Asymptomatic gonorrhea in women. Treatment of gonorrhea in women: basic and supportive therapy

Gonorrhea (gonorrhea) is a sexually transmitted disease that affects both men and women; its causative agent is gonococcus, a gram-negative diplococcus. There is no innate immunity to gonococcus and it cannot be acquired, any person can become infected with a dangerous infection many times, so it is so important to detect the disease in time and start treatment in a timely manner.

Causes of gonorrhea

Since the disease is highly contagious, with any type of intercourse, whether oral, anal or vaginal, there is a 99% chance that the infection will affect the partner. Moreover, women become infected much more often than men, this is due to the anatomical features of the genitourinary system. Sometimes there are cases of infection from a mother to a newborn child during childbirth or through household items - a towel, a washcloth, but this probability is negligible, since the bacterium quickly dies when it dries.

Usually, gonorrhea affects the mucous membranes of the urinary tract, intestines and even the nasopharynx, it all depends on what type of sexual intercourse the partners preferred. In some cases, the infection can go to the musculoskeletal system. Babies who get gonorrhea in the womb are born with blindness in 50% of cases.

Gonorrhea in women: symptoms

In most women infected with gonococcus, the disease is asymptomatic, which is especially dangerous. The manifestation of the disease directly depends on which organs were affected.

It is possible to identify gonorrhea that affected the urethra and thereby caused urethritis by the following signs:

pain during urination and sexual intercourse due to thinning of the vaginal mucosa;
cramps, itching and burning in the genital area;
yellow, greenish discharge mixed with blood and pus;
increasing frequency of urination;
constant feeling of fullness in the bladder.

The second area in terms of frequency of gonococcal lesions is the cervix. The disease cervicitis is almost painless, but often there is itching, burning and tickling in the vagina, as well as profuse discharge of whites. On examination, the doctor may suspect the development of the disease by the bright red color of the cervix.

In advanced cases, the infection rises higher, affecting the appendages and uterus. In this case, the patient may suffer from acute pain. The high temperature rises sharply, nausea, dizziness occur, intoxication of the whole organism occurs. Allocations are purulent in nature with an admixture of blood.

Gonorrhea of the rectum is called gonorrhea, it often has no symptoms, but sometimes patients complain of itching and burning in the anus, yellowish discharge mixed with blood, mild pain and false urge to defecate.

Gonococcal pharyngitis is a disease that can progress rapidly and affect the entire oral cavity. Its symptoms are similar to those of a sore throat - irritated throat, perspiration, swelling of the mucous membranes, inflammation of the lymph nodes, but with gonococcal pharyngitis, tonsils with a grayish coating are found.

Diagnosis of gonorrhea

Diagnosis of gonorrhea consists of several stages:

The history of the disease according to the patient (the estimated moment of infection, the number of unprotected connections).
The clinical picture of the disease.
Bacterioscopic and bacteriological examination (detection of infection in the secretions of the urethra, vagina, rectum, tonsils).
Since gonococci have the ability to adapt to adverse conditions, the bacterioscopic method of research is not always accurate. With hidden, asymptomatic forms of gonorrhea, a bacteriological examination is most often performed, and it is also more suitable for children.

The diagnosis of gonorrhea largely depends on the correct sampling of material for analysis and the qualifications of the doctor.

Stages and types of gonorrhea

For subsequent treatment to be successful, the doctor must determine the stage of the disease:

Medicines for gonorrhea

Treatment regimens for gonorrhea most often include treatment with tablets (Cefixime, Ciprofleksacin, Ofloxacin), and intramuscular injections (Ceftriaxone, Spectonomycin), it all depends on the form, stage and complications in the course of the disease.

If the infection occurred no more than two months ago and is in an acute stage, it is possible to eliminate the problem with the help of tablets alone, but it will be faster and more effective to cope with it with injections. Other stages of gonorrhea are treated only with antibiotics in the form of injections. In this case, the doctor also prescribes topical antiseptics and drugs that increase the patient's immunity.

It is worth remembering that any effective remedy for gonorrhea will first eliminate the symptoms, but you can’t stop there, you should continue the course of treatment until complete recovery, after which it is necessary to re-analyze for the presence of infection.

Treatment of gonorrhea in women

As soon as the examination showed the presence of a gonococcal infection, it is worth immediately starting a course of treatment according to the doctor's regimens. It is selected individually and depends on several factors - on what stage the disease is at the moment, what is the area of the lesion, whether there are complications and other accession.

The acute form of gonorrhea in women is treated with antibiotic therapy (antibiotics), usually these are drugs of the penicillin group (Oxacillin, Amoxicillin), and gonococcus is also sensitive to tetracycline and cephalosporin antibiotics.

In the event that resistance to penicillin is detected, a sensitivity test is performed and treatment with new generation antibiotics (Streptomycin, Levomycetin) is prescribed.

In addition, local therapy gives a good result - douching (Miramistin, manganese solution) and warm baths.

To increase the body's resistance to infections, immunostimulants and physiotherapy (electropheresis, laser therapy) are prescribed.

gonorrhea during pregnancy

Gonorrhea is also dangerous because it often proceeds without any signs, all the more often discomfort in the lower abdomen and perineum, discharge and slight discomfort, therefore, to accurately determine the diagnosis, it is necessary to conduct laboratory tests.

Possible consequences of infection of a pregnant woman:

there is a possibility that the child will be born prematurely;
the threat of miscarriage is great;
infection of the amniotic sac and amniotic fluid;
postpartum complications;
decreased immunity, and as a result, a greater likelihood of infection with HIV and other diseases of the genitourinary system.

In the womb or during childbirth, a child can become infected from an infected mother, quite often this leads to vision problems and even blindness. In especially severe cases, the consequence may be damage to other organs and sepsis.

Treatment of a pregnant woman is usually effectively carried out with antibiotics that do not have pregnancy on the list of contraindications. The partner also needs to drink a course of drugs so that the disease does not return again.

Consequences of gonorrhea

If gonorrhea is not treated in time, it will become chronic and cause the following consequences:

Untimely elimination of the disease will provoke the spread of infection to other organs and can cause miscarriage, endometritis, menstrual irregularities, miscarriages, female and male infertility, adhesive processes in the abdominal cavity, rupture of the fallopian tubes. In men, the prostate gland, urethra, testicular appendages, and testicles are affected.
The risk of contracting HIV and AIDS increases. A patient who has suffered from gonorrhea in the past has a reduced immune system and is susceptible to attack by serious diseases that are 100% likely to be transmitted to a sexual partner.
Complications in children often cause blindness, meningitis and abscesses.

Prevention of gonorrhea

Prevention of gonorrhea and other sexually transmitted diseases may be ineffective if a woman is at risk for the following factors:

constant change of partner;
the emergence of a new partner;
age from 18 to 30 years;
previously treated gonorrhea;
the presence of other STIs.

Methods for the primary prevention of gonorrhea include careful choice of a sexual partner, the presence of contraception, and the avoidance of promiscuity.

The method of secondary prevention and prevention is a drug therapy prescribed by a doctor in the first days after unprotected contact.

How does gonorrhea manifest in women and how is it treated?

Despite the fact that in recent years medicine has made great strides forward, such a sexually transmitted disease in women as gonorrhea remains relevant and continues to spread. This ailment does not always cause acute symptoms, it usually proceeds hidden, as a result of which it often has complications.

- an infectious disease, sexually transmitted. The causative agent of the infection is Neisseria gonorrhoeae (gonococcus), named after the researcher Neisser. From the Greek language, the word "gonorrhea" is translated as "the expiration of the seed."

Every year, WHO registers about 62 million people infected with gonorrhea.

Gonorrhea is most commonly transmitted sexual way, and infection is possible through any type of sexual contact (both traditional and anal, oral, and even petting).
Allowed but rare domestic route of infection. Infection is possible in case of non-compliance with the rules of hygiene, as well as the rules for using personal items (if shared towels, someone else's linen, a common bed for the child and parents, etc.) are used.
It is also possible to infect a newborn during the passage of the natural genital tract. In the external environment, gonococci are unstable, therefore they die under the influence of ultraviolet radiation and at temperatures above 55 degrees.

The causative agent is contagious (highly contagious), so the risk of getting a gonorrhea infection with a single sexual contact is about 70%. At the same time, gonorrhea is rarely the only disease; in 7-8 out of 10 cases, this disease is accompanied by chlamydia and / or Trichomonas.

Risk group:

women who are promiscuous in sexual relations;
women under 25;
the presence of an STI;
a history of sexually transmitted diseases;
neglect of condoms;
pregnant women.

Types of gonorrhea:

fresh gonorrhea- time of infection - no more than 2 months (subacute, acute);
chronic gonorrhea- duration of infection - more than 2 months (subacute, latent or latent and asymptomatic).

Gonococci have a tendency to spread, so they secrete fresh, chronic ascending gonorrhea (inflammation of the ovaries, endometrium of the uterus, pelvic peritoneum, fallopian tubes).

The duration of the incubation period ranges from 3 days - a week to 2-3 weeks. And, accordingly, the appearance of the first signs of the disease should be expected in 5 days. The lengthening or shortening of the incubation period depends on the protection of the organism.

If the immune system is weakened, the first symptoms will appear within 1-2 days(steroid treatment, recent infection, chemotherapy, etc.).

The late onset of gonorrhea is due to good immunity or taking antibiotics after infection due to other infections or as self-medication.

With gonorrhea, the disease manifests itself on the organs affected by the pathogen. And since during sex, gonococci enter the genital tract from the urethra, the cervix is the first to be attacked. In the future, with the development of infection, the appendages (tubes, ovaries), the uterine mucosa and sometimes the peritoneum are involved. The mucous membrane of the urethra and rectum is also involved in the process. Possible occurrence of gonorrheal pharyngitis (by oral contact).

After infection, discharge appears - this is the very first and classic symptom of the disease. As a rule, these are thick, white or yellow leucorrhea with an unpleasant odor. Often women take this as a manifestation of nonspecific colpitis or thrush and begin self-medication, which erases the clinical picture.

Also, gonorrhea has the following manifestations:

cervicitis- in addition to discharge, the patient is concerned about burning, itching or tickling in the perineum and in the vaginal area. On a gynecological examination, swelling of the cervix is noticeable, it acquires a bright scarlet hue. Leucorrhoea is discharged from the cervical canal with a yellow ribbon. These signs are evidence of gonorrheal cervicitis.
Inflammation of the uterus and appendages- with the spread of infection above, damage to the appendages and endometrium occurs. There are pains in the lower abdomen of a pulling or acute nature, purulent discharge with blood (damage to the uterine mucosa), an increase in body temperature to 38-39 degrees, intoxication occurs (malaise, weakness, loss of appetite, nausea, vomiting). In this case, salpingo-oophoritis and gonorrheal endometritis occur. With pelvic involvement and endocervicitis, a woman feels dyspareunia(pain during intercourse).
Urethritis, pyelonephritis, cystitis- Infection of the urethra causes gonorrheal urethritis, when women complain of painful and frequent urination. The urethra is hyperemic, edematous, its palpation is painful, there are false urges to urinate. When the infection ascends, the kidneys and bladder are involved in the process.
Proctitis. Manifestations of gonorrheal proctitis are burning and itching in the anus, false urges (tenesmus) and painful defecation. There is also a yellow discharge from the rectum, often with bloody streaks. Examination reveals pus in the folds of the anus and redness of the anus.
Pharyngitis- proceeds under the guise of a common sore throat. It is manifested by painful sensations in the throat and when swallowing, an increase in the submandibular lymph nodes, and an increase in temperature. However, most often gonorrheal pharyngitis is accompanied by mild symptoms (hoarseness, perspiration) or is asymptomatic. Hyperemic, edematous palatine tonsils with a yellowish-gray coating are found.

chronic gonorrhea

Gonorrhea in this form proceeds with erased, mild or completely invisible symptoms. Among the symptoms, only discharge can be noted, periodic pains in the lumbar region that radiate to the leg, aching pains in the lower abdomen.

Chronic inflammation of the uterus is characterized by menstrual irregularities. Intermenstrual bleeding is observed, and menstruation becomes more abundant and longer. Menstruation can provoke an exacerbation of infection (endometritis, cervicitis, adnexitis, urethritis).

Since gonococci prefer a cylindrical epithelium, they practically do not affect the vaginal mucosa, which is represented by a squamous epithelium. The only exceptions are girls and pregnant women with vulvovaginitis.

Complications

Gonorrhea is unpleasant both in its manifestations and in the high risk of complications:

infertility in women(defective endometrium, obstruction of the tubes);
bartholinitis(damage to the Bartholin glands);
decreased libido;
complication of pregnancy, postpartum period (intrauterine growth retardation, spontaneous abortion, high risk of ectopic pregnancy, early birth, premature rupture of amniotic fluid, postpartum septic diseases, antenatal death of the child, death of the child within a day after birth, chorionamnionitis);
child infection(blennorrhea, otitis, gonococcal sepsis, infection of the genital tract);
disseminated gonorrhea- entry into the blood of the pathogen and its dispersal throughout the body (skin hemorrhages, damage to the joints, brain, kidneys, liver, heart);
gonorrheal conjunctivitis(in case of non-compliance with hygiene).

Diagnostics

The diagnosis is confirmed after laboratory tests:

rapid tests(home diagnostics);
microscopy of smears taken from the vagina, cervical canal, rectum and urethra;
cultural method(sowing on a nutrient medium separated from the cervix and urethra);
REEF- immune fluorescence reaction (staining of a smear with dyes);
ELISA- enzyme immunoassay (urinalysis);
RSK- compliment binding reaction (serological method, venous blood is being studied, the method is very useful in diagnosing gonorrhea in a chronic form);
PCR- polymerase chain reaction (urine and smears are examined).

Provocation methods are used in the diagnosis of latent and chronic gonorrhea, when the pathogen is not detected in conventional tests. Provocation methods:

chemical(the urethra is lubricated with a 1-2% solution of silver nitrate, the cervical canal is lubricated with a 2-5% solution);
alimentary(consumption of spicy, salty foods or alcohol);
thermal(diathermy is performed for 3 days - smears are taken three times, one hour after the physiotherapy);
biological(pyrogenal and / or gonococcal vaccine is injected into the muscle);
physiological(smears are analyzed during menstruation).

Usually combine at least 2 methods. Swabs are taken at 24, 48 and 72 hours.

gonorrhea during pregnancy

The course of the disease during pregnancy largely depends on the timing of infection. If infection occurred before pregnancy, the disease in most patients is erased, and only a third of sick pregnant women complain. Having chronic gonorrhea increases the risk of infertility and ectopic pregnancy.

For pregnant women, the disease is characterized by inflammation of the vagina, which is atypical without pregnancy. This is due to hormonal changes in the vaginal mucosa. Usually patients have complaints of profuse discharge, burning, itching. The symptoms are very similar to the symptoms of thrush, but the remedies "for thrush" are completely ineffective.

Gonococcus itself does not cause the development of malformations in the fetus, but its presence at the same time as pregnancy is dangerous. If infection occurred in the first half of pregnancy, inflammation of the uterine mucosa is observed, which may cause a miscarriage.
When infected in the second half, gonococci are not able to enter the uterus, it is protected by membranes of the fetal bladder, so that abortion usually does not occur, but placental insufficiency may develop, which can lead to a lack of nutrients and oxygen.

Intrauterine infection is also possible, manifested by chorioamnionitis and nococcal sepsis. Chorioamnionitis is accompanied by increased heart rate, elevated body temperature, and a change in the general blood test. There may be no other signs. In the case of chorioamnionitis, preterm labor often occurs, which begins with the passage of water.

Infection of the child is possible during childbirth, which can cause damage to his eyes. Girls may develop genital gonorrhea.

In Russia, for prevention, all children immediately after birth are wiped with sterile cotton wool, and a 20% solution of sodium sulfacyl is also instilled; after two hours this procedure is repeated. In addition, the genitals are treated in the same way for girls.

In women with gonorrhea, inflammation of the uterus occurs after childbirth.

Treatment

Treatment of gonorrhea in women consists of a course of antibiotic therapy. Such treatment is necessary for both sexual partners, during the period of treatment they are prescribed abstinence from sexual intercourse and a ban on the use of alcohol. Of the antibiotics, preference is given to drugs of the cephalosporin, penicillin, fluoroquinolone series.

The easiest way to treat fresh gonorrhea of the lower genitalia. The course of therapy is limited to a single administration or administration of an antibiotic:

Sumamed 2 g (its analogues are Azitrox, Zi-factor, Hemomycin, Ecomed, Azitsid);
Cefixime 0.4 g or Ciprofloxacin 0.5 g - taken orally;
Ceftriaxone 0.25 g or Gentamicin 2.0 g - intramuscularly.

Acute ascending gonorrhea is treated with the following drugs:

Ceftriaxone 1 g intramuscularly - once a day, course duration - one week, Ciprofloxacin 500 mg intravenously - twice a day, course duration - one week, Ofloxacin 0.4 g - twice a day, course duration - one week.
It is possible to use other antibiotics (Clindamycin, Tetracycline, Rifampicin, Josamycin, Bicillin, Ofloxacin, etc.).
Treatment of the chronic form of gonorrhea is supplemented with gonococcal vaccine (Levamisole, Pyrogenal, Methyluracil, Prodigiosan) and immunity stimulants.
Autohemotherapy effectively activates the body's defenses.

Since gonorrhea is often accompanied by chlamydia and / or trichomoniasis, Doxycycline (for a course of 10 days) and Metronidazole (a course of 5-7 days) are included in the course of treatment. Local treatment - washing the urethra with a 0.5% solution of silver nitrate, as well as douching the vagina with a decoction of chamomile, solutions of manganese, Protargol, Miramistin, Chlorhexidine.

In recent years, the number of cases of pathogen resistance to certain antibiotics has been increasing. For example, Sally Davies, chief expert of the UK health system, stated that back in 2013, in 80% of clinical cases, the pathogen was resistant to tetracyclines.

For this reason, experts suggest using new treatment methods, using two drug- Gentamicin (injections) + Azithromycin (orally) or another combination of drugs - Azithromycin + Gemifloxacin - orally.

If complications occur, surgery is required.

Acute bartholinitis is opened, and the wound is washed and drained.

In the case of acute pelvioperitonitis, as well as the absence of positive dynamics during the day, a laparotomy is performed, appendages are removed, and the abdominal cavity is washed.

Prevention

In the case of unprotected intercourse, the likelihood of infection is reduced after the following measures are taken:

immediately after sex, you should urinate, preferably several times (as a result, urine will wash out pathogenic bacteria from the urethra);
the genitals and thighs should be washed with soap;
within 2 hours after intercourse, 1-2 ml should be injected into the urethra, up to 5 ml of Betadine or Miramistin solution into the vagina;
treat the surfaces of the thighs and the skin of the perineum with an antiseptic - a weak solution of potassium permanganate, Miramistin or Chlorhexidine solution. If there is no Betadine or Miramistin, you can douche with potassium permanganate (weakly diluted).

Miramistin reduces the risk of infection with trichomoniasis, gonorrhea, syphilis and genital herpes by 90%.

Not later than 2 days after unprotected sex, you should contact a specialist (the doctor will prescribe a scheme for the prevention of sexually transmitted diseases). After 2 weeks, it is recommended to take a smear for gonorrhea and other urogenital infections using the PCR method.

It should also be noted that an effective scheme has been developed that allows you to fight the spread of the disease.

This prevention scheme includes the following provisions:

Identification of infected people for subsequent treatment, and examination of persons who are constantly in contact with patients is also carried out.
Periodic examination and registration of patients with venereal infectious diseases.
Identification of sick people in risk groups, which include drug addicts, prostitutes, homosexuals, homeless people.
The use of generally accepted methods of treatment of gonorrhea in order to increase the effectiveness of the relief of the disease.
Informing the population, as well as holding events that are aimed at promoting the rejection of promiscuous sexual contacts and compliance with sanitary and hygienic rules.

Healing control

After completion of the course of therapy, a three-time follow-up examination of the patient after the provocation is required (usually this is the use of spicy foods and alcohol on the eve of the analysis).

Gonorrhea is transmitted exclusively through sexual contact. Outside the body, bacteria quickly die, and a certain amount of them is necessary for infection. The causative agent of the disease is gonococcus. The main areas that the disease affects are the rectum, cervix, urethra, pharynx and eyes. If infection occurs during pregnancy, it causes serious health problems for the newborn. Symptoms of gonorrhea in girls are similar to other sexually transmitted infections, but have their own nuances. The diagnosis is fixed on the basis of tests.

The first signs of infection in women

A feature of the manifestation of gonorrhea in women is the likelihood of asymptomatic development of the disease. Some signs are initially misdiagnosed by patients. The disease is accompanied by white-yellow discharge from the vagina, which is almost identical to thrush. Pain in the urethra is similar to cystitis. Treating the disease based on symptoms is not successful. To properly get rid of gonorrhea, you need to undergo a course of examination and pass tests.

The incubation period of gonorrhea is from 5 to 10 days, depending on individual factors. Some women learn about the disease unexpectedly. The disease develops almost asymptomatically. Signs of gonorrhea in women are manifested by frequent urination, slight discomfort in the genitals. The first symptomatology is expressed in those parts of the body through which the gonococcus entered the body. Often, the signal of the disease is general weakness, hand tremor, fever.

gonorrhea symptoms

Of particular importance is the method of contact with an infected man. If a normal sexual intercourse was performed, then the gonococcus enters the vagina and uterus. In other forms of sexual intercourse, it enters the body through the duodenum or pharynx. There are common symptoms of gonorrhea in women and specific to a specific individual situation. The second group includes watery eyes, sore throat, frequent urge to urinate, inflammation of the rectum.

Symptoms of gonorrhea in women are:

cloudy or white-yellow discharge from the vagina;
sharp sore throat (reminiscent of a cold, but not accompanied by additional symptoms);
bleeding between menstrual cycles;
pain in the lower abdomen;
difficult, painful urination.

acute form

Symptoms of gonococcal infection appear a few days after contact or remain unnoticed for a long time. In the acute form of the disease, the symptoms are always pronounced. A woman notices the first signs in 10-14 days. The labia turns red, itching and pain are felt during urination, an abundant cloudy yellow mass is released from the vagina. The patient has frequent headache, general weakness and apathy.

Chronic

Gonorrhea may develop asymptomatically and not manifest itself for several months. Such signs are characteristic of the chronic form of the disease. The danger of the disease increases due to the risk of developing additional complications. A woman learns about the fact of infection with gonorrhea during the diagnosis of infertility, the detection of scars on the fallopian tubes or other abnormalities in the body.

Diagnostic methods

The fact of infection with gonococcus is confirmed by laboratory tests. A visual examination or patient complaints is not enough to accurately establish the fact of a sexually transmitted disease. The doctor prescribes a series of procedures that a woman needs to undergo. Mandatory among them are crops, blood and urine tests, and a general smear. Diagnosis is carried out according to the results of the following procedures and tests:

a smear on the flora (vaginal discharge, cervix, urethra are examined, an inflammatory process is established);
enzyme immunoassay and direct immunofluorescence (discharges from the urethra, vagina, cervix are examined for the presence of pathogen antigens);
DNA diagnostics (in addition, urine is examined with secretions);
sowing (for research, discharge from the vagina, urethra, pharynx is taken);
detection of antibodies in the blood (the material for analysis is blood).

Blood and urine are considered the best indicators of inflammation in the body. In the process of development of sexually transmitted diseases, the number of leukocytes changes. Based on a comprehensive examination and complaints of the patient, the doctor diagnoses the presence or absence of gonorrhea. If infection is detected, then the disease is treated in several stages. Preparations are selected in accordance with the form of the disease and the characteristics of the woman's body.

Video about the symptoms and treatment of gonorrhea in women

For information on how to identify gonococci, the symptoms of gonorrhea in women, what they are and how to deal with them, see the video below. Experts provide answers to the most frequently asked questions and explain in detail some important nuances using photos and layouts. After watching the video, even a person who is not very knowledgeable in matters of medicine will have no doubts when signs of a sexually transmitted disease appear.

How does gonorrhea manifest in women and how is it treated?

Every year, WHO registers about 62 million people infected with gonorrhea.

Gonorrhea is most commonly transmitted sexual way, and infection is possible through any type of sexual contact (both traditional and anal, oral, and even petting).
Allowed but rare domestic route of infection. Infection is possible in case of non-compliance with the rules of hygiene, as well as the rules for using personal items (if shared towels, someone else's linen, a common bed for the child and parents, etc.) are used.
It is also possible to infect a newborn during the passage of the natural genital tract. In the external environment, gonococci are unstable, therefore they die under the influence of ultraviolet radiation and at temperatures above 55 degrees.

Risk group:

women who are promiscuous in sexual relations;
women under 25;
the presence of an STI;
a history of sexually transmitted diseases;
neglect of condoms;
pregnant women.

Types of gonorrhea:

fresh gonorrhea- time of infection - no more than 2 months (subacute, acute);
chronic gonorrhea- duration of infection - more than 2 months (subacute, latent or latent and asymptomatic).

Gonococci have a tendency to spread, so they secrete fresh, chronic ascending gonorrhea (inflammation of the ovaries, endometrium of the uterus, pelvic peritoneum, fallopian tubes).

If the immune system is weakened, the first symptoms will appear within 1-2 days(steroid treatment, recent infection, chemotherapy, etc.).

The late onset of gonorrhea is due to good immunity or taking antibiotics after infection due to other infections or as self-medication.

With gonorrhea, the disease manifests itself on the organs affected by the pathogen. And since during sex, gonococci enter the genital tract from the urethra, the cervix is the first to be attacked. In the future, with the development of infection, the appendages (tubes, ovaries), the uterine mucosa and sometimes the peritoneum are involved. The mucous membrane of the urethra and rectum is also involved in the process. Possible occurrence of gonorrheal pharyngitis (by oral contact).

Also, gonorrhea has the following manifestations:

cervicitis- in addition to discharge, the patient is concerned about burning, itching or tickling in the perineum and in the vaginal area. On a gynecological examination, swelling of the cervix is noticeable, it acquires a bright scarlet hue. Leucorrhoea is discharged from the cervical canal with a yellow ribbon. These signs are evidence of gonorrheal cervicitis.
Inflammation of the uterus and appendages- with the spread of infection above, damage to the appendages and endometrium occurs. There are pains in the lower abdomen of a pulling or acute nature, purulent discharge with blood (damage to the uterine mucosa), an increase in body temperature to 38-39 degrees, intoxication occurs (malaise, weakness, loss of appetite, nausea, vomiting). In this case, salpingo-oophoritis and gonorrheal endometritis occur. With pelvic involvement and endocervicitis, a woman feels dyspareunia(pain during intercourse).
Urethritis, pyelonephritis, cystitis- Infection of the urethra causes gonorrheal urethritis, when women complain of painful and frequent urination. The urethra is hyperemic, edematous, its palpation is painful, there are false urges to urinate. When the infection ascends, the kidneys and bladder are involved in the process.
Proctitis. Manifestations of gonorrheal proctitis are burning and itching in the anus, false urges (tenesmus) and painful defecation. There is also a yellow discharge from the rectum, often with bloody streaks. Examination reveals pus in the folds of the anus and redness of the anus.
Pharyngitis- proceeds under the guise of a common sore throat. It is manifested by painful sensations in the throat and when swallowing, an increase in the submandibular lymph nodes, and an increase in temperature. However, most often gonorrheal pharyngitis is accompanied by mild symptoms (hoarseness, perspiration) or is asymptomatic. Hyperemic, edematous palatine tonsils with a yellowish-gray coating are found.

chronic gonorrhea

Chronic inflammation of the uterus is characterized by menstrual irregularities. Intermenstrual bleeding is observed, and menstruation becomes more abundant and longer. Menstruation can provoke an exacerbation of infection (endometritis, cervicitis, adnexitis, urethritis).

Complications

Gonorrhea is unpleasant both in its manifestations and in the high risk of complications:

infertility in women(defective endometrium, obstruction of the tubes);
bartholinitis(damage to the Bartholin glands);
decreased libido;
complication of pregnancy, postpartum period (intrauterine growth retardation, spontaneous abortion, high risk of ectopic pregnancy, early birth, premature rupture of amniotic fluid, postpartum septic diseases, antenatal death of the child, death of the child within a day after birth, chorionamnionitis);
child infection(blennorrhea, otitis, gonococcal sepsis, infection of the genital tract);
disseminated gonorrhea- entry into the blood of the pathogen and its dispersal throughout the body (skin hemorrhages, damage to the joints, brain, kidneys, liver, heart);
gonorrheal conjunctivitis(in case of non-compliance with hygiene).

Diagnostics

The diagnosis is confirmed after laboratory tests:

rapid tests(home diagnostics);
microscopy of smears taken from the vagina, cervical canal, rectum and urethra;
cultural method(sowing on a nutrient medium separated from the cervix and urethra);
REEF- immune fluorescence reaction (staining of a smear with dyes);
ELISA- enzyme immunoassay (urinalysis);
RSK- compliment binding reaction (serological method, venous blood is being studied, the method is very useful in diagnosing gonorrhea in a chronic form);
PCR- polymerase chain reaction (urine and smears are examined).

Provocation methods are used in the diagnosis of latent and chronic gonorrhea, when the pathogen is not detected in conventional tests. Provocation methods:

chemical(the urethra is lubricated with a 1-2% solution of silver nitrate, the cervical canal is lubricated with a 2-5% solution);
alimentary(consumption of spicy, salty foods or alcohol);
thermal(diathermy is performed for 3 days - smears are taken three times, one hour after the physiotherapy);
biological(pyrogenal and / or gonococcal vaccine is injected into the muscle);
physiological(smears are analyzed during menstruation).

Usually combine at least 2 methods. Swabs are taken at 24, 48 and 72 hours.

gonorrhea during pregnancy

Gonococcus itself does not cause the development of malformations in the fetus, but its presence at the same time as pregnancy is dangerous. If infection occurred in the first half of pregnancy, inflammation of the uterine mucosa is observed, which may cause a miscarriage.
When infected in the second half, gonococci are not able to enter the uterus, it is protected by membranes of the fetal bladder, so that abortion usually does not occur, but placental insufficiency may develop, which can lead to a lack of nutrients and oxygen.

Infection of the child is possible during childbirth, which can cause damage to his eyes. Girls may develop genital gonorrhea.

In Russia, for prevention, all children immediately after birth are wiped with sterile cotton wool, and a 20% solution of sodium sulfacyl is also instilled; after two hours this procedure is repeated. In addition, the genitals are treated in the same way for girls.

In women with gonorrhea, inflammation of the uterus occurs after childbirth.

Treatment

The easiest way to treat fresh gonorrhea of the lower genitalia. The course of therapy is limited to a single administration or administration of an antibiotic:

Sumamed 2 g (its analogues are Azitrox, Zi-factor, Hemomycin, Ecomed, Azitsid);
Cefixime 0.4 g or Ciprofloxacin 0.5 g - taken orally;
Ceftriaxone 0.25 g or Gentamicin 2.0 g - intramuscularly.

Acute ascending gonorrhea is treated with the following drugs:

Ceftriaxone 1 g intramuscularly - once a day, course duration - one week, Ciprofloxacin 500 mg intravenously - twice a day, course duration - one week, Ofloxacin 0.4 g - twice a day, course duration - one week.
It is possible to use other antibiotics (Clindamycin, Tetracycline, Rifampicin, Josamycin, Bicillin, Ofloxacin, etc.).
Treatment of the chronic form of gonorrhea is supplemented with gonococcal vaccine (Levamisole, Pyrogenal, Methyluracil, Prodigiosan) and immunity stimulants.
Autohemotherapy effectively activates the body's defenses.

In recent years, the number of cases of pathogen resistance to certain antibiotics has been increasing. For example, Sally Davies, chief expert of the UK health system, stated that back in 2013, in 80% of clinical cases, the pathogen was resistant to tetracyclines.

If complications occur, surgery is required.

Acute bartholinitis is opened, and the wound is washed and drained.

In the case of acute pelvioperitonitis, as well as the absence of positive dynamics during the day, a laparotomy is performed, appendages are removed, and the abdominal cavity is washed.

Prevention

In the case of unprotected intercourse, the likelihood of infection is reduced after the following measures are taken:

immediately after sex, you should urinate, preferably several times (as a result, urine will wash out pathogenic bacteria from the urethra);
the genitals and thighs should be washed with soap;
within 2 hours after intercourse, 1-2 ml should be injected into the urethra, up to 5 ml of Betadine or Miramistin solution into the vagina;
treat the surfaces of the thighs and the skin of the perineum with an antiseptic - a weak solution of potassium permanganate, Miramistin or Chlorhexidine solution. If there is no Betadine or Miramistin, you can douche with potassium permanganate (weakly diluted).

Miramistin reduces the risk of infection with trichomoniasis, gonorrhea, syphilis and genital herpes by 90%.

Not later than 2 days after unprotected sex, you should contact a specialist (the doctor will prescribe a scheme for the prevention of sexually transmitted diseases). After 2 weeks, it is recommended to take a smear for gonorrhea and other urogenital infections using the PCR method.

It should also be noted that an effective scheme has been developed that allows you to fight the spread of the disease.

This prevention scheme includes the following provisions:

Identification of infected people for subsequent treatment, and examination of persons who are constantly in contact with patients is also carried out.
Periodic examination and registration of patients with venereal infectious diseases.
Identification of sick people in risk groups, which include drug addicts, prostitutes, homosexuals, homeless people.
The use of generally accepted methods of treatment of gonorrhea in order to increase the effectiveness of the relief of the disease.
Informing the population, as well as holding events that are aimed at promoting the rejection of promiscuous sexual contacts and compliance with sanitary and hygienic rules.

Healing control

Bacteria are microorganisms (mainly unicellular), the main feature of which is the absence of a nucleus placed in a cell membrane. The human microflora can include up to 10,000 different bacteria living on the mucous membranes of the digestive tract, nasopharynx, genital organs, urinary canal and other organs. Microorganisms can be useful, without which the normal activity of the body is impossible (for example, lactobacilli, which normalize the acidity of the vagina and ensure healthy bowel function), and opportunistic pathogens.

Opportunistic microorganisms are varieties of gram-positive and gram-negative bacteria that can normally inhabit the mucous membranes of the internal organs of a person, but they are in a "sleeping" state and do not harm health. When exposed to negative factors, these bacteria begin to rapidly divide and multiply, provoking an inflammatory process. One of these microorganisms is gonococcus, a gram-negative bacterium that causes gonorrhea. Gonorrhea is more common in women, can cause severe consequences up to infertility, so it is important to know its symptoms and start treatment in a timely manner.

Gonorrhea (popular name - gonorrhea) refers to sexually transmitted infections, since the main route of transmission of the pathogen to a healthy person is sexual. Despite this, gonococcus can be found in the biological material of the rectum, since it is located in close proximity to the inguinal zone, as well as the ocular conjunctiva. With unprotected oral contact with an infected partner or carrier of infection, Neisseria gonorrhoeae (the Latin name of the pathogen) can be sown in the discharge from the pharynx and oropharynx. When prescribing treatment and selecting therapeutic tactics, it is necessary to study biological material, since Neisseria diplococcus has more than 20 species, some of which may be insensitive to traditional bacterial preparations.

Gonorrhea is the combined name of an infection that can cause various diseases of the urogenital tract, bladder and other organs of the genitourinary system. The most common pathologies in women caused by bacteria of the gonococcal group are urethritis and salpingitis (inflammation of the fallopian tubes). With damage to the rectum, which is often the result of poor intimate hygiene, proctitis develops. Other conditions that can complicate gonorrhea are listed in the table below.

Diseases due to infection with gonococci in women

Name of the pathology	Image	What it is?
		Inflammation of the pharynx with damage to the lymphoid structures
		Purulent inflammation of the eye conjunctiva, which is most often provoked by bacteria of the Neisseria group
		Inflammatory process occurring in the vaginal part of the cervix and cervical canal
		Damage to the articular tissue (occurs quite rarely - less than 3.8%)

Note! In the vast majority of cases, the localization of the pathological process is the mucous membranes of the genital organs, urethra, bladder. If the disease is not treated in time, the infection will rise further, and the uterine appendages and cervix will be involved in the inflammatory process. In nulliparous women with prolonged gonorrhea, the risk of miscarriages and complications during a future pregnancy is several times higher compared to patients who received timely therapy.

Symptoms of gonorrhea in women

Almost half of the patients do not notice any symptoms of infection, so such patients receive treatment already at an advanced stage, when the likelihood of the disease becoming chronic is high. The first clinical manifestations in most women occur 3-4 days after infection, but sometimes the incubation period can be delayed by 7-10 days. The initial symptoms of gonorrhea in women with strong immunity may be lack of appetite, irritability, weakness, decreased performance. Many patients report frequent headaches, but even in the aggregate such manifestations cannot be considered signs of gonorrhea until the specific symptoms listed below appear.

Temperature rise and fever

The temperature in gonorrhea always rises rapidly and reaches high levels (up to 38.5 ° -39 °). This usually occurs on the 6-7th day of the disease, but in some women the temperature remains within the normal range or rises slightly, remaining at the lower border of subfebrile indicators. High temperature is often combined with febrile and intoxication syndrome, which is characterized by the following symptoms:

increased sweating;
chills at normal temperature indoors and outdoors;
compression in the temporal and occipital zone (some women may describe these sensations as squeezing or bursting);
headache;
lack of appetite;
drowsiness.

Note! The absence of temperature in gonorrhea is the norm for women with good physical health indicators, so this symptom should not be considered as a misdiagnosis or raise doubts about the correctness of the prescribed treatment.

Purulent discharge from the genital tract

This is one of the main symptoms of gonococcal infection. The discharge may look like thick yellow-green mucus or mucous lumps of brown and dark yellow. The amount of discharge can be moderate or large: if the daily amount of pus released from the vagina exceeds a tablespoon, the woman needs specific therapy with the use of potent antibacterial drugs (in some cases, hospitalization may be required).

Other signs of gonorrhea that appear simultaneously with purulent discharge and allow you to recognize the disease at an early stage are:

an unpleasant smell of the genitals and vaginal discharge (may resemble the smell of a rotten egg or spoiled fish);
itching in the intimate area, anorectal space, vaginal tract;
redness of the skin in the genital area.

During intimacy, a woman may experience discomfort and pain caused by dryness of the vaginal walls. Lactobacilli are responsible for the production of vaginal secretions and the normal functioning of the vaginal glands, which are destroyed during the reproduction of pathogenic flora, therefore, in an infected woman, vaginal lubrication ceases to be produced or is formed in an insufficient amount for a full-fledged sexual intercourse.

Painful urination

Pain during emptying of the bladder is almost always very strong, can occur both at the beginning of the process and after its completion. Most often, women describe the pain syndrome as cramps or sharp stabbing pains, but some patients complained of intense dull pain in the lower part of the urethra. Urine in women with gonorrhea may also change: purulent mucous or blood streaks may appear in it, or a sediment in the form of cloudy yellow or milky flakes.

The urge to urinate becomes frequent, the number of "false" urges to empty the bladder increases. With a prolonged course, inflammation of the Bartholin glands located at the entrance to the vaginal tract is possible, as well as an increase in the lymph nodes of the inguinal zone.

Important! In some women, gonorrhea may present with genital eczema. This is a skin disease, a type of dermatitis, caused by constant contact of the skin and mucous membranes with purulent vaginal contents. To avoid the appearance of eczema, it is important to carefully monitor the hygiene of the genital organs during the entire period of treatment and use local antiseptics in the form of vaginal capsules, suppositories, solutions or tablets for the sanitation of the intimate area.

Video - Signs of gonorrhea

Treatment of gonorrhea in women: basic and supportive therapy

The basis of the treatment of gonorrhea (gonorrhea) in patients of any gender is the use of antibacterial drugs. The most prescribed medicine for this pathology is " Ceftriaxone". It is a potent antibiotic from the cephalosporin group, active against almost all varieties of Neisseria gonorrhoeae. It must be injected deep into the muscle at a dosage of 255 mg 1 time per day.

Despite the high efficacy of Ceftriaxone, it is not recommended to use it as a monotherapy due to the rapidly developing resistance of gonococci to various antibacterial components. In order to prevent the transition of the disease into a chronic form, which is difficult to respond to standard treatment regimens, treatment with "Ceftriaxone" should be supplemented with " Doxycycline"- an antibiotic of the tetracycline group. It should be taken within a week 2 times a day at a dosage of 100 mg.

With an uncomplicated course of infection, "Doxycycline" can be replaced with drugs from the macrolide group. It can be:

"Azithromycin";
"Hemomycin";
"Azitrox";
"Sumamed";
"Zitrolide".

Note! These drugs are taken, as a rule, once at a dosage of 1 g (unless a different regimen is prescribed by the doctor).

Video - How to treat gonorrhea

Additional Treatment

If a woman has chronic or recurrent gonorrhea, antibiotics are combined with a broad-spectrum antimicrobial agent. The release form is determined by the localization of the pathological process. If the pharynx, organs of vision or intestines are affected, the doctor may prescribe oral administration " Metronidazole» 1 tablet 2-3 times a day for 10 days. If the pathogen is sown only in the genitourinary system, topical preparations are selected, for example, vaginal tablets " Trichopolum". Before use, they must be held a little under running cold water, and then inserted deep into the vagina for 20-30 minutes. You need to use "Trichopol" 1 time per day for a week (with complicated gonorrhea - within 10 days).

If a woman has a history of vaginal candidiasis (thrush), the doctor will prescribe a prophylactic administration of antimycotic agents: Miconazole», « Fluconazole», « Pimafucin". If necessary, treatment can also be prescribed to the woman's partner if sexual intercourse took place without the use of contraceptives.

Drugs that may also be included in the treatment regimen for gonorrhea in women are listed below.

Drug group

What are they assigned for?

What to apply?

acidophilus bacteria, probiotics, prebiotics, bifidobacteria

Restoration of the optimal balance of intestinal and vaginal microflora, prevention of bacterial vaginosis, normalization of the acidic environment of the vagina, strengthening of local immunity

"Acipol"

"Normobact"

"Yogulakt"

"Lineks"

"Acilact" (vaginal suppositories)

"Bifiform"

Bifidumbacterin (vaginal suppositories and capsules)

Antiseptics in the form of solutions for topical use

Disinfection of the genitals and vagina, destruction of pathogenic bacteria

"Hexicon"

"Furacilin" (ready solution)

Antibacterial and antifungal drugs of local action in the form of vaginal suppositories and tablets

Sanitation of the urogenital tract and organs of the genitourinary system

"Pimafucin"

"Terzhinan"

"Vagisept"

Important! If necessary, the doctor can adjust the above scheme. It is impossible to take any antibiotics without the appointment of a specialist. This also applies to cases of prophylactic administration of antibacterial drugs after contact with the alleged carrier of the infection. Frequent use of drugs of this group is dangerous for the development of resistance of bacterial strains to the active substance and the transition of the infection to a chronic form.

To speed up recovery and ensure the prevention of gonorrhea in the future, you should follow the recommendations of the doctors below.

To protect against pathogenic bacteria, you must always use a condom if you are not completely sure of the partner's health. It is better to choose latex products, since natural membrane condoms have the lowest reliability rate - no more than 87%.
If gonococcus is detected in at least one partner, everyone who has been in contact with an infected person in the last month should undergo treatment.
The probability of infection by household means is very small, but for prevention it is better to boil linen and dishes used by a sick person.

Sexual contacts for the entire period of treatment must be completely excluded - this will help maintain the health of others and avoid the re-introduction of pathogenic bacteria into the genital tract.