Gonorrhea – the venereal infection causing damage of mucous membranes of the bodies covered by a cylindrical epithelium: urethras, uterus, rectum, throat, conjunctiva of eyes. The activator - concerns to group of the infections, sexually transmitted (I,ST). It is characterized by mucous and purulent allocations from an urethra or a vagina, pain and discomfort during an urination, an itch and allocations from an anus. At damage of a throat – an inflammation of a throat and almonds. Nelechenny gonorrhea causes the inflammatory processes in bodies of a small pelvis leading to infertility in women and men; gonorrhea during pregnancy leads to infection of the child at the time of delivery.
Gonorrhea (gonorrhea) – the specific infectious and inflammatory process striking generally urinogenital system which activator are gonokokk (Neisseria gonorrhoeae). Gonorrhea - a venereal disease as it is transferred mainly at sexual contacts. Gonokokki quickly perish in the external environment (when heating, drying, processing by antiseptics, under direct sunshine). Gonokokki is struck, mainly, by mucous membranes of bodies with a cylindrical and ferruterous epithelium. They can settle down on a surface of cages and is intracellular (in leukocytes, trichomonads, epithelium cages), can form L-forms (not sensitive to influence of medicines and antibodies).
In the place of defeat allocate several types of a gonokokkovy infection:
- gonorrhea of urinogenital bodies;
- gonorrhea of anorektalny area (gonokokkovy proktit);
- gonorrhea of bone and muscular system (gonartrit);
- gonokokkovy infection of a conjunctiva of eyes ();
- gonokokkovy pharyngitis.
Gonorrhea from the lower departments to urinogenital system (urethras, periuretalny glands, the tservikalny channel) can extend in top (a uterus and appendages, a peritoneum). Gonorrheal vaginit almost does not meet as the flat epithelium mucous vaginas is steady against influence of gonokokk. But at some changes mucous (at girls, at women during pregnancy, in a menopause) its development is possible.
Gonorrhea is more widespread among young people of 20 - 30 years, but can meet at any age. Danger of complications of gonorrhea – various urinogenital frustration (including sexual), infertility at men and at women is very big. Gonokokki can get into blood and, circulating on all organism, to cause damages of joints, sometimes a gonorrheal endocarditis and meningitis, bacteremia, serious septic conditions. Infection of a fruit from the infected gonorrhea of mother at the time of delivery is noted.
At the erased gonorrhea symptoms patients aggravate the course of the disease and extend an infection further, without knowing about it.
Infection with gonorrhea
Gonorrhea is highly infectious infection, in 99% - has a sexual way of transfer. Infection with gonorrhea occurs at different forms of sexual contacts: vaginal (usual and "incomplete"), anal, oral.
At women after sexual intercourse with the sick man the probability of infection with gonorrhea makes 50-80%. Men at sexual contact with the woman, sick gonorrhea, catch not always - in 30-40% of cases. It is caused by some anatomic and functional features of urinogenital system at men (the narrow channel of an urethra, gonokokk can be washed away by urine.) The probability of infection with gonorrhea of the man is higher if the woman has periods, sexual intercourse is extended and has rough end.
The contact way of infection of the child from sick gonorrhea of mother at the time of delivery and household, indirect – through personal care products (bed linen, a bast, a towel), usually can sometimes occur at girls.
The incubatory (hidden) period at gonorrhea can last from 1 days to 2 weeks, up to 1 month more rare.
Infection with gonorrhea of the newborn child
Gonokokki cannot get through the intact fetal covers during pregnancy, but the premature rupture of these covers leads to infection of amniotic waters and a fruit. Infection with gonorrhea of the newborn can occur when passing it in patrimonial ways of sick mother. The conjunctiva of eyes, at girls also genitals is surprised at the same time. The blindness in half of cases is caused in newborns by infection with gonorrhea.
Proceeding from disease duration, distinguish fresh gonorrhea (from the moment of infection of 2 months).
Fresh gonorrhea can proceed in sharp, subsharp, malosimptomny (torpedo) forms. There is a gonokokkonositelstvo which subjectively is not shown though the causative agent of gonorrhea is present at an organism.
Now gonorrhea not always has typical clinical symptoms as the mixed infection often comes to light (with trichomonads, hlamidiya) which can change symptomatology, extend the incubatory period, complicate diagnostics and treatment of a disease. Many malosimptomny and asymptomatic cases of gonorrhea meet.
Classical manifestations of a sharp form of gonorrhea at women:
- purulent and serous and purulent vaginal allocations;
- hyperaemia, hypostasis and ulceration of mucous membranes;
- frequent and painful urination, burning, itch;
- intermenstrual bleedings;
- pains in the bottom of a stomach.
In more than a half of cases gonorrhea at women proceeds or faded, malosimptomno, or at all is not shown. In this case the late address to the doctor is dangerous by development of the ascending inflammatory process: gonorrhea affects a uterus, uterine tubes, ovaries, a peritoneum. The general state can worsen, raise temperature (to 39 °C), violation of a menstrual cycle, diarrhea, nausea, vomiting is observed.
At girls gonorrhea has a sharp current, is shown by hypostasis and hyperaemia of a mucous vulva and a threshold of a vagina, burning and an itch of genitals, emergence of purulent allocations, pains at an urination.
Gonorrhea at men proceeds generally in the form of a sharp uretrit:
- itch, burning, puffiness of an urethra;
- plentiful purulent, serous and purulent allocations;
- the urination which is speeded up painful, sometimes complicated.
Gonokokkovy pharyngitis can be shown by reddening and a sore throat, temperature increase of a body, but proceeds asymptomatically more often. At a gonokokkovy proktit allocations from a rectum, morbidity in an anus can be observed, especially at defecation; though usually symptoms are a little expressed.
Chronic gonorrhea has a long current with periodic aggravations, is shown by adhesive processes in a small basin, decrease in sexual desire at men, violations of a menstrual cycle and reproductive function at women.
Asymptomatic cases of gonorrhea seldom come to light at an early stage that promotes further spread of a disease and gives high percent of complications.
The ascending infection type at women with gonorrhea is promoted by periods, surgical termination of pregnancy, diagnostic procedures (a scraping, a biopsy, sounding), introduction of intrauterine spirals. Gonorrhea the uterus, uterine tubes, tissues of ovaries up to developing of abscesses are surprised. It leads to violation of a menstrual cycle, emergence of adhesive process in pipes, to development of infertility, extra-uterine pregnancy. If the woman sick with gonorrhea is pregnant, great probability of a spontaneous abortion, premature birth, infection of the newborn and development of septic states after the delivery. At infection with gonorrhea of newborns, they develop an inflammation of a conjunctiva of eyes which can lead to a blindness.
Serious complication of gonorrhea at men is the gonokokkovy epididymite, violation of a spermatogenesis, decline in the ability of spermatozoa to fertilization.
Gonorrhea can pass to a bladder, mochetochnik and kidneys, a throat and a rectum, to strike lymphatic glands, joints, and other internals.
It is possible to avoid undesirable complications of gonorrhea if in due time to begin treatment, strictly to observe appointments of the venereologist, to lead a healthy lifestyle.
Diagnosis of gonorrhea
For diagnosis of gonorrhea presence of clinical symptoms at the patient does not suffice, it is necessary to reveal the causative agent of a disease by means of laboratory methods:
- research of dabs with material under a microscope;
- material on specific nutrient mediums for allocation of true culture;
- IFA and PTsR-diagnostics.
In microscopy of dabs painted across Gram and methylene blue gonokokk are determined by a typical bean-shaped form and paired relationship, a gramnegativnost and intracellular situation. The causative agent of gonorrhea it is not always possible to find by this method because of its variability.
At diagnostics of asymptomatic forms of gonorrhea, and also at children and pregnant women, more suitable method is cultural (its accuracy of 90-100%). Use of selective environments (a blood agar) with addition of antibiotics allows to reveal precisely even a small amount of gonokokk and their sensitivity to medicines.
Material for a research on gonorrhea are purulent allocations from the tservikalny channel (at women), urethras, the lower department of a rectum, a rotoglotka, a conjunctiva of eyes. At girls and women after 60 years use only a cultural method.
Gonorrhea often proceeds in the form of the mixed infection. Therefore the patient with suspicion of gonorrhea, is examined in addition and on other STD. Carry out definition of antibodies to hepatitis B and C, to HIV, serological reactions to syphilis, the general and biochemical blood test and urine, ultrasonography of bodies of a small pelvis, an uretroskopiya, at women - a kolposkopiya, cytology mucous the tservikalny channel.
Examinations are conducted prior to treatment of gonorrhea, repeatedly in 7-10 days after treatment, serological – in 3-6-9 months.
The doctor solves need of use of "provocations" for diagnosis of gonorrhea in each case individually.
Treatment of gonorrhea
Unacceptably independent treatment of gonorrhea, it is dangerous by transition of a disease to a chronic form, and development of irreversible defeats of an organism. All sexual partners of patients with gonorrhea symptoms who had with them sexual contact for the last 14 days or the last sexual partner are subject to inspection and treatment if the contact happened before this term. In the absence of clinical symptoms at the patient with gonorrhea survey and treat all sexual partners for the last 2 months. For treatment of gonorrhea alcohol, the sexual relations is excluded, during dispensary observation sexual contacts with condom use are allowed.
The modern venereology is armed with the effective antibacterial medicines allowing to struggle successfully with gonorrhea. At treatment of gonorrhea the prescription of a disease, symptoms, the place of defeat, absence or existence of complications, the accompanying infection is considered. At the sharp ascending type of gonorrhea hospitalization, a bed rest, medical actions is necessary. In case of developing of purulent abscesses (a salpingit, a pelvioperitonit) carry out the emergency surgery – a laparoscopy or a laparotomy. The main place in treatment of gonorrhea is allocated to antibiotic treatment, at the same time resistance of some strains of gonokokk to antibiotics is considered (for example, to penicillin). At inefficiency of the applied antibiotic other medicine, taking into account sensitivity of the causative agent of gonorrhea to it is appointed.
Gonorrhea of urinogenital system treat the following antibiotics: , , tsefiksy, ciprofloxacin, . Alternative schemes of treatment of gonorrhea include application of an ofloksatsin, tsefozidim, kanamitsin (in the absence of diseases of organs of hearing), amoxicillin, a trimetoprim.
To children up to 14 years in treatment of gonorrhea ftorkhinolona are contraindicated, to pregnant women and nursing mothers of a tetratsiklina, ftorkhinolona, aminoglycosides. The antibiotics which are not influencing a fruit are appointed (, , erythromycin), carry out preventive treatment of newborns at mothers of patients with gonorrhea ( – intramuscularly, washing of eyes by solution of nitrate of silver or a mortgaging of eritromitsinovy eye ointment).
Treatment of gonorrhea can be corrected if there is a mixed infection. At torpedo, chronic and asymptomatic forms of gonorrhea the combination of the main treatment to an immunotherapy, local treatment and physiotherapy is important.
Local treatment of gonorrhea includes introduction to a vagina, an urethra of 1-2% of solution of a protorgol, 0,5% of solution of nitrate of silver, microenemas with camomile infusion. Physiotreatment (an electrophoresis, Ural federal district, UVCh currents, magnetotherapy, laser therapy) is applied in the absence of sharp inflammatory process. The immunotherapy at gonorrhea is appointed out of an aggravation for increase in level of immune reactions and shares on specific (gonovatsina) and nonspecific (pirogenat, an autogemoterapiya, , , methyluracil, to glitser, etc.). To children up to 3 years the immunotherapy is not carried out. After treatment antibiotics appoint lakto-and bifidopreparata (orally and intravaginalno).
Successful result of treatment of gonorrhea disappearance of symptoms of a disease and lack of the activator by results of laboratory analyses is considered (in 7-10 days after the end of treatment).
Now need of different types of provocations and numerous control inspections after the end of the treatment of gonorrhea which is carried out by modern highly effective antibacterial medicines is challenged. One control survey of the patient for definition of adequacy of this treatment of gonorrhea is recommended. Laboratory control is appointed if there are clinical symptoms, there are disease recurrence, perhaps repeated infection with gonorrhea.
Prevention of gonorrhea
Prevention of gonorrhea, as well as other STD, includes:
- personal prevention (exception of casual sexual communications, use of condoms, observance of rules of personal hygiene);
- timely identification and treatment of patients with gonorrhea, especially in risk groups;
- professional surveys (employees of child care facilities, medical personnel, workers have spheres of food);
- obligatory inspection of pregnant women and conducting pregnancy.
For the purpose of prevention of gonorrhea, the newborn right after the birth in eyes dig in solution of a sulfatsil of sodium.