Clinic and methods of treatment of gonococcal infection in men and women. What is gonococcal infection?

• Which doctors should you contact if you have Gonococcal infection (gonorrhea)

What is Gonococcal infection (gonorrhea)

Gonococcal infection (gonorrhea) Gonorrhoea, Gonococcal Infection is an infectious disease caused by Neisseria gonorrhoeae, sexually transmitted with a predominant lesion of the human genitourinary system.

Over the past 20 years, the number of identified cases of gonococcal infection has decreased significantly, but about 62 million people around the world still get this infection every year. Gonococcal infection is most dangerous for young women under the age of 25 due to the rapid development of pelvic inflammatory diseases and infertility in them. Every year in the United States alone, up to 4 fatal cases are recorded due to gonococcal sepsis in patients.

Gonococcal infection still remains the second most important and widespread sexual infection after chlamydia.

What causes gonococcal infection (gonorrhea)

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 using a condom.

Infection with gonorrhea occurs through all kinds of forms of sexual intercourse: during normal sexual intercourse, during oral-genital intercourse, during anal intercourse, and simply through contact of the genitals, without insertion of the penis into the vagina.

In some cases, infection through household means is possible, for example, through household items: bed linen, underwear, washcloth, towel, etc. This route of infection is mainly characteristic of the female half of the population and especially girls.

A child can become infected from a mother suffering from gonorrhea when passing through the birth canal. At the same time, the mucous membrane of the eyes is affected, and in newborn girls, the genitals are also affected. 60% of blindness in newborns is caused by gonorrhea.

Symptoms of Gonococcal infection (gonorrhea)

Incubation period of gonorrhea may 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. The incubation period usually ranges from 2 to 7 days, although it can be longer. The main symptoms are urethral discharge and dysuria. The discharge may initially be scanty and mucous, but after a day or two it becomes profuse 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.

Manifestations of gonorrhea in women are much more varied, they include:
1. Gonococcal cervicitis.
Mucopurulent cervicitis, which is a very common sexually transmitted disease in women, is caused not only by gonococci, but also by chlamydia and some other organisms.

The main symptoms of gonorrhea infection in women are vaginal discharge and dysuria. These symptoms appear within ten days and pass more acutely and intensely than with cervicitis caused by chlamydia. In addition, complications may appear - pain in the side or lower abdomen.

Ascending infection, that is, the movement of bacteria up the reproductive tract, occurs in 20% of cases. It leads to acute endometritis, which is accompanied by abnormal menstrual bleeding, and if the infection penetrates the fallopian tubes, the result can be salpingitis. The most devastating consequence of salpingitis is scarring of the tubes, leading to infertility. In addition, the risk of ectopic pregnancy increases, when the fetus begins to develop in an abnormal location.

2. Gonococcal vaginitis.
When the first signs of gonococcal vaginitis appear, any examination turns into an extremely painful procedure. The vaginal mucosa becomes red and swollen, and profuse purulent discharge begins.

3. Anorectal gonorrhea.
Due to the anatomical features of the structure of the female body, the infection can spread to the rectal area. Basically, these cases are associated with the development of cervicitis, and variants when the rectum is the only place affected by the microorganism are extremely rare.

4. Gonorrhea in pregnant women, newborns and children.
Gonococcal infection during pregnancy can cause serious problems for both mother and child. Therefore, it is so important to identify and neutralize the infection as early as possible. Pharyngeal infection, often asymptomatic, is the most common occurrence in pregnancy. Acquiring an infection in late pregnancy can negatively affect childbirth and the condition of the child. Prolonged membrane ruptures, premature birth, chorioamniotitis and sepsis in the newborn are the most common complications of maternal gonococcal infection. The risk to the fetus includes the possibility of spontaneous abortion, intrauterine death, and premature birth.

The most common form of gonorrhea in newborns is ophthalmia neonatorum, which occurs as a result of the child passing through the birth canal and contact with infected secretions. Therefore, this infection should be immediately excluded in case of any eye damage in a child. This is exactly the case when additional precautions are not superfluous.

Up to 70% women with gonorrhea disease do not feel any unpleasant sensations. In both women and men, advanced gonorrhea causes changes in the genital organs, often leading to infertility and other complications, and also affects other organs: kidneys, heart, liver, brain, skin, bones, muscles, joints and can cause blood poisoning .

Consequences of gonorrhea
When gonococci enter the human body, they infect the mucous membranes of the urethra, cervix and anus, causing purulent inflammation. Untreated infection can be ascending and spread into the uterus, fallopian tubes and pelvic cavity in women, 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 eyes (gonorrheal conjunctivitis) are also possible. Very rarely, serious complications such as the spread of infection through the bloodstream and damage to the heart, joints or brain are observed. If 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.

Diagnosis of gonococcal infection (gonorrhea)

Even if the described symptoms of gonorrhea are present, diagnosing the disease and making an accurate diagnosis is only possible in the laboratory. Usually a smear is taken from the urogenital tract and examined for the presence of gonococci.

Treatment of gonococcal infection (gonorrhea)

If you suspect gonorrhea, do not self-diagnose or self-medicate under any circumstances. Gonorrhea is a very serious disease that leads to serious consequences if not treated correctly - when the first signs of the disease appear, immediately contact a venereologist, urologist or gynecologist.

If you have gonorrhea, you must strictly observe the rules of personal hygiene; after visiting the toilet, be sure to wash your hands with soap. Men should not squeeze pus from the urethra - this can cause the infection to spread.

When treating gonorrhea, it is recommended to drink plenty of fluids and exclude spicy foods, alcohol and beer from the daily diet. Visiting the pool, riding bicycles and exercise bikes, as well as heavy physical activity and long walking are not recommended.

Antibiotics are prescribed to treat gonorrhea. The most effective are 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 a course of treatment.

Prevention of gonococcal infection (gonorrhea)

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

Using a condom is the most reliable method of preventing infection from both gonorrhea and other sexually transmitted diseases.

With gonorrhea, there is no immunity and, if you are careless, repeated infections with gonorrhea are possible.

After sexual intercourse without a condom, you should immediately urinate and wash the external genitalia with warm water and soap (preferably household soap). In this way, you can wash off any gonococci that have gotten on them. Within 2 hours after sexual intercourse, special antiseptics in the form of solutions are used for prevention - gibitan, cidipol, miramistin and others. They destroy gonococci and pathogens of other sexually transmitted infectious diseases. However, do not forget that these remedies are not 100% effective, and it decreases as the period of time from sexual intercourse increases.

Gonorrhea– a sexually transmitted infection, about a quarter of a billion clinical cases are registered annually. Despite modern treatment methods, the disease cannot be completely controlled: the causative agent of gonorrhea mutates, gradually acquiring resistance to the newest antibiotics.

Immunity to gonorrhea is not developed; the risk of getting sick again is approximately the same in women and men.

The disease is a classic of venereology and has its own history. Ancient medical treatises ( Galen) mention the “passive leakage of sperm” - gonorrhea, referring to the characteristic discharge from the penis. The Dutch and Germans preferred to rename gonorrhea gonorrhea, associating the disease with travel and love affairs.

Towards the end of the 19th century, the causative agents of gonorrhea were discovered. They turned out to be diplococci - paired bacteria of a round shape, reminiscent of coffee beans. He was the first to describe all their signs, methods of reproduction and effects on the human body. Neisser(1872) and gave the microorganisms their own name - gonococci. The grateful scientific community, in recognition of the scientist’s merits, officially renamed gonococci into Neisseria. Since then, the causative agent of gonorrhea has received a sonorous name - Neisseria gonorrhoeae.

Transmission and prevalence

It has been proven that the predominant route of transmission of gonococcal infection is sexual contact. 50-70% of women become infected after the first contact, among men the infection rate is 25-50%.

It is recognized that gonorrhea is contracted equally both during “everyday” sexual intercourse and during oral or anal sex. The last two methods of infection are most common among gay and lesbian couples. There are no living gonococci on household items, in swimming pool water or on bath accessories: Neisseria do not reproduce outside the body and die when released into the external environment within 2-4 hours.

Transmission of gonococci through contact and household contact is possible through bed and underwear, towels and toothbrushes, if fresh biomaterials of an infected person remain on them - saliva in the oral form of gonorrhea, discharge from the urethra, anus or vagina in the corresponding localizations of gonorrhea. The child is infected through non-sexual contact during childbirth if the mother is sick or is a carrier of gonococci. In such cases, children develop neonatal blenorrhea, a specific inflammation of the conjunctiva, between 2 and 4 days of life.

The prevalence of gonorrhea does not depend on the degree of development of society or the economic well-being of countries. Statistical data for the European Union revealed that the maximum incidence rate is observed in traditionally rich countries and states with a “Nordic” character. The sad champion in the number of cases per 100,000 population was England (27.6), Latvia (18.5) was in second place, Iceland (14.7) and Lithuania (11.7) occupied an honorable third position. It was also revealed that up to 60% of patients with gonorrhea from the Netherlands and France were infected through homosexual contacts, in Norway - up to 40%.

For many years, statistics have not changed regarding the age of most patients with gonorrhea. The risk group remains young people from 15 to 34 years old, they account for up to 75% of all identified cases. It has been noted that in countries that respect traditional marriage and family values, gonorrhea is much less common: in Greece, Romania, the Czech Republic and Spain, the incidence rate tends to zero.

The causative agent of gonorrhea

solitary gonococcus

Gonococci are very sensitive to living conditions. They die if the temperature is below 35 or more than 55 ° C, they are susceptible to drying and exposure to sunlight, and to the effects of even weak antiseptics. In fresh purulent masses, live gonorrhea pathogens are only preserved; They can multiply comfortably inside cells - in the cytoplasm of leukocytes, in the epithelial layer of the mucous membranes of the genitals, rectum, mouth and eyes.

Gonococci cannot move and are not able to form spores. However, with the help of the thinnest pili threads, they are fixed on the membrane of red blood cells, sperm and epithelial cells, due to which they move inside the body and end up outside it. Around the Neisseria there are some kind of capsules that protect against the effects of cellular enzymes. Therefore, leukocytes that “attack” gonococci cannot digest them, and red blood cells and trichomonas become a barrier that complicates the treatment of gonorrhea.

The phenomenon of resistance (immunity) to antibiotics is explained by the formation of L-forms of gonococci, which, if gonorrhea is not treated correctly, lose some properties important for triggering the immune response. L-forms are difficult to treat: they do not give a clear clinical picture of the disease, but are sexually transmitted and remain viable for a long time. Under favorable conditions (hypothermia, stress, colds, fasting), the infection becomes more active and signs of gonorrhea appear.

Forms of gonorrhea, incubation period

Based on duration, a distinction is made between the fresh form of gonorrhea, which lasts no more than two months, and the chronic form, which lasts more than 2 months. Chronic gonorrhea is also diagnosed if the period of limitation of the disease has not been established. The classification, based on the severity of symptoms, divides gonorrhea into acute, subacute and torpid - low-symptomatic and asymptomatic variants, or carriage of gonococci.

Gonococci infect mainly the lower parts of the genitourinary system, which are covered with columnar epithelium. This mucous membranes of the paraurethral glands and urethra - in men; urethra, cervical canal, fallopian tubes, Bartholin glands - in women. The walls of the vagina are covered with stratified squamous epithelium; normally it is immune to gonococci. The development of gonorrheal occurs when the epithelium loosens during pregnancy, puberty, or menopause.

After genital-oral contacts, gonorrheal tonsillitis, stomatitis (erosions and ulcers in the mouth) or pharyngitis (sore throat) appears, after genital-anal contacts - proctitis, and when the mucous membrane of the eyes is infected - gonorrheal conjunctivitis. The disease spreads beyond the mucous membranes, destroys tissue under the epithelium and provokes local inflammation. Without treatment, gonococci spread throughout the body through the lymph and blood, affecting the liver, joints, kidneys, and brain. Sepsis may develop.

skin-joint syndrome caused by gonorrhea

Differences in the localization of gonococcal inflammation and its consequences: gonorrhea of ​​the lower parts of the genitourinary system with and without complications, upper parts, pelvic organs, gonorrhea of ​​other organs.

The incubation period varies from 2 to 14-15 days, sometimes a month can pass from the moment of infection with gonococci to the first symptoms. In case of carriage, there are no signs of disease, but a person always poses a danger as a spreader of infection.

Gonorrhea symptoms

purulent discharge is typical for both women and men

The onset of the disease is sometimes violent. The first signs of gonorrhea, acquired through conventional sexual contact, are copious mucopurulent discharge, reminiscent of thick cream, from the urethra (in men) and the cervical canal (in women). Redness and swelling around the urethra or cervical canal are visually determined. Locally, the temperature may rise to 38-39, signs of general intoxication appear - chills, muscle pain, thirst and weakness.

If the infection occurs orally, inflammation of the throat and tonsils occurs - gonorrheal tonsillitis and pharyngitis, as well as inflammation of the mucous membrane in the mouth - stomatitis. First, local redness with uneven edges forms, then erosion and a white coating characteristic of gonorrhea. Its thickness and prevalence are constantly increasing; without adequate treatment, stomatitis covers almost the entire oral cavity and spreads to the throat.

It is important to distinguish gonorrheal inflammation of the mouth and throat from candidiasis:

• The smell from plaque during gonorrhea is immediately associated with rot;
• After its removal, the surface bleeds;
• Erosions form on the anterior 2/3 of the tongue, leaving the edges free;
• Frequent starting localizations are the lower lip, gums, soft palate;
• Plaque does not disappear when treated with fungicidal drugs, but is sensitive to the effects of methylene blue (blue solution).

With anal infection with gonococci, proctitis, inflammation of the rectum, develops. Rectal symptoms of gonorrhea: copious discharge from the anus, severe itching, burning and swelling of the tissues surrounding the anus. Complications are the formation of perianal ulcers (paraproctitis), gonorrheal myocarditis and pneumonia, sepsis. The purulent process in the lower third of the rectum is especially dangerous in terms of the spread of gonococci. Venous blood from this area does not pass through the liver, where infection and tissue breakdown products could linger, but goes directly into the inferior vena cava system. The further path of infected blood is the heart and lungs, then again the heart and aorta, then the kidneys and all internal organs.

Gonorrhea of ​​the eyes is more common in newborns; the infection is transmitted during childbirth from a mother infected or sick with gonorrhea. It begins as a banal conjunctivitis - with redness of the mucous membranes and swelling of the eyelids, but the inflammation quickly turns purulent. The discharge becomes abundant, forms yellowish crusts on the eyelids and eyelashes, and the disease spreads to the cornea of ​​the eye. Without adequate treatment, a child may lose vision, so all newborns are given prophylaxis by instilling sodium sulfacyl solution into the eyes. Gonorrheal conjunctivitis, acquired during childbirth, manifests itself before the 4-5th day of the baby’s life.

Gonorrhea in women

The course of the disease varies depending on the location and severity of inflammation caused by gonococci.

1) Gonorrhea in the lower genitourinary system

The disease, localized in the urethra, vagina, cervix, Bartholin glands, often occurs without subjective discomfort. Discharge is present, but a woman may not notice it or confuse it with, the itching is not particularly bothersome or disappears after douching with a weak solution of potassium permanganate. Gradually, the disease becomes a carrier state or a chronic form with mild exacerbations in the form of the same itching and scanty vaginal discharge. Upon examination by a gynecologist, thick swelling and redness of the cervical canal and the urethral orifice are noticeable.

The main complications are purulent inflammation of the Bartholin glands, cervix and vagina. In these cases, the symptoms immediately worsen: the temperature rises sharply (39-40), pain appears in the perineum and lower abdomen, and copious purulent discharge appears. When a one- or two-sided swelling is detected in the area of ​​the posterior commissure of the labia majora, palpation is painful. Hospitalization, opening and drainage of festering glands, antibiotics and droppers are indicated.

2) Ascending gonococcal infection

It spreads to the upper part of the genitourinary system, that is, above the internal opening of the cervical canal. The process involves the uterus, fallopian tubes, ovaries, para- and perimetrium (the outer lining of the uterus and the tissue around it), often the pelvic nerve plexus. The reasons are medical procedures: diagnostic curettage and abortion, probing of the uterus, cervical biopsy, insertion of an intrauterine device. Acute inflammation may be preceded by menstruation or childbirth.

Symptoms: severe pain in the lower abdomen, high fever, nausea and vomiting, loose stools, intermenstrual bleeding with bright scarlet blood, frequent.

Upon examination, purulent-bloody discharge from the cervical canal is detected; soft enlarged uterus and sharply painful on palpation; Ultrasound shows swollen fallopian tubes and ovaries. The main complications are ovarian abscesses, peritonitis (inflammation of the peritoneum). In both cases, the picture of an “acute abdomen” is characteristic, when any pressure on its anterior wall causes sharp pain. The woman assumes the fetal position: lies on her side, bends her knees and pulls them towards her stomach, crosses her arms over her chest and lowers her head. In this position, the abdominal muscles relax as much as possible, irritation of the peritoneum is minimal and the pain becomes slightly less.

Treatment is carried out only in a hospital; the ovaries often have to be removed. If pyometra (accumulation of pus in the uterus) is determined and the patient’s general condition is satisfactory, then the uterus is drained and treated with antibiotics. If there is a threat of sepsis and the therapeutic approach is ineffective, the organ is removed.

3) Chronic form

Chronic gonococcal inflammation is not expressed symptomatically, but the consequences of an invisible disease are dangerous complications. The menstrual cycle is disrupted and adhesions develop in the pelvis, leading to ectopic pregnancy, spontaneous abortions and infertility, and chronic pelvic pain.

4) Tripper during pregnancy

Gonorrhea in pregnant women is manifested by inflammation of the vagina and cervix, premature opening of the membranes or their inflammation, labor fever, and septic abortion. Quite rarely, before the 4th month of pregnancy, a gonococcal infection can occur as (inflammation of the fallopian tubes). Characteristic is the development of gonorrheal vaginitis, which usually does not occur outside of pregnancy and is associated with hormonal changes in the vaginal epithelium. The symptoms are similar to thrush, but standard medications do not help. Danger for the child is intrauterine infection with gonococci, postpartum gonorrheal conjunctivitis, and in girls – gonorrhea of ​​the genital organs. Pregnant women with gonorrhea are treated in a hospital.

Gonorrhea in men

photo: gonorrheal discharge from the urethra in men

Signs of gonorrhea may appear 2-3 days after sexual intercourse, but often asymptomatic periods last up to 2-3 weeks. The scenario for the development of the disease is directly dependent on age, the state of the immune system, and the presence of other diseases. In young people, resistance is higher, acute forms of gonorrhea are more often observed, which are quickly and safely cured, while older men mainly suffer from low-symptomatic variants of the disease, which develop into chronic gonorrhea or carriage of gonococci.

1) Acute gonorrheal epididymitis - inflammation of the epididymis

The infection spreads from the urethra along the vas deferens. It begins with swelling of the testicle and such sharp pain in the scrotum that the man actually cannot move. Then pain appears in the lower back, moving to the side of the abdomen and to the groin area. The pain is stronger on the side where the inflammation is more intense. As swelling increases, the epididymis increases 2-4 times in just a couple of hours; At the same time, pain during urination increases, and blood appears in the urine.

The temperature is understood, the person feels a strong chill, the pulse quickens. The main complications of epididymitis are the formation of an epididymal abscess and the spread of infection to the testicle (). The normal functions of the epididymis are limited to transporting, storing and maturing sperm. When the ducts become inflamed, they become narrowed or completely blocked by adhesions, resulting in infertility. With unilateral epididymitis - in 35% of cases, with bilateral - in 87%.

2) Gonorrheal prostatitis

Gonococci enter the prostate through the ducts connecting the gland to the urethra. Acute inflammation is characterized by pain in the lower back and lower abdomen, radiating to the scrotum and groin areas. The prostate gland swells and can compress the urethra, making it difficult to urinate; mucus and blood appear in the urine. Chronic forms develop unnoticed, but ultimately lead to adhesions inside the ducts, acute forms lead to purulent inflammation with the formation of an abscess. In both cases, the possible outcome is infertility and impotence.

3) Gonorrheal inflammation of the periurethral canals and glands, foreskin, head of the penis

They can be complicated by narrowing of the urethra and its opening, fusion of the internal layers of the foreskin, and erosions on the skin of the genital organs.

Gonorrheal epididymitis and prostatitis are diagnosed by a smear from the urethra, and appropriate antibiotics and restoratives are prescribed. Purulent complications are treated in a hospital, chronic and subacute forms are treated on an outpatient basis, also with the use of antibiotics and then physiotherapy. To reduce pain, it is suggested to put a suspensor on the testicles; if urinary retention occurs, drink a decoction of parsley and make local baths with chamomile or sage. Recommendations for the regimen: restriction of activity with temporary cessation of sexual activity, as well as cycling and horseback riding. Diet with limited fats and spices, without alcoholic beverages.

Diagnostics

The first point of the diagnostic algorithm is patient interview. The doctor finds out what exactly is bothering you at the moment, when the problems started and what they may be associated with, whether such symptoms existed before.

Then proceeds to inspection, urological or gynecological, if necessary, evaluates the condition of the genital organs by palpation (palpation). In women with acute form of gonorrhea, hyperemia of the cervical canal is visible, liquid yellowish-milky pus is released from it.In men, the discharge is in the form of a drop, the color is the same, there may be an admixture of blood. Chronic gonorrhea gives a more modest picture: there is little discharge, they appear after pressing on the opening of the urethra.

Gonorrhea smear taken with a sterile loop or swab. If gonorrheal inflammation outside the genital organs is suspected, material is obtained from the mucous membrane of the mouth and throat, from the anus, and from the corners of the eyes. With standard localization of gonorrhea: in women - from the urethra, cervical canal, vagina and the mouth of the Bartholin glands, in men - from the urethra.

If necessary, a sample of discharge from the prostate gland is additionally examined. To do this, the doctor massages the prostate through the rectum, and the patient holds the test tube near the opening of the urethra. The procedure is unpleasant, but goes quickly. With normal inflammation, the prostatic secretion contains only leukocytes and columnar epithelium, with gonorrhea - leukocytes, epithelium and gonococci, and Neisseria are located inside the cells.

Culture method

This involves inoculating material from the area of ​​inflammation on nutrient media, isolating gonococcal colonies and determining their sensitivity to antibiotics. Used as a definitive diagnosis of gonorrhea to prescribe specific treatment.

Antibiotic sensitivity test: gonococci isolated from colonies are mixed with a nutrient medium, which is placed in a special container (Petri dish). Pieces of paper, similar to confetti, soaked in solutions of various antibiotics are placed on the surface in a circle. After the growth of gonococci in it, the medium becomes cloudy, and only round transparent areas are visible around the “confetti” with certain antibiotics. They are measured, with a diameter of 1-1.5 cm, the sensitivity of a given microflora to an antibiotic is considered average, a diameter of 2 cm or more indicates high sensitivity. It is this medicine that can successfully cope with the infection.

The disadvantage of the method is the long execution time; it takes 7 to 10 days for colonies to grow successively on two media. Plus – detection of gonorrhea in 95% of cases.

Smear microscopy

The material to be studied is placed on a glass slide, the preparation is stained and examined under a microscope. The causative agents of gonorrhea are found in the form of bluish-violet diplococci, located mainly inside other cells. The technique is not complicated, but depends on the qualifications of the laboratory doctor, so its accuracy is only 30-70%. Microscopy is used to make a preliminary diagnosis.

Analyzes

Blood for general clinical research, for PCR and ELISA tests.

1. General clinical analysis reveals signs of inflammation: leukocytosis, increased lymphocyte count, ESR, and possibly increased platelets.
2. , polymerase chain reaction. The method is highly sensitive and is based on the determination of gonococcal DNA. Used for preliminary diagnosis, it is often false positive. To confirm it is supplemented.
3. (linked immunosorbent assay). The results may be distorted by concomitant autoimmune diseases. In general, the method has a confidence level of 70%, is inexpensive and can be done quickly.

Hardware methods are used after treatment to assess the severity of the consequences of gonorrhea for the internal genital and other organs. In women, sclerosis (replacement of active tissue with scar tissue) of the ovaries and fallopian tubes is possible, in men – of the seminal ducts and urethra. In both cases, infertility occurs.

Treatment with antibiotics

The main principle: be sure to treat sexual partners, in whom gonococci were detected using the culture method. Acute and chronic gonorrhea require an etiotropic approach, that is, an impact on the cause of the disease.

Sexual contact and alcohol are prohibited for the entire treatment period!

Therapy with antibiotics taken orally is always carried out against the background hepatoprotectors(karsil) and probiotics(Linex, yogurt). Local remedies with eubiotics (intravaginal) - acylact, lacto- and bifidumbacterin. It would also be useful to prescribe antifungal drugs (fluconazole).

It is better to stop the temptation to heal yourself immediately , since the antibiotic may not work and gonorrhea will become chronic, and medications are increasingly causing allergies and its complication - anaphylactic shock - develops at lightning speed. And most importantly: only a doctor can reliably diagnose gonorrhea, based on objective data.

Acute uncomplicated gonorrhea of ​​the lower genitourinary system is treated literally according to instructions compiled on the basis of official recommendations. Preferably one of the following antibiotics is prescribed:

• tablets for gonorrhea, single dose - azithromycin (2 g), cefixime (0.4 g), ciprofloxacin (0.5 g);
• intramuscularly, once - ceftriaxone (0.25 g), spectinomycin (2 g).

Exist alternative schemes, in which ofloxacin (0.4 g) or cefozidime (0.5 g), kanamycin (2.0 g) intramuscularly, once are used (once, orally). After treatment, it is necessary to monitor the sensitivity of gonococci to antibiotics.

Acute complicated gonorrhea of ​​the lower and upper parts of the genitourinary system requires long-term treatment. The antibiotic is changed after a maximum of 7 days, or the drugs are prescribed in long courses - until the symptoms disappear, plus another 48 hours.

1. Ceftriaxone 1.0 IM (intramuscular) or IV (intravenous), x 1 per day, 7 days.
2. Spectinomycin 2.0 IM, x 2 per day, 7 days.
3. Cefotaxime 1.0 IV, x 3 per day or Ciprofloxacin 0.5 IV, x 2 per day - until symptoms disappear + 48 hours.

After the acute manifestations of gonorrheal inflammation have been relieved (the temperature should return to normal, discharge is scanty or undetectable, there is no acute pain, local swelling has decreased), antibiotics continue to be used. Twice a day - ciprofloxacin 0.5 or ofloxacin 0.4 g.

In the presence of a mixed infection of gonorrhea, the regimen is expanded by adding azithromycin tablets (1.0 g once) or doxycycline (0.1 x 2, 7 days). Trichomoniasis can be treated with metronidazole, ornidazole, or tinidazole. , accompanying gonorrhea, is treated with penicillins or tetracyclines. If you are allergic to these groups of drugs, erythromycin or oleandomycin is prescribed, which are also active against chlamydia.

How are pregnant women and children treated?

Treatment of gonorrhea during pregnancy

At any stage of pregnancy, it is important to use only antibiotics that do not have a negative effect on the child: ceftriaxone (0.25 IM once) or spectinomycin (2.0 IM once). Drugs from the group of tetracyclines (doxycycline), sulfonamides (Biseptol) and fluoroquinolones (ofloxacin) are strictly contraindicated. For complications of gonorrhea chorioamnionitis Urgent hospitalization and antibiotics are indicated (ampicillin 0.5 IM x 4 per day, 7 days).

Always add immunomodulators, combined with local treatment of gonorrhea and drugs that affect metabolic processes and improve blood circulation (trental, chimes, actovegin). A week after treatment for the pregnant woman, the first control for gonococci is carried out; this is repeated for three months in a row. The partner or husband is also treated, and children are necessarily examined.

Treatment of gonorrhea in children

Antibiotics of the same groups are prescribed that are used to treat pregnant women. The dosage is calculated based on body weight: up to 45 kg - ceftriaxone 0.125 IM once or spectinomycin 40 mg per kilogram (no more than 2 g) IM once; after 45 kg – dosages as for adults. For newborns, ceftriaxone at the rate of 50 mg per kg of weight (not more than 125 mg), intramuscularly once.

Other treatments for gonorrhea

Local impact– instillation of the urethra or vagina with protargol (1-2%), silver nitrate solution 0.5%, microenemas with chamomile infusion. It is prepared at the rate of 1 tbsp. spoon of dry chamomile in 1 cup of boiling water, leave for 2 hours, then strain through cheesecloth. All of the above products have astringent and antiseptic properties.

Physiotherapy It is used only outside of acute inflammation and its manifestations. They use UHF, treatment with electromagnetic fields, laser and UV rays, electro- and phonophoresis of drugs. All effects are aimed at reducing the effects of inflammation, local improvement of lymph and blood flow.

Immunotherapy: the goal is to activate the immune response to gonococcal infection, increasing the susceptibility of cells to antibiotics. Gonococcal vaccine, autohemotherapy, and drugs (pyrogenal) are used. Begin only after treatment of acute manifestations of gonorrhea and always against the background of antibiotics; for chronic or subacute gonorrhea - before starting a course of antibiotics.

Treatment for acute ascending infection

A prerequisite is hospital treatment. In case of severe pain in the lower abdomen (for women) or the scrotum and penis, apply cold lotions or a rubber “hot water bottle” with ice, and, if necessary, numb the pain with medication. Medicines are administered intravenously. Droppers with physical therapy are prescribed. glucose solution and novocaine, no-spa and insulin, antihistamines (suprastin, diphenhydramine). Hemodez and rheopolyglucin are administered. The purpose of infusion therapy is to reduce intoxication, reduce blood viscosity to prevent thrombosis and DIC syndrome, reduce smooth muscle spasm and relieve pain.

Acute inflammation of the fallopian tubes and/or ovaries is treated conservatively for the first 24 hours using antibiotics and infusion therapy. If the patient's condition does not improve, an operation is performed to drain the purulent focus or the organ is removed. When diffuse peritonitis develops, active drainage of the abdominal cavity is used. The outcome of treatment depends on the general condition of the woman, so if you suspect a purulent ascending gonococcal infection, it is important to consult a doctor as soon as possible.

Treatment control

Gonorrhea cure criteria are used to assess the effectiveness of treatment.

• There are no symptoms of inflammation, gonococci are not detected in smears.
• Once provoked, the symptoms of the disease do not return. Provocation can be physiological (menstruation), chemical (the urethra is lubricated with a solution of silver nitrate 1-2%, the cervical canal - 2-5%), biological (gonovax IM), physical (locally - inductothermy) and food (spicy, salty, alcohol) or combined.
• Three-time examination of smears from the urethra, cervical canal or anus, taken at intervals of 24 hours. In women - during menstruation.
• Combined provocation, tank. examination of smears (three times microscopy every other day, culture).

If gonococci are not detected, then gonorrhea is considered completely cured. It is recommended to do tests after 3 months. after completion of treatment.

Home treatment

Treatment at home is a supplement to the basic regimen with local procedures, diet and herbal medicine, but not for acute manifestations of gonorrhea. Some folk remedies recommended for chronic gonorrhea during periods of exacerbations and remissions, during the period of recovery after an acute form.

1. Baths for the external genitalia and gargling, douching and microenemas with chamomile, sage, eucalyptus oil. Antiseptic, anti-inflammatory effect.
2. A decoction of burdock, dill, and parsley is diuretic and anti-inflammatory.
3. Tincture of ginseng, golden root – immunomodulatory.

Gonorrhea prevention

Preventing infection with gonococci and blocking the spread of the disease are the main goals of gonorrhea prevention. The risk of infection during sexual intercourse is reduced by using a condom and subsequent use of chlorine-based antiseptics (miramitan). Washing with plain water and soap is ineffective, as are spermicides. The best way to maintain health remains a reliable partner, preferably in the singular.

Safe sex with gonorrhea without a condom with a patient or carrier of the infection is possible, but such actions can hardly be called full sexual intercourse. Experts include body massage, dry kissing, oral contact with the body with the exception of the external genital area, self-masturbation and individual sex toys.

Identification of patients with gonorrhea and carriers takes place during routine examinations, registration of medical records, and during the registration of pregnant women. All sexual partners should be tested, if after contact, symptoms of gonorrhea appeared within 30 days, and in the asymptomatic form - within 60 days before diagnosis, if at least one of them showed signs of the disease. Mothers whose children have gonorrhea are examined, and girls if their parents or guardians have been diagnosed with gonorrhea.

Video: STI encyclopedia about gonorrhea

Video: specialist about gonorrhea

In rare cases, gonococci spread throughout the body.

In doing so, they can affect:

• Joints;
• The inner lining of the heart;
• Meninges of the brain;
• Liver;
• Skin, etc.

Multiple infections come in two forms:

• Severe gonorrheal sepsis.

The patient feels extremely unwell, he is worried about high temperature, chills, sweating and rapid heartbeat.

In addition, a rash appears on the skin. The patient also experiences joint pain - this happens due to damage to the joints by gonococci, which provokes the accumulation of pus in the cavity of the diarthrosis.

• Benign gonorrheal sepsis.

In this case, the symptoms of intoxication are not so strong. The patient is more concerned about joint pain, skin rash, enlarged lymph nodes and painful palpation. With this form of gonococcal infection, inflammation of the pia mater and liver abscess develop in parallel. With any form of disseminated infection with gonococci, a person should be taken to the hospital as soon as possible.

Diagnosis of gonococcal infection

Patients who are faced with the symptoms described above are concerned about the question of which doctor deals with the treatment and diagnosis of gonococcal infection. If you suspect gonorrhea, you should contact a venereologist. To make a correct diagnosis, the doctor first of all collects anamnesis, takes into account the patient’s main complaints and clarifies whether unprotected sex has occurred.

Methods for diagnosing gonococcal infection:

• Bacterial culture followed by microscopy;
• Linked immunosorbent assay;
• RCOA;
• Polymerase chain reaction.

In men, a scraping from the urethra serves as a biomaterial for analysis. In women, biomaterial is collected from the walls of the cervix, vagina, throat, rectum and eyes. Laboratory assistants carry out special staining of microorganisms and microscopy.

In addition, they reveal the sensitivity of bacteria to antibacterial drugs. The study should be carried out before treatment and ten days after it.

Treatment of gonococcal infection

Therapy for gonorrheal infection is carried out in highly specialized clinics. Treatment methods for gonococcal infection are medicinal and physiotherapeutic. Doctors prescribe antibacterial drugs, sulfonamides, a special diet, immunostimulating drugs and local effects to patients.

Antibiotics for the treatment of gonococcal infection are prescribed as follows:

• "Ceftriaxone";
• "Ciprofloxacin";
• Azithromycin.

Most often, patients are also given a special vaccine - for a protracted form of gonorrhea.

To support immunity, the patient takes immunostimulants:

• "Amiksin";
• "Levamisole".

Also, gonococcal infection is treated directly locally: both sexes are prescribed baths and rinsing of the genitals with the addition of antiseptics. Physiotherapeutic procedures used against gonorrhea include the use of ultrasound and ultra-high-frequency inductothermy. Both partners should undergo treatment for gonococcal infection. During treatment, it is forbidden to have sexual intercourse or go to the pool. Doctors' recommendations also include eliminating alcohol and spicy foods from the diet.

Prevention of gonococcus infection

Prevention of gonorrhea includes maintaining basic intimate hygiene, using contraceptives and mandatory testing a couple of times a year. Pregnant women are tested regularly. Since forms of gonococci can pass from mother to child, it is imperative to take preventive measures. Drug prevention of gonococcal infection is carried out using Erythromycin or Ceftriaxone.

If you suspect gonococcus, contact competent venereologists.

Gonococcal infection is a disease caused by the gram-negative bacteria Neisseria gonorrhoeae. This is a typical infection and is classified as a sexually transmitted disease because it is sexually transmitted. The former name is gonorrhoea, another common name is gonorrhea, translated from Greek as “discharge of semen.”

It ranks second in prevalence after chlamydia. Every year, 62 million cases are diagnosed worldwide, most often affecting young people aged 15 to 35 years. In men, the pathology is detected 2 times more often than in women, although both sexual partners are equally affected. This is due to the fact that males consult a doctor more often due to rapidly developing signs of infection. In women, the disease is asymptomatic or with minimal symptoms, so it is detected by chance during medical examinations or in advanced stages, when complications have developed.

The causative agent of the disease

There are latent L - forms of the pathogen, their reversion to the original state. It has been established that some strains of gonococcus produce lactamase, which causes resistance of the pathogen to penicillin. Another part of the strains develops high resistance to tetracycline.

After an illness, specific immunity is not developed: there is a high probability of re-infection and the development of the disease - reinfection.

Ways of transmission of gonorrhea

Transmission of the pathogen occurs sexually in 98% of cases. Infection is possible through any type of sexual contact. Therefore, inflammation develops in the rectum, pharynx, eyes, and in the musculoskeletal system.

Even one-time sexual contact with a gonococcus carrier or a sick partner has a very high risk of infection - 60-90%. In 80% of confirmed cases of gonorrhea, trichomonas or chlamydia are simultaneously detected. Infection and development of the disease occurs in both partners.

The existence of a household route of transmission of the disease is described. Since the pathogen is not resistant to external factors and can remain alive outside the body for about 4 hours, the probability of infection through the underwear of a carrier or patient, personal hygiene items, and water in the pool is present, although extremely low. To do this, a person must receive a large number of bacteria, which is extremely rare in the case of household infection.

Gonococcus, present in a sick or infected mother, affects the mucous membrane of the child’s eye when the fetus passes through the birth canal. Suppuration develops - blenorrhea, and blindness can become a complication. In girls at birth, gonococcus enters through the genital opening. Children can become infected (extremely rarely) from a sick person caring for them.

Causes leading to illness

gonococcal infection can be caused by the following reasons:

• low sexual culture;
• promiscuity with many sexual partners;
• lack of contraceptives.

In addition to the above main reasons, women have other important reasons for the further spread of the disease:

• medical manipulations and operations (probing of the uterus, termination of pregnancy);
• childbirth;
• menses.

Course of gonorrhea

The latent period ranges from 2 days to a month. It lengthens if the patient is taking antibacterial or sulfonamide drugs for another existing pathology at the time of infection. In many cases, the incubation period becomes latent and does not manifest itself clinically. Neisseria may be in a latent form and cannot be treated for a long time. Many women do not know about their disease and are a source of infection. An asymptomatic course in some cases is also found in men.

Gonorrheal infection manifests itself clinically in two forms: urogenital and extragenital.

In the first case (98%), the organs of the genitourinary system are affected. In the extragenital form, the inflammatory process covers: the rectum (proctitis), the oral cavity (stomatitis), the pharyngeal mucosa (pharyngitis), the eyes (blennorrhea), muscles and bones.

The cylindrical epithelium of the urethra, cervix, lower part of the rectum, and the mucous membrane of the eyes undergoes pathological changes. The stratified epithelium that lines the vagina and pharynx is affected by low immunity, post-traumatic consequences, and hormonal changes. The entry of an infectious agent into the blood leads to transient bacteremia. Disseminated damage to internal organs and sepsis develop infrequently.

Based on the time from the onset of the disease, there are:

• fresh form (acute, subacute, torpid - less than 2 months from the moment of infection);
• chronic (more than 2 months after infection);
• carrier status

The acute course is manifested by a pronounced clinical picture, forcing you to immediately consult a doctor.

The subacute form is less clinically pronounced. Torpid disease occurs with subtle symptoms; its main danger lies in the chronicity of the process and the development of serious complications, one of which is infertility.

If you are a carrier, there may be no signs of the disease, but the person is still highly contagious.

Clinical symptoms of the disease

Common clinical manifestations of the disease are:

• frequent urination with severe pain;
• burning in the urethra and suppuration from it;
• itching and discomfort in the genital area.

The main reason for contacting a specialist is intense pain that occurs when urinating. These sensations can be so strong that the process itself becomes impossible.

Course of infection in men

The disease primarily affects the urinary system. For primary diagnosis, a two-glass Thompson test is used: urine is collected in two containers sequentially. The presence of turbidity, flakes, or purulent threads in the first glass (in the initial portions of urine) indicates the presence of anterior urethritis. If cloudy urine is found simultaneously in two containers, this indicates total (posterior) inflammation of the urethra.

Anterior acute urethritis is manifested by clinical manifestations typical of inflammation of the urinary system:

• constant false urge to urinate (every 10-15 minutes);
• intense pain when passing urine;
• severe burning and pain in the perineum;
• profuse suppuration;
• redness and swelling of the visible part of the urethra.

Signs of subacute urethritis are less pronounced: pain and burning during urination of moderate intensity, serous-mucous discharge in small quantities in the morning.

Torpid urethritis has scanty symptoms: slight hyperemia and stickiness of the urethral orifice, scanty discharge, invisible to the patient.

In chronic gonorrhea, focal inflammation develops at the site of entry of the infectious agent into the body, associated with metaplasia of the columnar epithelium. This is manifested by the formation of soft and hard infiltrates. Pathological changes occur in the mucous membranes of the urethral glands. All changes are diagnosed urethroscopically.

Complications of gonorrhea in men

Gonococcal infection spreads quickly without treatment. Its complications include:

• Cuperitis is an inflammatory process in the bulbourethral glands. Manifested by aching pain or heaviness in the perineum, fever, dysuria. For an accurate diagnosis, a rectal examination is performed.
• Prostatitis causes discomfort and pain in the external genitalia, sacrum, premature ejaculation, and decreased erection. Upon examination and palpation, an enlarged prostate gland is determined.
• Vesiculitis is inflammation in the vesicles. Combined with prostatitis and epididymitis. It is asymptomatic and is diagnosed by changes in the seminal fluid and palpation of the vesicles.
• Epididymitis is inflammation of the epididymis. It occurs acutely, with pronounced pain, fever, hyperemia and swelling of the scrotum.

Course of infection in women

The course of gonorrhea in women differs from gonorrhea in men. The clinical manifestations of the disease depend on which organ is affected first and where the pathological process occurs. Most often it develops: gonorrheal cervicitis, gonococcal vaginitis, anorectal gonorrhea. The disease begins in most cases asymptomatically. A woman may not feel anything and consider herself healthy.

Symptoms that occur under certain conditions (decreased immunity, concomitant diseases) are common to damage to any organ:

• pain in the lower abdomen and back;
• discomfort and severe pain when urinating;
• profuse discharge (leucorrhoea) of yellow color with an unpleasant odor.

Without treatment, the symptoms gradually subside, the disease becomes chronic, or the patient becomes an asymptomatic carrier of gonococcus.

Initially, the pathogen penetrates the cervix, it further spreads and damages the appendages (ovaries, tubes), entering the uterine cavity and the peritoneum.

In the extragenital form, depending on the type of sexual contact, the following develop: proctitis, stomatitis, pharyngitis.

Excessive leucorrhoea is often perceived by women as candidiasis or colpitis. When taking antifungal and anti-inflammatory drugs on your own, the clinical picture becomes blurred. Discharge is a classic sign of gonorrhea in both men and women.

Complications of gonorrhea in women

• Cervicitis is a sign of gonorrhea in women. The first to be affected is the cervix with the development of cervicitis. In addition to the characteristic discharge, a burning and itching sensation appears in the vagina. Upon examination, a swollen, hyperemic cervix with a constantly leaking yellow ribbon of leucorrhoea is visible.
• Damage to the uterus and appendages. With an ascending infection from the cervix, the pathogen penetrates the uterus, appendages, and bladder. At this stage, pulling or acute pain appears in the lower abdomen, an admixture of blood is detected in the discharge - this is due to damage to the uterine mucosa. A fever of up to 39 0 C appears, accompanied by intoxication in the form of general weakness, malaise, lack of appetite, nausea, vomiting, and diarrhea. The menstrual cycle is disrupted, endometritis and salpingoophoritis develop. All signs of inflammation are accompanied by pain during sexual intercourse - dyspareunia.
• Inflammation of the urinary system. When it enters the urethra upward, the infection affects the urinary system, causing urethritis, cystitis, and pyelonephritis. In these cases, there is a swollen red urethra, painful on palpation. The changes are accompanied by a feeling of cutting and burning when urinating, frequent false urges: sometimes it is necessary to visit the toilet every 10-15 minutes, the amount of urine produced decreases sharply, the process of urination requires physical effort due to pain. The pain syndrome can be minor, but in many cases it is intense, making urination even more difficult. Urine is cloudy and purulent. When the infection spreads to the kidney tissue, the clinical picture of pyelonephritis develops: fever with intoxication, pain in the lumbar region, changes in urine under microscopy.
• Extragenital lesions - proctitis. Extragenital development of gonorrheal infection in the form of damage to the rectum in women sometimes occurs without clinical manifestations. But in most cases, the following appear: typical for gonorrhea, thick yellow discharge from the rectum, streaked with blood, regardless of bowel movements, accompanied by itching and sharp pain, tenesmus, frequent painful bowel movements. An objective examination reveals redness and swelling of the anus and accumulation of pus in its folds.
• Extragenital lesions - stomatitis, pharyngitis. Gonorrheal stomatitis has no specific features. Pharyngitis clinically resembles lacunar tonsillitis: sharp pain appears when swallowing, hyperemia of the pharynx, enlarged tonsils, submandibular lymphadenitis, and hoarseness. Upon examination, a characteristic yellow coating is observed against the background of bright red enlarged tonsils. This may not make a woman wary. As a rule, patients self-medicate without consulting a doctor.

Chronic course

Without treatment, over time, all clinical manifestations of the infection subside, and symptoms of imaginary well-being appear. In such cases, it is possible to identify the disease only in the chronic stage, when complications appear in the form of infertility, complications during childbirth, ectopic pregnancy, and miscarriage. Chronic gonococcal infection has a protracted course with periodic exacerbations, with the development of adhesions in the pelvis, disruption of reproductive function and the menstrual cycle. In 60% of cases, due to the lack of expression or erasure of symptoms as a result of self-medication or untimely consultation with a doctor, signs of the disease are mistaken for the consequences of stress, overheating, and mental stress.

The chronic course of the disease in men and women shows little effect; occasionally, nagging pain in the lower back may occur, radiating to the leg, and discomfort in the lower abdomen. At this stage, few people seek help; the disease remains undiagnosed for a long time.

Diagnosis of the disease

Laboratory tests are performed to confirm the diagnosis of gonorrhea. There is a wide range of methods for detecting infection; they must be used with all sexual partners:

• microscopy – a smear taken from the site of inflammation is examined;
• bacteriological culture;
• staining of the taken smear - RIF (immune fluorescence reaction);
• enzyme-linked immunosorbent assay (ELISA), which examines urine;
• complement fixation reaction (FFR) – blood serum is studied and used to diagnose the chronic course of the disease;
• polymerase chain reaction (PCR) is the most expensive and highly accurate technique.

When the pathogen is not determined by laboratory research methods, provocations are carried out (in case of latent and chronic course). There are several of them, the simplest ones:

• nutritional: intake of alcoholic beverages, salty, spicy foods;
• physiological - a smear for analysis is taken on the days of menstruation.

Two methods of provocation are used; if necessary, three or more are prescribed; studies are carried out after 24, 48 and 72 hours.

Prevention

You need to know what you can do after unprotected sex to protect yourself from infection:

• It is recommended to urinate immediately to flush out pathogenic bacteria from the urethra.
• Wash the genitals and inner thighs with soap (preferably household soap), and then treat with an antiseptic (Miramistin, Chlorhexidine or a self-prepared solution of potassium permanganate).
• The same antiseptics must be injected into the urethra (2 ml) and into the vagina (5 ml). Miramistin or Betadine are used. To facilitate the procedure, it is convenient to use bottles with a ready-made urological attachment. Such measures are effective when carried out within the first two hours after unprotected sex.

If you take these steps in a timely manner, you can significantly reduce the risk of infection. It has been established that Miramistin reduces the likelihood of infection by 10 times.

Treatment

Treatment of both partners is carried out simultaneously, regardless of the severity of clinical manifestations, strictly under the supervision of a doctor. This is associated with severe complications of the disease. A course of antibiotic therapy and sexual rest are prescribed, and alcohol consumption is prohibited.

Antibacterial drugs include cephalosporins, macrolides, and tetracyclines. When prescribing, sensitivity is determined. Treatment begins with a single intramuscular injection of Ceftriaxone at a dose of 250 mg or oral administration of 3 g of Amoxicillin once. In case of intolerance, use Azithromycin (1 g orally once) or 800 mg of Norfloxacin. At the same time, Doxycycline 100 mg is prescribed twice a day for a week. This is necessary to influence chlamydia, given that gonococcal infection is combined in most cases with chlamydia.

In case of complications, surgical intervention is performed.

There are no traditional methods of treatment. It is possible to use decoctions of medicinal herbs that have anti-inflammatory properties (chamomile, dandelion, celandine). They are used to wash the genitals.

7-10 days after a course of antibiotics, laboratory monitoring is carried out even in the absence of complaints and good health. After provocation, a smear is taken for microscopy and bacteriological culture. The procedure is repeated after 2 - 3 weeks in men, in women - after 2 -3 menstrual cycles.

Patients whose source of infection has not been identified are subject to clinical and serological control after 3 months.

Stable immunity does not develop after an infection, so you can get sick again. To avoid the unpleasant consequences of gonorrhea, it is necessary to consult a doctor even with minor manifestations of the disease.

There is information that you need to know about gonococci - what it is, what diseases pathogenic bacteria can cause, what are the symptoms of the disease and why it is dangerous. And most importantly, the routes of infection.

Almost all adults, and even children of a certain age, know about a disease such as gonorrhea (gonorrhoea). But few have heard about the characteristics of its pathogen. Also, few people know that the disease can be deadly and cause serious complications.

In the modern world, gonococcus has become resistant to some types of antibiotics. That is why only a specialist can choose adequate treatment methods after conducting certain tests.

You should not rely on the fact that the information you read on the Internet on the treatment of gonorrhea will be a one hundred percent panacea and will make it possible to completely get rid of the disease on your own. This is just a standard scheme, on the basis of which the dermatovenerologist will draw up an individual treatment plan for each specific patient.

General characteristics

Gonococcus Neisser is a gram-negative diplococcus. This representative of pathogenic microflora is not normally present in the human body at all. The infection is anaerobic, that is, it does not require an oxygen environment to survive. When infected, it lives and multiplies on the mucous membranes of human internal organs. Mainly on those lined with columnar epithelium - the urethra, bladder.

These pathogenic microorganisms were discovered at the end of the 19th century by the German scientist Neisser (after whom they were named). It was he who was able to isolate the infectious agent by Gram staining and examine it under a microscope.

Gonococcus resembles the structure of coffee beans, which are connected in pairs by concave surfaces inward. The bacterium is extremely susceptible to the environment. Outside the human body, it does not live long, dying without the protein substrate necessary for life. But in a humid environment, rich in whey protein and minimal carbon dioxide in the surrounding air, it feels great.

The microbe, although immobile, is protected by a very strong “film” consisting mainly of glycolipids (compounds of glucose and fat molecules). This structure is unique and not inherent in any gram-negative microorganism.

It is this shell that allows gonococci to evade the body’s immune response for a long time. The pathogenic bacterium mimics (disguises itself) as the human body's own cells.

Pathogenicity factors

The structural features of Neisseria determine its resistance to the protective functions of the body and resistance to treatment. It is in this way that gonorrhea tends to become chronic, which is very dangerous both for the health and for the life of the patient. The following protective mechanisms of gonococci are distinguished:

All these qualities together make it possible for gonococcus to remain in the human body for a long time, to survive and multiply even with certain treatment. But we must remember that therapy for gonorrhea, the causative agent of which is this microorganism, must be adequate and complete. An incomplete course of treatment, incorrectly selected antibiotic therapy, and failure to comply with basic rules of personal hygiene and behavior can cause the pathology to become chronic.

Gonorrhea

Gonorrhea is a sexually transmitted disease caused by Neisser's gonococcus. Belongs to the group of sexually transmitted infections. It is characterized by damage to the mucous membranes of organs with columnar epithelium (uterus, urethra, rectum, pharynx, conjunctiva of the eyes).

Symptoms will vary depending on the location of the lesion. But the main feature is inflammatory processes, accompanied by discomfort and the release of pus. If treatment is not carried out in time, the pathology can cause pelvic inflammation and infertility. If the disease is detected in a pregnant woman, then the child becomes infected during childbirth.

Gonococci die very quickly in the external environment, as they are afraid of direct sunlight, drying, relatively high temperatures (above human body temperature), and treatment with antiseptics. But inside the body they feel great, live and reproduce, causing disease.

Pathogenic microorganisms can be located both on the surface of cells and inside them. Under certain circumstances, they form specific forms that are insensitive to antibiotics.

Based on the location of the pathogenic process, the following forms of gonorrhea are distinguished:

• genitourinary organs (vagina in women, urethra in men);
• anorectal (gonorrheal proctitis);
• musculoskeletal (gonarthritis);
• conjunctiva of the eyes (blennorrhea), this pathology is usually diagnosed in newborns;
• Gnococcal pharyngitis.

You can “catch it” in only two ways, one of which makes up a very small percentage. Knowing what gonococci are, you also need to know the reasons for their entry into the body.

Routes of infection and risk groups

As we have already found out, gonorrhea is a sexually transmitted disease. It is transmitted sexually in 99% of all cases. It can occur during any form of sexual contact, both traditional and “non-traditional.”

Anal and oral sex, according to venereologists, is even more dangerous in terms of, since the mucous membranes of the rectum and mouth are more vulnerable and sensitive than the mucous membranes of the vagina and urethra.

Gonorrhea is a disease that oppresses gender equality. But there are purely physiological reasons for this - the structural features of the genitourinary system in women. In men, the urethral canal is narrower and longer than in women. It is this circumstance that explains that during unprotected sexual contact with a sick man (or carrier), a woman becomes infected in 50-80% of cases.

A man, in the event of similar contact with a patient or carrier, receives an infection as a “bonus” for pleasure of only 30-40%. But the likelihood increases significantly with violent sexual intercourse, unnatural satisfaction of passion and when the partner has critical days.

There is a second, indirect route of transmission - household. But it makes up a tiny percentage - only 1. Moreover, here, too, girls or women are in greater danger than representatives of the stronger sex of any age.

The likelihood of such an infection exists if you have very close contact at home with a sick person or a carrier of the infection. The use of personal hygiene items (washcloths, towels, soap) can cause infection to enter the body.

Among the risk groups are the following:

• persons engaged in prostitution, injection drug addicts;
• homosexuals;
• people who are promiscuous;
• family members of the patient or carrier.

But even one sexual contact with an unfamiliar or unfamiliar partner can result in a trip to the venereology clinic and a course of not the most “useful” treatment, if you do not use barrier contraception. In this case, a condom will help avoid infection.

Clinical picture

In 10% of men and more than 50% of women, this disease is asymptomatic - that is, clinical manifestations are absent or mild and are not specific.

Fresh gonorrhea is diagnosed if less than 2 months have passed since infection, and chronic gonorrhea is diagnosed if more than 2 months have passed since infection.

According to its form, gonorrhea is classified as acute, subacute and asymptomatic. There is also carriage, when there are no subjective signs of pathology, but gonococcus is present in the body.

Symptoms of the disease may appear 1-5 days after infection. Sometimes the incubation period lasts up to a month, but it is extremely rare.

Signs of the disease can be significantly blurred or changed, since gonorrhea in its pure form is often becoming less common. Chlamydia, trichomoniasis and other sexually transmitted pathologies are diagnosed as concomitant illnesses. These combinations can lengthen the incubation period, change symptoms, and complicate diagnosis and treatment.

Classic manifestations of gonorrhea in men:

• discharge of purulent and serous-purulent masses from the urethra, mainly in the morning in large quantities;
• difficulty urinating or painful process;
• classic signs of urethritis are itching, swelling, hyperemia of the urethra, pain on tactile contact.

In representatives of the stronger sex, symptoms usually appear very quickly. If gonorrhea has an ascending course, then the seminal canals, testicles, prostate, and seminal vesicles are involved in the pathological process. Fever, chills and general malaise may occur. The act of defecation becomes painful if the large intestine is involved in the process, and diarrhea is possible, sometimes with blood.

For the acute course of the disease in women, the characteristic signs will be:

• vaginal discharge is gray with a yellowish or greenish tint, with pus. They have a specific, rather strong odor;
• swelling, severe redness and the appearance of ulcers on the external genital organs;
• the process of urination is accompanied by pain, itching, burning, and becomes significantly more frequent;
• menstruation becomes very painful and profuse, with the release of blood clots, offensive;
• Bleeding is often observed between critical days;
• cramping, fairly intense pain in the lower abdomen.

The pathological process in the early stages is usually localized in the vagina, and ascending gonorrhea can affect the cervix and urethra. Very rarely, lesions of the uterus itself can develop, since the squamous epithelium of this organ is immune to the pathogen.

However, some other pathologies that a woman has can provoke such a scenario. In particular, changes in hormonal levels during menopause, during puberty and with some endocrine ailments (for example, pathologies of the thyroid gland that affect hormonal status).

Since gonorrhea in women can be sluggish or completely asymptomatic, very often a visit to the doctor occurs at the stage of the chronic process. During this period, pathological changes can affect the uterus, appendages, and peritoneum. There is a significant increase in body temperature, diarrhea, nausea and vomiting. The general condition worsens.

Treatment methods

There is a standard scheme for how to treat gonorrhea. Typically, all therapeutic measures are carried out in specialized hospitals. Antibiotics are mandatory, as well as sulfonamides, immunomodulators and a nutritious diet.

If found in women, this does not always indicate the disease itself. If there are no symptoms, we are talking about carriage. However, comprehensive treatment is mandatory.

The treatment protocol is as follows:

• antibiotics of the cephalosporin, fluoroquinolone or macrolide series. Which drug will be prescribed depends on laboratory parameters. A test is carried out to determine the sensitivity of gonococcus to a certain type of drug;
• introduction of a special gonococcal vaccine as an adjuvant in the treatment of chronic forms of the disease;
• drugs that stimulate the immune system (immunomodulators). This could be Amiksin, Isoprinosine, Levamisole;
• natural-based medications that are biostimulants and adaptogens. This is a tincture of ginseng, eleutherococcus, lemongrass, aloe;
• local procedures in the form of baths and rinses with medicinal solutions;
• physiotherapeutic procedures affecting pathogenic microflora.

Complications of gonorrhea can lead to serious pathologies of internal organs. Once in the lymphatic system and bloodstream, gonococcus can provoke any disease that can be fatal.

If adequate treatment is carried out, gonococci die within 10-14 days. But it is necessary to follow all the doctor’s instructions and not interrupt the course when the discomfort symptoms disappear. Otherwise, the disease will go into a chronic stage, and it will be much more difficult to cure it.