Gonococcal infection (gonorrhea). Causes. Symptoms. Diagnosis and treatment. gonorrhea in women

Gonococcal infection (gonorrhea) Gonorrhoea, GonococcalInfection - an infectious disease caused by Neisseriagonorrhoeae, sexually transmitted with a primary lesion of the human genitourinary system.

Causes

The causative agent of gonorrhea is gonococcus. In most cases, gonorrhea (gonococcus) is transmitted sexually. In most cases, gonorrhea is transmitted through sexual contact, mainly after casual sex without the use of a condom.

Infection with gonorrhea occurs with all sorts of forms of sexual intercourse: with normal intercourse, with oral-genital, with anal and simply by contact of the genitals, without the introduction of the penis into the vagina.

In some cases, it is possible to become infected by household means, for example, through household items: bedding, underwear, washcloths, towels, etc. This route of infection is mainly characteristic of the female half of the population, and especially for girls.

gonorrhea symptoms

The incubation period for gonorrhea can range from 1 to 15 days. But usually the first signs of gonorrhea appear 3-5 days after infection.

Acute urethritis is the most common manifestation of gonorrhea in men. Usually the incubation period takes from 2 to 7 days, although it can last longer. The main symptoms are urethral discharge and dysuria. The discharge may initially be scanty and slimy, but after a day or two it becomes copious and purulent. These severe and obvious manifestations distinguish gonococcal urethritis from non-gonococcal urethritis, which can be caused, for example, by chlamydia. Men with asymptomatic urethritis are the main reservoir for the spread of infection. In addition, they and those who leave the disease untreated are at greater risk of developing complications.

Diagnostics

Even in the presence of the described symptoms of gonorrhea, it is possible to diagnose the disease and make an accurate diagnosis only in the laboratory. Usually a swab is taken from the urogenital tract and examined for the presence of gonococci.

Types of disease

There are two forms of gonorrhea:

1. A fresh form is when the duration of the disease does not exceed 2 months from the moment the first clinical signs of gonorrhea appear. In turn, in the phase of the fresh form, the following are distinguished:

• acute gonorrhea,
• subacute gonorrhea,
• torpid gonorrhea, characterized by minor symptoms of the disease, lasting no more than 2 months.

2. The chronic form is a sluggish process of gonorrhea lasting over 2 months or with an undetermined duration of the disease.

Patient's actions

If you have the described symptoms, be sure to consult a doctor.

gonorrhea treatment

If you have suspicions of gonorrhea, in no case do not self-diagnose and self-medicate. Gonorrhea is a very serious disease that leads to serious consequences if not properly treated - if the first signs of the disease appear, immediately contact a venereologist, urologist or gynecologist.

In case of gonorrhea, it is necessary to strictly observe the rules of personal hygiene, after visiting the toilet, be sure to wash your hands with soap and water. Men should not squeeze out pus from the urethra - this can cause the spread of infection.

In the treatment of gonorrhea, it is recommended to drink plenty of water and exclude spicy foods, alcohol and beer from the daily diet. It is not recommended to visit the pool, ride bicycles and exercise bikes, as well as heavy physical exertion and long walking.

Antibiotics are prescribed to treat gonorrhea. The most effective are mucrolides, fluoroquinolones and cephalosporins. Premature termination of treatment is unacceptable, it is necessary to complete the full course of treatment, because. even with the first improvements and the disappearance of external signs of gonorrhea, the pathogen (gonococcus) remains in the body and the disease becomes chronic. It is recommended to re-examine after the course of treatment.

Complications

When ingested, gonococci infect the mucous membranes of the urethra, cervix and anus, causing their purulent inflammation. Untreated infection can be ascending and spread in women to the uterus, fallopian tubes and pelvic cavity, and in men it can cause damage to the epididymis. In addition, gonorrhea can lead to ectopic pregnancy, the development of adhesions in the abdominal cavity and persistent male and female infertility. Complications such as inflammation of the rectum (proctitis) and the eye (gonorrheal conjunctivitis) are also possible. Very rarely, such serious complications as the spread of infection through the bloodstream and damage to the heart, joints or brain are observed. When a newborn is infected from a sick mother during childbirth, inflammation of the conjunctiva of the eyes (blenorrhea) and the development of blindness in the newborn are possible.

Prevention of gonorrhea

It is necessary to examine, and if a disease (signs of gonorrhea) is detected, and treatment of all persons who have had sexual contact with a patient with gonorrhea. It is also necessary to examine girls in case of illness even of one of the parents.

The use of a condom is the most reliable method of preventing both gonorrhea and other sexually transmitted diseases.

With gonorrhea, immunity does not arise and, in case of negligence, repeated infections with gonorrhea are possible.

After intercourse without a condom, you should immediately urinate and wash the external genitalia with warm water and soap (preferably laundry). Thus, it is possible to wash off the gonococci that have fallen on them. Within 2 hours after intercourse, special antiseptics are used for prophylaxis in the form of solutions - gibitan, cidipol, miramistin and others. They destroy gonococci and pathogens of other venereal infectious diseases. However, do not forget that these funds do not have one hundred percent effectiveness, and it decreases as the time interval from sexual contact increases.

- a specific infection caused by the gram-negative microorganism Neisseria gonorrhoeae and affecting the mucous membrane of the genitourinary tract, rectum, oral cavity, pharynx. The genitourinary form is manifested by purulent discharge from the vagina with an unpleasant odor, dysuria, pulling pains in the abdomen, itching and soreness in the external genital area, but it can also be asymptomatic. Methods for diagnosing gonorrhea in women include an examination on a chair and laboratory tests (microscopy of smears, culture of secretions, PCR, PIF). Etiotropic antibiotic therapy is carried out with cephalosporins, penicillins, fluoroquinolones.

Causes of gonorrhea in women

The pathogen that causes gonorrhea, Neisseria gonorrhoeae, is a gram-negative aerobic diplococcus that has a bean-shaped form. Inside the human body, the pathogen is highly resistant, in the external environment it quickly dies. The pathogenicity factors of gonococcus are: a capsule with antiphagocytic activity; villi, with the help of which the bacterium attaches to the epithelium; endotoxin secreted by the cell wall; membrane proteins with pronounced antigenic properties.

With the help of surface proteins, gonococci attach to the cells of the cylindrical epithelium, causing their death and desquamation. They are phagocytosed by polynuclear neutrophils, inside which they remain viable and able to reproduce. Usually, gonococci initiate a specific local inflammation, however, when released into the blood, they can cause disseminated gonococcal infection. Quite often, gonorrhea in women occurs in the form of a mixed infection: gonorrheal-chlamydial, gonorrheal-trichomonas, gonorrheal-mycoplasma, gonorrheal-candidiasis.

The predominant route of infection is sexual, infection is possible both through unprotected vaginal and oral-genital or anal-genital contact. Often there is a multifocal, multiple organ lesion. The non-sexual route of infection can be realized during childbirth when the child passes through the birth canal. Domestic infection is extremely rare - mainly through close contact of a child with a mother with gonorrhea (for example, in the case of using a common bed, towels, hygiene items, etc.).

The factors contributing to the high prevalence of gonorrhea among women are the low level of general culture, the early onset of sexual activity, numerous sexual relationships, the neglect of barrier methods of contraception and spermicidal agents during casual sexual contacts, and prostitution. Childbirth, intrauterine interventions (probing of the uterine cavity, abortion, RFE), menstruation, and non-compliance with intimate hygiene contribute to the ascent of the infection.

Classification of gonorrhea in women

Depending on the duration of the disease, fresh (lasting up to 2 months) and chronic (lasting more than 2 months) gonorrhea in women are distinguished. Given the severity of symptoms, the fresh form may have an acute, subacute, or torpid course. Chronic infection, as a rule, is asymptomatic, with periodic exacerbations. In the absence of specific local manifestations, but the release of the pathogen in scrapings from the mucous membranes, they speak of a latent infection, or gonococcal carriage.

There are genital and extragenital forms of gonorrhea in women. According to the localization principle, gonorrhea of ​​the lower urogenital tract (urethritis, paraurethritis, vestibulitis, bartholinitis, cervicitis) and gonorrhea of ​​the pelvic organs (endometritis, salpingitis, adnexitis, pelvioperitonitis) are differentiated. The course of gonorrhea in women can be uncomplicated and complicated.

Symptoms of gonorrhea in women

Gonorrhea of ​​the lower urinary tract

The incubation period for lesions of the lower genitourinary tract averages 5-10 days (with ascending, disseminated gonorrhea and estrogenital forms, it may increase). In almost half of infected women, gonorrhea is asymptomatic or oligosymptomatic. Local manifestations depend on the primary lesion of a particular organ, but gonorrhea in women often occurs in a mixed form. The classic signs of the disease are the appearance of profuse vaginal discharge of white or yellowish color with an unpleasant odor. This symptom is often regarded by a woman as a manifestation of nonspecific vaginitis or thrush, in connection with which attempts are made to self-treat the infection, erasing the true clinical picture.

gonorrheal urethritis. The damage to the urinary tract is indicated by frequent urination, accompanied by a burning sensation and pain, imperative urges, a feeling of incomplete emptying of the bladder. The external opening of the urethra is edematous and hyperemic on examination, painful on palpation; when pressed, a purulent discharge appears from it. Complications of gonorrheal urethritis with an upward spread of infection can be cystitis and pyelonephritis.

Gonorrheal bartholinitis. Bartholin's glands in gonorrhea in women are affected a second time due to leakage of pus from the urethra or cervix. When the excretory duct is blocked, the glands become inflamed, increase in size, become sharply painful - an abscess of the Bartholin gland is formed. In advanced cases, the abscess can spontaneously open with the formation of non-healing fistulas, from which there is a constant outflow of pus.

ascending gonorrhea

Gonorrheal endometritis. This clinical form of gonorrhea in women occurs with liquid purulent-serous or sanious discharge from the genital tract, dull pain in the lower abdomen and back, low-grade fever. As a result of violations of the proliferative and secretory transformation of the endometrium, menstrual disorders of the type hyperpolymenorrhea can be observed; sometimes acyclic uterine bleeding occurs. With the delay of purulent contents in the uterine cavity, a pyometra clinic develops.

Gonorrheal salpingitis and salpingoophoritis. It develops with damage to the fallopian tubes and ovaries, often bilateral. The acute phase of gonorrhea in women manifests with fever and chills, aching (sometimes cramping) pain in the lower abdomen. When both ends of the fallopian tube (uterine and ampullar) are sealed, it is possible to form a hydrosalpinx, and then a pyosalpinx, and in the case of the transition of inflammation to the ovary, a pyovar, a tubo-ovarian abscess. Against the background of an extensive inflammatory process in the small pelvis, a pronounced adhesive process is formed.

Gonorrheal pelvioperitonitis. This form of gonorrhea in women is caused by the spread of infection from the fallopian tubes to the pelvic peritoneum. Pelvioperitonitis of gonococcal etiology manifests violently: there are sharp pains in the lower abdomen with irradiation to the epigastrium and mesogastrium, symptoms of muscular protection. The temperature is quickly understood to febrile values, vomiting, gas and stool retention are noted. Peritonitis rarely develops, since the rapid formation of adhesions delimits the inflammatory process from the abdominal cavity.

Complications of gonorrhea in women

The danger of gonorrhea lies not only in the high degree of contagiousness and the variety of clinical forms, but also in the frequent development of complications, both in the woman herself and in the offspring. So, gonorrheal endometritis often causes uterine infertility in women, and gonorrheal salpingitis and salpingo-oophoritis - tubal infertility and ectopic pregnancy.

Pregnancy gonorrhea can cause miscarriage and preterm labor; cause intrauterine growth retardation and antenatal fetal death, intrauterine infection of the fetus with the development of gonoblenorrhea, otitis media, gonococcal sepsis of the newborn; postpartum purulent-septic complications in a woman in labor.

With disseminated gonococcal infection, skin lesions, gonorrheal tenosynovitis, arthritis, hepatitis, myopericarditis, endocarditis, meningitis, pneumonia, osteomyelitis, sepsis can occur. Asymptomatic gonorrhea in women does not guarantee the absence of complications.

Diagnosis of gonorrhea in women

Genital forms of gonorrhea in women are usually diagnosed by a gynecologist or venereologist, extragenital forms can be detected by a dentist, otolaryngologist, ophthalmologist or proctologist. In the anamnesis, as a rule, there are indications of casual sexual intercourse or multiple sexual contacts. In typical cases, when viewed on a chair, the expiration of ribbon-like mucopurulent discharge from the external pharynx of the cervix, signs of vulvovaginitis, is revealed. During a vaginal examination, a slightly enlarged, painful uterus, a conglomerate of fallopian tubes and ovaries soldered together, can be palpated.

In order to confirm the diagnosis, material is taken from the vagina, cervical canal, urethra, rectum, oral cavity, conjunctiva (depending on the location of the primary focus). Laboratory diagnostic tests include microscopy of smears with Gram stain, culture of discharge for gonococcus, examination of scrapings by PCR and PIF. Serological studies (RIF, ELISA, RSK) do not allow differentiating previously transferred and current gonorrhea in women, therefore, they usually do not play a decisive role in diagnosis.

If latent or chronic gonorrhea is suspected in women, when the pathogen is not detected in scrapings, various provocation methods are used: chemical (lubrication of the urethra and cervical canal with protargol solution), mechanical (urethral massage), biological (intramuscular injection of pyrogenal or gonovaccine), thermal (carrying out physiotherapy - ozokeritotherapy, paraffin therapy, UHF, etc.), alimentary (consumption of spicy, salty foods, alcohol), physiological (menstruation). After provocation, biological material is taken three times: after 24, 48, 72 hours.

Treatment and prevention of gonorrhea in women

When prescribing therapy, the form, localization, severity of manifestations of gonorrhea in women, the presence of concomitant infections and complications are taken into account. The basis of therapy is course antibiotic therapy with penicillin, cephalosporin, fluoroquinolone drugs. When gonorrhea is combined with chlamydia or trichomoniasis, metronidazole or doxycycline is connected to therapy.

With fresh gonorrhea in women, occurring with lesions of the lower urogenital tract, a single dose or administration of an antibiotic (ceftriaxone, azithromycin, ciprofloxacin, cefixime) is sufficient. The course of treatment for ascending gonorrhea or mixed infection is extended to 7-10 days. Immunity stimulants, autohemotherapy, and the introduction of gonococcal vaccines are connected to the treatment of chronic gonorrhea in women. Local treatment includes washing the urethra with 0.5% solution of silver nitrate, washing the vagina with antiseptics (solutions of potassium permanganate, chlorhexidine, miramistin). A mandatory measure is the treatment of the sexual partner. After the inflammatory process subsides, physiotherapeutic procedures are prescribed (UVI, electrophoresis, UHF).

With complicated forms of gonorrhea in women (tuboovarian abscess, pyosalpinx, etc.), surgical treatment is indicated - removal of appendages. In the case of the development of pelvioperitonitis, a laparotomy is necessary to sanitize the abdominal cavity. In case of an acute suppurative process in the region of the Bartholin gland, an abscess is opened, the wound is washed and drained.

When identifying a woman with gonorrhea, it is necessary to examine family members or sexual partners. For the purpose of personal prevention, it is recommended to use condoms during casual sexual contacts. After unprotected intercourse, you should contact a medical institution for emergency prevention of STIs as soon as possible. Testing for gonorrhea is a mandatory part of the pregnancy management program and the annual gynecological examination of women. Sanitary education plays an important role in the prevention of gonorrhea.

Gonococcal infection, or, in other words, gonorrhea, is a fairly common sexually transmitted disease transmitted during unprotected sexual contact. Very often, the development of this disease is accompanied by damage to the genitourinary system.

Statistics show that over the past 15 years, the number of cases of gonorrhea has decreased significantly. But, despite this, about 62 million people face gonococcal infection every year. This disease poses the greatest danger to young girls under 25 years of age. This is due to the excessive speed of development in such individuals of inflammatory processes in the pelvic area, leading to infertility.

Gonorrhea ranks second among sexually transmitted diseases in terms of significance and distribution. Only chlamydial infection is ahead of her.

Causes of gonorrhea

Most often, cases of infection with gonorrhea can be observed in people leading an immoral way of life. Every casual sexual contact without the use of a condom can result in the development of this problematic disease. The causative agent of gonococcal sepsis is gonococcus.

Gonococcal infection can be contracted through any unprotected sexual contact:

• During normal intercourse;
• With oral-genital contact;
• During anal sex;
• With a simple touch of the genitals, even without penis penetration into the vagina.

There is also the possibility of infection due to the sharing of hygiene items or household items with a sick person. Such items can be:

• Linens;
• A bath towel;
• Washcloth;
• Underwear.

This method of infection is more typical for women than for men.

Expectant mothers should be especially careful with gonococcal infection. The same fate awaits a child born to an infected girl. In addition to a venereal disease, the baby will have big vision problems, and maybe even go blind. More than half of the cases of congenital blindness in infants are caused by gonorrhea.

Symptoms of gonorrhea in men

The patient can observe the earliest signs of gonococcal infection already 3-5 days after unprotected intercourse with a sick person. In rare cases, the disease may not appear for up to two weeks.

A characteristic manifestation of the development of gonococcal sepsis in men is acute urethritis, which can usually be observed 3 days after infection. In very rare cases, symptoms may not appear for about 10 days. The most important sign of gonorrhea is discharge from the urethra and dysuria. The very first secretions have a mucous structure, but after a couple of days they will become purulent and their number will increase significantly.

It is worth noting that in some men, urethritis may be asymptomatic. It is these representatives of the stronger sex that are the most dangerous carriers of gonococcal infection.

Manifestations of gonococcal sepsis in women

The nature of the manifestation of gonorrhea in the fair sex is much more diverse and may include the following symptoms:

1. Gonococcal cervicitis

It should be noted that this disease can be caused not only by gonococcus, its development can also be provoked by chlamydia and other pathogenic bacteria.
The main symptom of gonorrhea in women is a specific vaginal discharge. In addition, there may also be pain in the lower abdomen.

2. Gonococcal vaginitis.

If a woman has this disease, then any examination will bring her a lot of discomfort. This is due to the extreme swelling of the vaginal mucosa and the presence of copious purulent discharge.

3. Anorectal gonorrhea

The essence of this disease is the development of gonococcal infection in the rectum.

Diagnosis and treatment of gonorrhea

Even if all of the above symptoms of the disease are present, a conclusion about the presence or absence of gonorrhea can only be made after a laboratory analysis. Most often, a smear of the urogenital tract is examined for the presence of gonococcus in its composition.

In the event that the first signs of gonorrhea are found in oneself, the patient should in no case self-medicate. The first thing to do is to consult a good venereologist or gynecologist.

Gonorrhea is a very dangerous disease that can lead to terrible consequences. That is why it is necessary to strictly follow all the recommendations of a specialist. Men need to squeeze pus out of the urethra to prevent the spread of infection.

The treatment of gonorrhea involves the observance of a special diet, in which you need:

• Drink plenty of fluids;
• Exclude spicy food from the diet;
• Give up alcohol and smoking.

Gonococcal infection is an infectious disease that is most often transmitted during sexual intercourse from an infected person to a healthy one. The gonococcal environment affects the genitourinary system, and then manifests itself in the form of many other secondary symptoms. The resulting disease is called gonorrhea or gonorrhea.

If a patient is diagnosed with gonococcal infection, then he needs immediate treatment.

The organisms that cause the infection are Neisser's gonorrheae (neisseria gonorrhoeae). If you look at them under magnification, they are shaped like beans, folded side by side with concave sides inward. In the external environment, the bacterium quickly dies, but in the human body it can be quite a long time.

The thing is that they are surrounded by a special protective capsule that prevents them from interacting with human immunoglobulin. The duration of treatment is also explained by the fact that gonococci also produce beta-lactamase, which neutralizes the effect of most modern antibiotics.

Gonococci that enter the body "live" inside the cells, namely, in leukocytes. The likelihood of infection for women is 50-70%. This figure rises to 90% if a woman's regular sexual partner is infected with gonorrhea. A man who has had several contacts with a sick partner has a risk of infection of up to 80%.

Etiology

In medicine, several ways of getting gonococcal bacteria into the patient's body are known. The very first is unprotected or casual sexual contact with an infected person. Infection is possible with any act: anal, oral or vaginal.

The next method of transmission is the infection of a child, which during childbirth passes through the genitals of a mother who has gonorrhea. Microorganisms are very likely to enter the body of a newborn.

Infection is also possible in domestic conditions (through hygiene items, towels, dirty linen). But in medicine, such cases are recorded quite rarely.

Symptoms in men

Symptoms of gonorrhea in men are as follows:

1. burning in the genital area.
2. itching, which, if left untreated, becomes severe.
3. inflammatory process on the head of the penis and foreskin.

If you press lightly on the head, then a small amount of pus will come out of the urethral canal. If the gonococcal pathogen reaches the back of the urethra, then urination becomes frequent, during which the patient feels pain. At the end of the urination process, blood discharge is possible. A secondary symptom is inflammation of the lymph nodes in the groin, they enlarge and become inflamed.

Gonococci are pathogenic microorganisms that require immediate treatment. If you do not go to the hospital in time, the inflammatory process will spread to the urethra, prostate, seminal glands and testicles.

Symptoms in women

The main signs of infection are extensive damage to the uterus and its cervix, urethra, and vagina. Symptoms depend on how much the female organs are affected by the disease. Inflammation in the urethra leads to, accompanied by. If the cervix and vaginal tissues are inflamed, then discharge with pus is characteristic, pulling pain in the lower abdomen. When the infection settles on the external genitalia, it develops.

The danger of this disease in women is that in 50% of patients its initial stage is asymptomatic. The woman does not feel discomfort, but at the same time she is a carrier of the infection and needs medical treatment. Gonorrhea enters the advanced stage, causing damage to the fallopian tubes and ovaries. In the future, this may provoke a difficult birth or even.

Diagnostics

The studies that gynecologists use today are as follows:

• Collecting the patient's history. To compile a general picture of human health, the doctor must know the presence of chronic diseases in the reproductive system, pathologies that occurred during pregnancy, if any, the condition of the urinary organs of a permanent partner.
• Visual inspection of the outer part of the genitals. With it, you can identify the inflammatory process, swelling or hyperemia of the urethral mucosa, the pathological nature of the discharge.
• Inspection on a chair using a special mirror. Thus, inflammation in the uterus, vagina, and atypical discharge are detected.
• Gynecological examination of a bimanual nature for the presence of inflammation of the appendages and uterus.

A laboratory analysis will be prescribed by a doctor if the patient has the following indications:

1. infertility diagnosis.
2. pathological course of pregnancy, miscarriage or.
3. the presence of urogenital infections of an acute or chronic nature.
4. detection of urogenital diseases in a sexual partner.

If there is a suspicion of gonorrhea, then all stages of diagnosis should be performed:

• bacterioscopic examination of secretions (smear for Trichomonas and gonococci);
• culture to detect sensitivity to antibiotics.

To detect gonorrhea, a detailed analysis of secretions collected from the urethra () is most often used. The probability of detecting gonococci in a smear in men is about 90%. Gonococci in a smear in women are determined in only 60% of cases. Therefore, this study alone is not enough. In parallel, other, more accurate diagnostic methods are performed.

A smear taken from the genitals is bacteriological and bacterioscopic. The bacterioscopic type analysis is performed by staining the smear with a chemical solution of methylene blue. A rapid reaction occurs, during which stained gonococci are clearly visible on the laboratory glass, which stand out against the background of other cells.

With 95-100% accuracy, gonorrhea in women is diagnosed by culture of secretions. Biomaterial sampling is carried out from the urethra, vagina, oral cavity (pharynx), rectum, cervix. To get a reliable result, a minimum amount of material is sufficient. This research is ongoing up to 7 days. By analyzing the sowing of the secret from the vagina, it is also possible to establish the sensitivity of the internal microflora to various antibiotics. This is very important for the subsequent treatment of gonococcal infection.

Deciphering the analysis

There are only two possible outcomes:

1. positive - gonococci were found in the examined material;
2. negative - deciphering the study for gonococcus completely excludes the presence of Neisser's gonococci.

It is necessary to take into account the factor that a negative indicator may be the result of improper sampling of material or unskilled microexamination. A false answer is possible if the patient has taken a course of antibiotic therapy in the current month.

Treatment

Treatment of gonococcal infection is a long process, which consists of a complex of medical prescriptions. Initially, the disease was eliminated with the help of penicillin-containing drugs. But modern strains of gonorrhea have become resistant to this component. Treatment regimens have changed. Now the infection is treated with drugs of the tetracycline group, macrolides, fluoroquinolones. Antibiotic therapy is performed according to the scheme, which the doctor prescribes individually for each patient. In no case should you self-medicate or exceed the prescribed dosages.

If a person has chronic gonorrhea, then it is advisable to inject the gonococcal vaccine. Vaccination is an effective adjuvant in the implementation of medical therapy. It is prescribed to patients from 3 years old. If all other types of therapy have failed, then this vaccination will be the last recommendation of the doctor.

To increase the body's defenses, patients are prescribed treatment with biostimulants, immunomodulating agents, baths with a weak solution of Miramistin.

During the period of treatment, the patient is strictly prohibited from sexual relations, the use of alcoholic beverages. It is advisable to observe bed rest during the acute phase.

Prevention

The only preventive measure is the exclusion of casual sexual contacts. If you have a new partner, then be sure to use. After an intimate act, carefully treat the genitals with soap and warm water.

Gonorrhea is a sexually transmitted disease. It can occur in both men and women. The infection is often asymptomatic, which leads to late seeking medical help and the development of serious complications, including infertility. The causative agent of the disease is gonococcus (Neisseria gonorrhoeae). In everyday life, you can hear another name for gonorrhea - "gonorrhea".
Despite the fact that in recent decades there has been significant progress in the treatment of infection, gonococcus is gradually becoming resistant to modern antibacterial agents. Therefore, if the scheme of their intake is violated, gonorrhea can become chronic. Having been ill once, a person can become infected again and again.
Although the susceptibility is the same for both sexes, after the first intimate contact with a patient with gonorrhea, every second to fourth man and every fifth to seventh woman becomes infected. In the vast majority of cases (70-80%), simultaneous infection with chlamydia, trichomoniasis and other STDs occurs.

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1. Manifestations of gonorrhea in women

Due to the peculiarities of the anatomy and physiology, gonococcal infection in women often proceeds almost imperceptibly or has very poor symptoms.

The bacteria can affect more than just the mucous membranes of the urinary tract, so the symptoms of gonorrhea can vary from woman to woman. It depends not only on the way of infection, the state of the immune system, the presence of chronic diseases are also of great importance.

1.1. First symptoms

The first signs appear immediately after the end of the incubation period, which in a woman can range from 3 days to 1 month, but usually does not exceed two weeks. They may be pronounced or weak. As a rule, when infected during vaginal intercourse, the following symptoms are observed:

• Vaginal discharge white, white-green, green, gray-white (mucous and mucopurulent, copious, viscous).
• Urinary disorders (frequent painful urination, increased frequency of going to the toilet, burning and itching in the urethra).
• Drawing pains in the lower abdomen.

In this case, the general condition may not suffer: the body temperature does not rise, weakness, chills do not occur.

1.2. Damage to the genitourinary system

First of all, gonococci cause an inflammatory process in the urethra, the vestibule of the vagina and inside it, the paraurethral and Bartholin glands.

The most common signs of gonococcal urethritis, vulvovaginitis, cervicitis:

• Intense or moderate pain at the end / beginning of urination, quite sharp.
• Enlarged inguinal lymph nodes.
• Pain and discomfort during intercourse.
• Discharges in gonorrhea are abundant or scanty, mucopurulent, thick, gray-green, yellow-green, gray-white in color with an unpleasant odor.
• Frequent painful urination.
• Swelling and redness of the opening of the urethra, vulva, vaginal walls, with endocervicitis - the cervical region.

An inflammatory process may occur in the Bartholin glands with the development of an abscess. They are rounded formations with a diameter of 1-2 cm and are filled with pus. With the spread of infection to the overlying sections and organs of the small pelvis, endometritis, adnexitis, pelpioperitonitis develop.

1.3. Gonococcal pharyngitis

Infection of the mucous membrane of the pharynx occurs mainly during oral sex. Gonococcal pharyngitis often occurs latently.

The following symptoms may be observed:

• Feeling of dryness and pain when swallowing, perspiration.
• Hoarseness of voice.
• Enlarged submandibular lymph nodes.
• Redness of the throat area.
• Purulent plaque on the tonsils, their redness and increase in size.
• Bad breath.
• Possible inflammation of the gums and oral cavity (gingivitis, stomatitis).

1.4. Proctitis

Infection occurs during anal sex, as well as when discharge from the vagina flows into the anus. The disease manifests itself:

1. 1 Itching and burning in the anus.
2. 2 Constipation, false painful urge to defecate.
3. 3 Periodic purulent discharge from the anus, sometimes with an admixture of blood.
4. 4 Going to the toilet becomes more frequent, brings discomfort.

2. Gonococcal conjunctivitis

Gonococcal eye infection can occur at any age and occurs as inflammation of the iris (iridocyclitis) or conjunctiva (conjunctivitis).

This is most often associated with the introduction of infection with dirty hands, as well as with the general use of hygiene items, including towels. Blennorrhea (gonococcal ophthalmia) of newborns is isolated separately, when the child becomes infected when passing through the mother's birth canal.

Symptoms:

• Severe swelling of the eyelids (they swell).
• Photophobia - hypersensitivity to bright light.
• Purulent discharge, which usually accumulates in the corners of the eye, on the eyelashes.
• Redness of the conjunctiva, its increased bleeding.

In advanced cases, corneal ulcers appear, its perforation, blindness develops.

3. Gonorrhea of ​​other organs and systems

Sometimes gonococcal infection occurs with damage to the joints - arthritis, articular bags (burs) - bursitis, bone tissue - osteomyelitis.

Gonorrheal arthritis is characterized by inflammation of a small number (two or three) of large joints, and subsequently by a persistent limitation of mobility up to the development of ankylosis. Bursitis and osteomyelitis are typical.

In other distant organs, gonococci enter with the bloodstream against the background of a weakening of the body's defenses. At the same time, classic diseases develop:

• myocarditis, endocarditis;
• meningitis;
• pneumonia;
• brain abscess;
• sepsis and so on.

4. Features of mixed infection

In recent years, an atypical course of gonorrhea has often been observed against the background of simultaneous infection with gonococcus, chlamydia, mycoplasmas, Trichomonas, etc. In this case, the classic symptoms of gonorrhea fade into the background. A mixed infection is more difficult to treat, often becomes chronic.

4.1. Chlamydia

Against the background of chlamydia, the incubation period of gonorrhea is often extended to three months. Mixed chlamydial-gonococcal infection tends to be chronic, difficult to cure after the first course of antibiotics, usually requires the use of provocative techniques.

Trichomonas are single-celled microorganisms that can "mask" as human cells and "escape" from immunity.

Another property of them is to penetrate deep into the tissues of the host. Gonococci are able to stay inside Trichomonas for quite a long time and "hide" from adverse environmental conditions.

Simply put, prescribing antibiotics may not be effective. Gonococci that exist inside Trichomonas survive, and then begin to multiply actively.

For this reason, a combined infection (gonorrhea + trichomoniasis) tends to have a long undulating course with a high risk of chronicity.

Its symptoms depend on the state of the body and the depth of the inflammatory process:

1. 1 With good immunity - an asymptomatic course, the presence of scant discharge with an unpleasant odor, soreness or just a feeling of discomfort during intercourse, urination.
2. 2 When the defenses are weakened - pain during urination, foamy, mucopurulent discharge with an unpleasant odor, discomfort, soreness and slight bleeding are observed during sexual intercourse.

Gonorrhea can also be combined with diseases such as syphilis, genital herpes, HPV infection, HIV, candidiasis and others.

5. Diagnosis and treatment

If any warning symptoms appear, you should undergo a comprehensive examination for STDs.

As a rule, for this, a smear is taken for microscopic examination (for flora and GN), and a comprehensive analysis is carried out that detects the DNA of the main causative agents of sexual infections by polymerase chain reaction (PCR, real-time PCR).

The doctor prescribes treatment based on the results obtained. The scheme necessarily includes one or more antibacterial drugs. At the same time, all sexual partners are treated. Otherwise, therapy will be useless.

The drugs of choice that are most effective for gonorrhea are:

• Ceftriaxone;
• Cefixime;
• Cefotaxime;
• Spectinomycin.

Most often, gonorrhea is treated on an outpatient basis, only pregnant women, children, as well as women with complications and requiring further examination are hospitalized.

2 weeks after the end of the course of antibiotics, repeat tests are performed (NASBA - detection of gonococcal RNA in scrapings). The PCR method can be used no earlier than 30 days after the end of therapy.

Gonorrhea is considered cured with a double negative result. If the therapy is ineffective, alternative antibiotics are prescribed after bakposev with sensitivity determination.