubes in women, additional instrumental methods of minimally invasive diagnostics in gynecology, hysteroscopy and laparoscopy, may be prescribed. They allow you to make a biomaterial sampling directly in places of possible damage to gonococcus.

Tests that may be needed for laboratory diagnosis

• Polymerase chain reaction (PCR) - involves the collection and examination of biological material from the urethra, cervical canal, external openings of the excretory ducts of the Bartholin glands, as well as from the rectum. In the chronic stage of the disease, the bacterioscopic method is not suitable, it can give a false negative result.

• Bacteriological (cultural) method. It is used in the presence of symptoms of gonorrhea in a patient with no confirmation of the presence of infection by bacterioscopic method. Cultures grown on a nutrient medium are subjected to microscopy with a study of their sensitivity to antibacterial drugs.

In age-related patients and children, the diagnosis of gonorrhea necessarily includes bacteriological confirmation of the diagnosis.

gonorrhea treatment

Treatment of gonorrhea is prescribed taking into account the focus of the pathology, the general condition of the body, the form and stage of the disease, the patient's age and the presence of concomitant diagnoses (not necessarily having a similar etiology).

Medical treatment for gonorrhea:

Antibiotic treatment1. 

sulfa drugs.2. 

To stimulate the natural protective response of the body, immunotherapy is carried out: a gonococcal vaccine is introduced, pyrogenic drugs are prescribed, and autohemotherapy is used.

With intolerance to the body of an antibiotic and antimicrobial agents, local treatment of gonorrhea is performed:

washing the canals and cavities of the external genitalia and urinary canals with antiseptic preparations;1. 

urethral massage;2. 

warm waist baths;3. 

vaginal baths;4. 

With the appearance of suppuration, pseudoabscesses, cysts, surgery is recommended.

Monitoring and checking the results of therapy

To be completely sure that the infection has completely left the body, and not just temporarily subsided, it is necessary to undergo a control check of the results of treatment. Not earlier than 1 week after the completion of the course of therapy, the first combined provocation with gonovaccine is carried out. In the absence of pathogens in the test results, observation is continued for another 2-3 months. Only if after this period the tests are clear and there are not even subjective symptoms of gonorrhea, the patient is considered healthy.

TREATMENT OF GONORRHEA IN WOMEN

TREATMENT OF GONORRHEA IN WOMEN

Gonorrhea is treated with medication. The doctor develops the course of therapy individually. Of great importance is the stage of the disease, the presence of concomitant pathologies or complications.

With timely diagnosis, gonorrhea is successfully treated with antibacterial drugs. Your doctor may prescribe oral or intramuscular antibiotics (shots). The duration of treatment averages 7-10 days, but in some cases a single use of the drug in a high dosage is recommended.

Against the background of taking antibiotics, the symptoms of gonorrhea should decrease after a few days. If this does not happen or the condition worsens, you should consult a doctor again. The reason may be the resistance of the gonococcus to the selected drugs. In such cases, antibiotics of another group are prescribed.

Treatment of chronic gonorrhea is more complex and lengthy. In addition to antibiotic therapy, it includes taking immunostimulating drugs, vitamins and other medications. In the presence of complications and other diseases, appropriate therapy is additionally carried out.

The effectiveness of treatment is monitored by laboratory tests. The first are prescribed immediately after the end of the course of antibiotics, and the next after 2-3 months. In chronic infections, repeat tests are recommended every month for the first six months after treatment.

Treatment of gonorrhea in men

If the process is fresh (acute, subacute) and uncomplicated, it is enough to carry out only etiotropic therapy, i.e. antibacterial. Spectinomycin (Trobicin) is considered one of the effective drugs for the treatment of gonorrhea. However, there is a drawback: often inflammation of the mucous membranes in men is caused not only by gonococci, but by mixed microflora. In this case, the use of the drug will not work. Therefore, only a doctor prescribes treatment!

The following groups of antibiotics may be recommended for the treatment of gonorrhea in men:

cephalosporins;

fluoroquinolones;

macrolides;

tetracyclines;

aminoglycosides;

penicillins;

sulfonamides (with intolerance to antibiotics).

It is now known that certain strains of gonococci produce substances that provide resistance to penicillin and its derivatives. Therefore, antibiotic susceptibility testing may be necessary to prescribe treatment.

And remember: simultaneous treatment of sexual partners is a must!

Risk factors for contracting gonorrhea

frequent change of sexual partners;

refusal of contact contraception (condoms);

the presence of STIs in the partner;

non-compliance with the rules of intimate hygiene.

Unlike many other types of STIs, gonorrhea risk factors do not include weak immunity, bad habits, and other lifestyle habits. It has been confirmed that upon contact with an infection, infection occurs even with strong immunity and the absence of other diseases.

Gonorrhea prevention

Since the disease is transmitted by contact with mucous membranes, condoms cannot provide 100% protection against infection. The infection can enter the body through oral sex or contact with the body fluids of an infected person on the mucous membranes of a partner.

Therefore, even if you are completely confident in your partner, but begin to notice alarming symptoms, you need to make an appointment with a specialist (for women - a gynecologist, for men - a urologist) and take tests for sexually transmitted diseases, incl. gonorrhea;

It must be remembered that your sexual partner may not know about his contagious condition if his illness is asymptomatic. In addition, it is impossible to completely exclude the possibility of infection through the home path. Especially if it is not always possible to strictly follow hygiene standards.

Prevention of gonorrhea includes:

regular preventive examination by a gynecologist and urologist;1. 

detection of infection in a short time, after the penetration of the pathogen into the body;2. 

rational and most optimal treatment of the sick person and all persons who are in intimate proximity with him;3. 

avoiding casual sexual relationships, and if they occur, contact a dermatologist-venereologist for a consultation4.  without delay

healthy lifestyle.5. 

oxford-med.com. Source,/medikom,kp.ru/doctor/bolezni/gonoreya