What are the signs of gonorrhea in women? Gonorrhea in women - symptoms and treatment, drugs, prevention
Gonorrhea is an infectious disease in which the pathogen is transmitted sexually (STI - sexually transmitted infections). Gonorrhea in women has certain characteristics associated with the characteristics of the female reproductive system. Gonorrhea in women is dangerous because if left untreated and the process becomes chronic, it can lead to infertility.
Cause of gonorrhea in women
The cause of gonorrhea in women is, in the vast majority of cases, unprotected sexual contact with a carrier of the infection. In rare cases, it is possible for a woman to become infected with gonorrhea through household means, usually by sharing towels or washcloths with the carrier of the pathogen. Most often, young girls (2-6 years old) become infected with gonorrhea through the household, and in the vast majority of cases, the source of infection is the infected mother.
The causative agent of gonorrhea is gonococcus. Gonococci are a type of bacteria that are sensitive to drying, antiseptics, high temperature treatment (death occurs at temperatures exceeding 55°C), and also to direct sunlight. Gonococcus is a highly contagious microorganism. This means that the chances of a woman becoming infected with gonorrhea through direct contact with the pathogen are very high, the probability is about 70%.
Symptoms of gonorrhea in women
The insidiousness of this disease is that early symptoms of gonorrhea in women, as a rule, are absent. This is the main difference between gonorrhea in women and gonorrhea in men, since due to the blurred clinical picture, gonorrhea in women more often spreads to the internal organs of the genitourinary system and becomes chronic.
Signs of gonorrhea in women in the initial stage of the acute form, with damage to the lower genital tract (labia, vagina, cervical canal, urethra), are not expressed. You may experience a slight burning sensation when urinating, vaginal itching, and a white, thick discharge. If treatment is not undertaken at this stage, gonococci spread further through the genitourinary tract and affect the upper part of the genitourinary system, usually the fallopian tubes and paraurethral glands. Symptoms of gonorrhea in women in this case are more pronounced. These are pain in the lower abdomen, fever, a sharp deterioration in general condition, frequent painful urination, and menstrual disorder.
When the inflammatory process becomes chronic, the signs of gonorrhea in women disappear again. The leading symptoms of gonorrhea in women in this case are menstrual irregularities and infertility.
In addition, in some cases, women may not have any signs of gonorrhea, and the disease will proceed in a latent form until it is discovered either when building a chain from an infected partner, or during an examination for another reason.
It should be noted that gonococcus affects the epithelium mainly at the site of infection. Therefore, if sexual contact with a carrier of the infection was carried out oral or anal, then signs of gonorrhea in women will appear in the form of gonorrheal stomatitis, tonsillitis, pharyngitis, or gonorrheal paraproctitis.
Diagnosis of gonorrhea in women
Gonorrhea in women is detected by bacteriological examination of the vaginal contents. A diagnostic sign is the detection of gonococcus in a smear. Doctors note that in recent years gonococcus has almost never been found in isolation, but polyinfection occurs when other STIs are present along with gonococcus.
Treatment of gonorrhea in women
Treatment of gonorrhea in women, as well as gonorrhea in men, must begin immediately after confirmation of the diagnosis. The later treatment for gonorrhea in women is started, the greater the likelihood of developing irreversible changes in the uterine appendages as a result of a chronic inflammatory process.
The main treatment for gonorrhea in women is antibiotic therapy. Antibiotics of the latest generation are used that can have an effect on gram-negative flora, which includes gonococcus. It must be borne in mind that gonococcus may be resistant to antibiotics, and also that treatment of gonorrhea in women at different stages requires different dosages, so self-medication is unacceptable.
The use of antibiotics leads to dysbiosis of both the intestines and the vagina, so treatment of gonorrhea in women is completed by taking drugs that help restore the microflora. An important condition for the treatment of gonorrhea in women is avoidance of alcohol and sexual intercourse. Therapy is carried out under bacteriological control. Gonorrhea in a woman is considered cured only when a control bacteriological examination shows the absence of gonococci in smears or scrapings.
Consequences of gonorrhea in women
As already mentioned, chronic gonorrhea in women can cause adhesions in the uterine appendages, which causes their obstruction and subsequent infertility. Since the uterus is also involved in the process, even if pregnancy occurs, the risk of miscarriage is very high. In most cases, pregnancy in women with gonorrhea ends in miscarriage or premature birth. A child passing through the birth canal of a woman with gonorrhea comes into direct contact with the pathogen, resulting in gonorrheal blepharitis and conjunctivitis of newborns.
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Gonorrhea in women is a disease that is transmitted sexually or transplacentally. The causative agent is the pathogenic organism gonococcus. During vaginal sex, the risk of infection is 100%, slightly less during oral sex, but only due to the antibacterial properties of salivary fluid.
The household method of transmission of such a disease is impossible, so you cannot become infected from a sick person, for example, through common household objects or in the bathroom. However, if the mother has such a disease, then at the birth of the child there is a fairly high probability that he will be infected.
The symptoms of gonorrhea in women are quite pronounced, but are somewhat nonspecific. Moreover, an asymptomatic course of the infectious process is also allowed, and in some cases a woman may have asymptomatic chronic gonorrheal pharyngitis. It should be noted that this variant of the course of the disease is more typical for those who are promiscuous.
The final diagnosis is made based on the results of diagnostic measures. You cannot compare symptoms and treatment on your own. Any medications and the duration of their use are prescribed only by a doctor.
Provided that treatment for gonorrhea in women is started in a timely manner, complications can be avoided. But for this, the patient must consult a doctor at the first sign.
Etiology
The causative agent of the disease is the pathogenic organism gonococcus. Infection occurs mainly through sexual contact, namely:
- during oral sex;
- during vaginal intercourse;
- during anal sex.
A household route of infection is possible, but this is unlikely. It is also possible that the child may become infected during passage through the birth canal.
The pathogenic organism itself is unstable to the external environment and quickly dies when exposed to direct ultraviolet rays and temperatures above 55 °C.
Predisposing factors for infection are:
- promiscuous sex life;
- ignoring barrier contraceptives;
- wearing someone else's underwear;
- presence of other infectious diseases;
- presence of such a disease in the anamnesis.
Women who lead an immoral lifestyle are at risk. This should include those who provide intimate services, drink alcohol in excessive quantities, take drugs, and do not have a permanent place of residence.
Classification
The disease is classified according to duration:
- fresh – the infection and development of the infectious process are no more than two months old;
- chronic – more than two months have passed since infection.
In the fresh form of the disease there are:
- spicy;
- I'll sharpen the form.
Chronic gonorrhea in women is also divided into several subtypes:
- asymptomatic;
- latent;
- hidden;
- acute;
- subacute.
In addition, depending on the localization of the infectious process, a fresh form and a chronic ascending form are distinguished. In the latter case, the infectious process can affect:
- pelvic peritoneum;
- fallopian tubes;
- ovaries.
Inflammation of the endometrium of the uterus cannot be ruled out.
The shape affects how gonorrhea manifests itself in women. However, you do not need to start treatment on your own, even if you are completely confident in the diagnosis. The treatment regimen, the selection of drugs - all this lies within the competence of a qualified doctor.
Symptoms
The incubation period for gonorrhea can last 3-7 days, in some cases 2-3 weeks. If the immune system is too weakened, the first signs of gonorrhea in women may appear as early as 48 hours after infection.
An asymptomatic course is usually observed in cases where the patient took antibacterial drugs for another disease, or began treatment on her own at home. In both the first and second cases, this does not guarantee complete elimination of the disease. It should also be noted that it does not provide immunity.
In women, the first signs of the disease will depend on what form it occurs. So, if the genitourinary system is affected in women, the possible symptoms of gonorrhea will be of the following nature:
- Discharge from gonorrhea in women is white-yellow in color, purulent consistency, with a strong unpleasant odor. This is a specific symptom of this disease;
- the external opening of the urethra is inflamed, swelling and severe redness are possible;
- severe, sharp pain when urinating;
- itching and burning in the external genitalia;
- nagging pain in the lower abdomen;
- bleeding of a viscous consistency that is not related to menstruation;
- pain and discomfort during sexual intercourse, decreased libido.
With gonorrheal pharyngitis, the clinical picture will be characterized as follows:
- the appearance of purulent foci on the tonsils and palatine arches;
- increased salivation;
- sore throat, but this symptom is not always present;
- swelling of the throat.
Due to this nature of the clinical picture, the disease is often confused with sore throat and they begin treatment with various drugs on their own at home, without consulting a doctor.
With gonorrheal proctitis the following symptomatic complex will be present:
- itching in the anal area;
- discharge of mucopurulent exudate from the anus;
- pain during defecation;
- the presence of blood and mucus in the stool.
In the chronic course of the pathological process, the clinical picture may be almost completely absent. From time to time, “morning drop syndrome” may occur - in the morning after sleep, there may be a small amount of purulent exudate at the opening of the urethra.
Diagnostics
At the first signs of a clinical picture, you should urgently seek medical help. In order to determine how to treat gonorrhea in women, the doctor prescribes diagnostic procedures, namely:
- direct bacterioscopy;
- A smear is taken from the vagina for gonorrhea in women;
- antibiotic sensitivity test;
- sowing biological material on a nutrient medium.
It should be noted that testing for gonorrhea not only makes it possible to accurately determine the type of pathological process, but also helps to select effective drugs, for example, tablets for gonorrhea.
The doctor who will conduct the tests will show you how to take a vaginal smear correctly. The patient must have a special gynecological kit with her.
Treatment
If treatment is started in a timely manner, complications can be avoided. Moreover, the patient’s well-being usually improves after just a few days of taking medications prescribed by the doctor.
Since the pathogenic organism has many strains, not one antibiotic drug can be used in treatment, but several at once - the dosage regimen is determined individually.
In general, drug therapy may include:
- antibiotics;
- suppositories for gonorrhea;
- vitamin and mineral complexes to strengthen the immune system;
- probiotics or prebiotics.
We can talk about complete recovery only when the woman finishes taking various medications prescribed by the doctor, and the test results show the complete absence of gonococcus in the female body. Also, complete sexual rest is indicated for the period of treatment.
Possible complications
For women, this disease is extremely dangerous, since when it becomes chronic, the following complications may develop:
- frigidity;
- miscarriage;
- complications during childbirth;
- development of adhesions leading to infertility;
- damage to other parts of the genitourinary system, with all the ensuing consequences.
To prevent the development of such serious and partly irreversible complications, you need to see a doctor immediately - as soon as the first symptoms appear, and not prescribe medications to yourself.
Prevention
- prevention of infectious diseases;
- use of barrier contraceptives;
- avoiding frequent changes of sexual partners;
- refusal of drugs, excessive amounts of alcohol.
Once again, it is worth noting that you cannot self-medicate without an accurate diagnosis from a doctor. Such actions can lead to significant complications.
In the age of antibiotics, contracting an infectious disease is not as dangerous as it was several centuries ago. Usually, the symptoms of gonorrhea in women are difficult to confuse with another pathology, so treatment can be started on time, without waiting for complications to develop. But erased signs of the disease are also common. In this case, taking medications becomes untimely. What are the risks and how to prevent complications?
Inflammatory diseases of the genital area cause a lot of inconvenience. In women, they are associated with discomfort, the appearance of pain depending on the level of damage, and the addition of dysuric disorders. The lack of timely treatment leads to the transition of inflammation to the overlying sections, and non-compliance with the recommended regimens results in chronicity of the process. Gonorrhea is no exception. Chronic forms are no less dangerous than acute gonorrhea.
Disease history
The first mentions of gonorrhea appeared in the 16th century BC. e. in the Egyptian Ebers Papyrus. At the same time, the first methods of treatment were proposed - washing with astringents. There are references to the symptoms of the disease in the Bible, the works of ancient Greek scientists, Hippocrates, and Celsus. Galen called this disease “discharge of semen,” although he pointed out the need to distinguish it from true ejaculation during sexual arousal. But the name was firmly entrenched and preserved to this day.
Treatment was carried out by douching with lead solutions, Avicenna washed the bladder with water from a silver syringe. Basic preventive measures were also identified:
- sexual relations- prohibited until seven days after the end of the illness;
- isolation - of every patient with gonorrhea;
- personal belongings - the patient’s bed, chair and people with whom he was in contact were considered “unclean”.
The syphilis epidemic that swept through Europe after the discovery of America diverted attention from gonorrhea. For a long time it was considered one of the manifestations of syphilis. In 1527, a French scientist classified them as a group of venereal diseases.
Gradually, the development of microbiology and immunology made it possible to identify the causative agent of the disease, as well as to develop a vaccine, thanks to which it was proven that syphilis and gonorrhea are different diseases.
The discovery of antibiotics in the 20th century advanced the treatment of gonorrhea to a new level. But even in modern conditions, the disease does not lose its relevance: the latent course in some women, the development of resistance to many drugs makes it dangerous for reproductive health.
Features of the pathogen
The development of microbiology allowed the German doctor Albert Ludwig Neisser to isolate the causative agent of gonorrhea in 1879. These are cocci, which are shaped like coffee beans and are arranged in pairs. They have the following features.
- Incomplete phagocytosis. In pus, diplococci can be located inside leukocytes, but remain viable. This property explains the ability of the disease to become chronic. It also allows the pathogen to evade the action of drugs and spread to other parts of the genital organs.
- Low stability. In the external environment, bacteria quickly die. When heated to 40°C, they die within three to six hours, and at 56°C, within five minutes. Can't withstand refrigeration. The pus can persist for 24 hours. They die under the influence of silver salts. They are sensitive to penicillins and streptomycin, but during treatment they become resistant to them.
- Antigenic structure. During treatment, it can seriously change and form L-forms. The latter have a different structure, which allows them to persist in the body for a long time and evade the action of antibiotics.
- Immunity. There is no innate resistance to gonorrhea. Having the disease does not protect against re-infection.
Development of the pathological process
The infection is transmitted only from person to person; animals do not get sick. The causes of gonorrhea in women are a sick man and sexual contact with him. Gonococcus can survive in pus, so there is a possibility of infection through a shared towel, washcloth, or underwear. But this method is more relevant for girls.
- Penetration method. Bacteria are often found attached to sperm, epithelial cells, and also inside Trichomonas. They act as carriers that help the pathogen penetrate into the overlying parts of the genitourinary tract.
- Affected areas. Parts of the genitourinary system lined with columnar epithelium are affected - the urethra, cervical canal, fallopian tubes. With oral contact, stomatitis, pharyngitis, and tonsillitis develop. When rectal - gonorrheal proctitis. Children after childbirth from an infected mother have blepharitis (eye damage).
- Protection in the vagina. The vaginal wall is lined with stratified squamous epithelium, which is not suitable for the life of gonococcus. But when it becomes thinner or has a loose structure, conditions are created for the microbe to attach. Such features of the epithelium appear during pregnancy, postmenopause, and also in girls before puberty.
- Penetration into the blood. Gonococci are able to enter the blood, but most of them die. The remaining ones spread throughout the body and form extragenital lesions. The joints are most often affected; gonococcal endocarditis and meningitis develop less often.
- Incubation period. Usually lasts 3-15 days, very rarely up to a month. In women it lasts longer than in men.
For infection to occur, a sufficient number of pathogens must enter the vagina. That is, a single contact does not always lead to illness. Therefore, the household transmission mechanism is irrelevant.
Symptoms of gonorrhea in women
Often the pathology is asymptomatic. Signs of gonorrhea in women are nonspecific and can be mistaken for symptoms of candidiasis or cystitis. How long it takes for gonorrhea to appear depends on the number of gonococci and the reactivity of the body. At the end of the incubation period, symptoms may not appear or may not be expressed.
- Urinary disorders. Dysuric disorders manifest themselves in the form of burning sensation and frequent urge to go to the toilet. In men, there is pronounced discharge of pus and hyperemia of the urethra (in women this sign is invisible). Some pus may be released and stick to the urethra. But these symptoms are not expressed.
- Vaginal discharge. The appearance of yellowish-white discharge is not always associated with gonorrhea. They are odorless and scanty. This is due to the fact that it is not the vagina itself that is affected, but the cervical canal. Therefore, the discharge may not be noticeable on the gynecologist’s chair during an external examination, but can only be seen in the mirrors.
- Bleeding. With advanced gonorrhea, intermenstrual bleeding may appear.
- Lower abdominal pain. This is a mild symptom that may be absent in most cases.
In women, the process is often multifocal, affecting the urethra and internal organs. Cervical lesions cannot be recognized from the outside. On examination, it appears swollen and inflamed. Pus leaks from the cervical canal.
Gonococcal goes into. At the same time, the condition worsens, the symptoms become more pronounced. Damage to the muscular layer of the uterus leads to myometritis. In this case, the uterus becomes dense, increases in size, and hurts during palpation and during sexual intercourse.
From the uterus, gonorrhea quickly spreads to the fallopian tubes and ovaries. Salpingoophoritis develops. If gonococci penetrate into the abdominal cavity through the ampullary end of the tube, peritonitis will form.
Gonorrhea is dangerous during pregnancy due to the possibility of infecting the child during childbirth. In this case, the eyes are affected, and gonorrheal blepharitis develops. Since the disease can have a hidden course and be undiagnosed before birth, all newborns are given prophylaxis: immediately after birth, the eyes are instilled with a 30% Albucid solution. For girls, it is also instilled into the genital opening.
A rash is not typical for gonorrhea. This is a mandatory sign of syphilis. Therefore, if spots appear on the skin, you must inform your doctor.
Risks for girls
Before puberty, the vulvar ring and labia are involved in the inflammatory process. Children infected with gonorrhea are characterized by a tendency to relapse, multifocal lesions, as well as post-gonorrheal complications.
It should be remembered that in modern conditions latent gonorrhea is often observed, which is detected only by laboratory tests.
Diagnostic approaches
Dermatovenerologists examine and treat patients with gonorrhea. Diagnosis includes a mandatory examination and medical history. The doctor finds out the following points:
- time of sexual intercourse;
- timing of symptoms;
- whether the person who infected is a family member;
- Has he been examined?
The woman is offered a smear test for gonorrhea. This is the most reliable diagnostic method. Material for research is taken from the following places:
- urethra;
- cervical canal;
- lateral vaginal vaults;
- large vestibular glands;
- paraurethral glands.
A smear is necessary for microscopic examination. Cultural analysis is carried out based on the results of inoculation on special nutrient media. In this case, decoding helps determine the sensitivity of the pathogen to certain antibiotics.
The following studies are also relevant.
- Analysis of urine . Necessary for identifying concomitant diseases of the urinary system.
- Colposcopy. Examination of the vagina and cervix using a colposcope. Gonorrhea may be accompanied by the formation of cervical erosion, which increases the risk of cancer.
- Ultrasound of the pelvic organs. Allows you to see the area of spread of the inflammatory process to the uterus and appendages. This determines further treatment tactics.
According to indications, in the presence of purulent lesions in the rectum, oral cavity, eyes, consultations with a proctologist, ENT doctor, or ophthalmologist are prescribed.
Due to the peculiarities of the physiology of the genitourinary system in girls, if the mother or father is ill, the child must be examined.
Treatment tactics
Treatment of gonorrhea in women is based on the protocols of the Ministry of Health. They determine the list of medications for local localization of the infectious process. The treatment regimen for gonorrhea in women is presented in the table.
Table - Treatment of localized uncomplicated gonorrhea
| A drug | Dosage | Reception features | Level of Evidence of Effectiveness |
|---|---|---|---|
| "Ceftriaxone" | 250 mg per muscle | One time | A |
| "Ciprofloxacin" | 500 mg orally | One time | A |
| "Ofloxacin" | 400 mg orally | One time | A |
| "Spectinomycin" | 2.0 g per muscle | One time | A |
| Benzylpenicillin sodium and potassium salt | - Initial dose of 60 thousand units into the muscle; - every 3 hours, 40 thousand units | For the entire course 3 million 400 thousand units | WITH |
The course of treatment may change if gonorrhea is combined with other sexually transmitted infections. Frequent companions can be chlamydia, trichomonas. Then drugs are added depending on the type of pathogen. For chronic gonorrhea, a vaccine is added to the regimen. Treatment of gonorrhea is supplemented by the following recommendations.
- Alcohol . A strict ban on alcohol consumption is introduced for the entire duration of treatment until negative culture results are obtained. It acts as a provocateur. Sometimes it is recommended to drink a glass of beer in the evening before taking the next test. If gonorrhea is not treated, it will make itself felt in the tests.
- Nutrition . A balanced diet enriched with protein and increased amounts of fluid is necessary. Hot spices and seasonings are not recommended.
- Sex life. During treatment and until normal tests are obtained, complete rest. Otherwise, further spread of infection will occur.
ethnoscience
Many people prefer folk remedies to evidence-based medicine. At the same time, they independently make candles, ointments, and decoctions based on herbs and various chemicals. But it should be remembered that the causative agent of gonorrhea is a bacterium that is surrounded by a special protective layer and is able to hide inside cells. Local drugs are not able to have an effect on it or will lead to a temporary subsidence of the process, followed by a relapse.
Therefore, it is impossible to cure gonorrhea at home without the use of antibiotics. For women, the consequences of such irresponsibility can result in infertility.
Preventive measures
It is much easier to prevent a disease than to treat it later. To do this, you should pay attention to the following rules.
- Personal safety. The most reliable means of protection is a condom.
- Control of connections. You should not engage in casual sex. Strangers may show no signs of obvious infection or may simply not say that they have recently been treated.
- Emergency prevention. After accidental unprotected sexual intercourse, be sure to immediately urinate, wash with soap, and treat the genitals with Miramistin or Chlorhexidine solution. You can also inject 1 ml of the drug into the urethra.
Prevention after sexual intercourse is effective in the first 2 hours. If more time has passed, you can consult your doctor for recommendations on taking preventive medications. But after 72 hours, these measures will also become ineffective and can only mask the signs of the disease.
The consequences of gonorrhea for women can be the most unpleasant. The tendency of the bacterium to infect the epithelium of the fallopian tubes leads to the development of adhesions in them. This is one of the causes of infertility, which is very difficult to treat. Reviews from survivors confirm this. If the tubes are obstructed, there is only one option for pregnancy - in vitro fertilization.
In Western countries, it is prevalent mainly among homosexuals, as well as among men (and, accordingly, their partners) who have had sexual intercourse in developing countries.
Causes of gonorrhea in women
The causative agent of gonorrhea is a gram-negative diplococcus (gonococcus), which is localized in columnar epithelial cells. In women, gonorrhea can affect the urethra, cervix and rectum, as well as the pharynx and tonsils. The classic symptom of gonorrhea in men is mucopurulent discharge from the urethra, while in women, gonorrhea, like chlamydia, is often asymptomatic. The incubation period is 4-7 days. Gonococci, like chlamydia, can cause PID, as well as bartholinitis.
Nowadays, it affects mainly young people aged 16-18 years. Previously, the disease was called gonorrhea. Since the human body does not develop immunity to the pathogen, re-infection is possible.
Newborns from mothers with gonorrhea during childbirth can become infected through extrasexual contact. Gonococcus, getting into the eyes of a baby, causes blenorrhea, which is manifested by suppuration from the eyes. In girls, the microbe may end up in the genital opening.
Infection can also occur through shared beds, toiletries, etc. contaminated with secretions. Pathogenesis. Gonococcus infects mucous membranes covered with columnar epithelium (urethra, cervical canal, excretory duct of Bartholin's gland, rectum), penetrates into the submucosa, where it multiplies and causes an inflammatory reaction. From the primary focus, the infection spreads by the lymphatic route, less often hematogenously. There are gonorrhea of the lower sections (up to the cervix inclusive) and the upper sections (body of the uterus, appendages, pelvic peritoneum). Infection during sexual intercourse with primary infection of the urethra occurs, as a rule, in nulliparous women, with primary infection of the cervical canal in women who have given birth. Primary damage to organs covered with stratified squamous epithelium (vagina, vestibule of the vagina) is possible only in girls, elderly women and pregnant women.
Gonorrhea, according to its clinical course, is divided into acute and chronic; it can be asymptomatic, when without painful manifestations the diagnosis is established only on the basis of the detection of gonococci, and latent, when in the absence of symptoms and without detection of gonococci, a woman is an undoubted source of infection.
Symptoms and signs of gonorrhea in women
In Women, the disease may not manifest itself, even if gonorrhea is “fresh”. The symptoms can be very minor, and the woman often does not pay attention to them. In the absence of signs of disease, carriers of gonococcus usually do not suspect an infection, but they may well infect their sexual partner.
Signs of the disease in women: burning around the vagina, slight itching, burning after urination, increased menstrual bleeding, pain in the lower abdomen, vaginal discharge - yellowish-green and viscous. If left untreated, acute inflammation turns into a sluggish chronic disease. The inflammatory process develops in an ascending manner, affecting the uterus, appendages, urethra, ovaries and even the peritoneum.
The consequences of chronic gonorrhea in women are that the fallopian tube, due to the formation of adhesions, becomes impassable for sperm and eggs, which leads to infertility.
Recognizing gonorrhea in women
Women with urethritis, bilateral bartholinitis, bilateral inflammation of the uterine appendages, endocervicitis in primary infertility, and the appearance of acute inflammatory diseases of the genital area after menstruation, abortion, childbirth, often suffering from exacerbation of chronic inflammatory processes, are subject to special examination for gonorrhea.
The diagnosis is established based on an assessment of the totality of data from the anamnesis, clinical, bacterioscopic, bacteriological and immunological examination. When collecting anamnesis, attention is paid to the presence of symptoms of the disease and their connection with sexual intercourse. During a clinical examination, the excretory ducts of the Bartholin glands, the external opening of the urethra, the Skenian ducts, the external os of the cervix, and the appendages are carefully examined and palpated. During the examination, after a preliminary massage, a sharp spoon is used to take discharge from the urethra and from the cervical canal for bacterioscopic examination. Gonococcus is a gram-negative microbe.
There are three bacterioscopic pictures: K 1 - in the smear there is a large number of segmented leukocytes, there is no flora, but gonococci are detected intra- and extracellularly; K2 - a large number of segmented leukocytes, desquamated epithelial cells, no flora - the smear is very suspicious of gonorrhea; K3 - a small number of leukocytes and a diverse flora, which is not typical for gonorrhea. To detect rectal gonorrhea, lumps of mucus from the washing water are examined.
The bacteriological method of growing a culture makes it possible to increase the number of identified patients. When sending the material to the laboratory, it is necessary to place a cotton swab with secretions in a test tube, at the bottom of which pour a little water to moisten it. The test tube is placed in a thermos and covered with pieces of ice, because at a temperature of 5° and above, the gonococcus begins to multiply, without a sufficient nutrient medium it degenerates and loses germination. The bacteriological method is especially useful for asymptomatic, chronic and latent forms of gonorrhea.
The increase in the number of identified cases is facilitated by various methods of provocation aimed at exacerbating the course of local processes, increasing exudation, washing out of crevices and detecting gonococci in increased secretions.
Provocation methods:
- biological - taking smears during menstruation;
- immunobiological - taking smears after administration of the gonovaccine;
- chemical - lubricating foci of inflammation with 1-2-3% lapis solution;
- mechanical - bougienage, massage;
- thermal - abdominal-sacral diathermy for 30-40 minutes;
- a combined method that includes various methods. For example, after the introduction of gonovaccine, chemical methods are used, etc.
Gonovaccine is administered in an amount of 200-300 million microbial bodies, after 48 hours smears are taken and the general and local focal reaction is observed.
Immunological diagnostic methods are based on the use of the Bordet-Zhangu reaction (important in retrospective diagnosis), the Lisovskaya-Feigel reaction in discharge from the urethra and cervical canal.
Gonorrhea of the urethra. Symptoms are pain at the end of urination, swelling and eversion of the urethral mucosa, discharge of pus with a light massage from the vagina. In the chronic form, the clinical picture is blurred.
Gonorrhea of the paraurethral ducts. The result of a secondary lesion from the urethra. Manifests itself in the form of swelling, purulent plugs in the area of the small glands of the vestibule, infiltration. In the chronic stage, periurethral infiltrates and abscesses are often found.
Vaginal gonorrhea. Swelling, hyperemia of the mucous membrane, profuse flow of pus, formation of genital warts. The mucous membrane is rough and bleeds easily. Patients complain of itching, burning, nagging pain in the lower abdomen.
Gonorrhea of the rectum. The disease develops secondarily when secretions enter the genital tract during defecation. Usually occurs 2-3 weeks after the initial lesion of the genital area.
Patients complain of itching, burning in the anus, pain during bowel movements. Upon examination, swelling, hyperemia, purulent plaque, and ulceration of the rectum are determined. In the chronic stage, the picture is more blurred, and infiltrates may occur.
Gonorrhea of the cervical canal of the uterus. Patients complain of the appearance of viscous pain, mucopurulent discharge, and a feeling of pressure in the lower abdomen. In the acute stage, upon examination, hyperemia and swelling of the external pharynx and the discharge of pus are determined. In the chronic stage, erosions and ectropions are formed. Blockage of the glands of the mucous membrane of the cervical canal leads to the formation of small retention cysts (ovula Nabothii), infiltration and hypertrophy of the cervix.
Gonorrhea of the uterine mucosa. In the acute stage, symptoms of a general illness appear: chills, high temperature, general deterioration, severe pain in the lower abdomen. A gynecological examination reveals an enlarged, painful, pasty uterus, serous-purulent or purulent-bloody discharge; The menstrual cycle is often disrupted.
Gonorrhea of the uterus. The acute period is manifested by chills, high fever, severe pain in the lower abdomen, and mild symptoms of peritoneal irritation in the lower abdomen. Bilateral damage to the appendages is typical. Primary tubal disease develops as endosal ingitis. Subsequently, the muscle layer is also affected with the formation of infiltrates. The outcome of tubal damage is the formation of closed chambers along the tube and its thickening (nodose salpingitis), accumulation of exudate in its lumen and saccular expansion (sactosalpinx) with serous (hydrosalpinx) or purulent (pyosalpinx) contents. In 75% of cases of gonorrhea, tubal obstruction and infertility develop. The transfer of gonorrhea to the ovary and its damage occurs either by the lymphogenous route or by the introduction of gonococcus into the ovulated follicle with the formation of purulent inflammation (oophoritis). Often an adhesive process occurs between the tubes and ovaries (periadnexitis) with the formation of a general inflammatory tumor (andex-tumor). The addition of pyogenic microbes plays a significant role in the occurrence and development of gonorrheal adnexitis. Involvement of the ovary in the inflammatory process usually leads to menstrual dysfunction. Perforation of ulcers is possible.
Gonorrhea of the tissue and peritoneum. It occurs when an infection is transmitted through the lymphatic tract and is characterized by severe pain, high fever, chills, and severe peritoneal symptoms in the lower abdomen. In the acute stage, vaginal examination is extremely painful. The general conglomerate of the pelvic organs and their infiltration are determined. Numerous fusions of the genital organs with the rectum, bladder, large intestine, closed cavities with purulent contents are formed, especially often in the area of the posterior pouch of Douglas.
Gonorrhea during pregnancy. The disease manifests itself with very clear clinical symptoms: frequent, painful urination, profuse purulent discharge, rapid formation of cervical erosions, damage to the mucous membrane of the vagina and vestibule with the appearance of genital warts. With infection in the first 3-4 months of pregnancy, miscarriages are possible due to the development of specific endometritis.
Gonorrhea in the postpartum period. Symptoms appear at the end of the 1st - beginning of the 2nd week of the postpartum period with chills, high fever, pain in the lower abdomen, slow involution of the uterus, prolonged discharge of purulent-bloody or serous-purulent lochia.
Gonorrhea in girls. The vulva is primarily affected, and then the vagina. In 60% of cases, gonorrheal proctitis occurs, and urethritis often develops. Gonorrhea of the upper genital tract does not occur in girls. As a rule, due to scratching and the addition of other flora, the disease is accompanied by cracks, dermatitis of the external genitalia, intergluteal fold, and inner thighs. Girls complain of pain, itching, burning, and heavy discharge. An adhesive process of the labia minora and vagina may develop. The disease often takes a protracted course.
Treatment of gonorrhea in women
There are several treatments for gonorrhea:
- ciprofloxacin;
- ofloxacin;
- ampicillin and probenecid (if local prevalence of penicillin-resistant Neisseria gonorrhoeae< 5 %).
Treatment should be combined (general, local, symptomatic). In the acute stage, treatment is carried out in a hospital: bed rest, a diet without spicy foods, painkillers, penicillin in combination with streptomycin and sulfonamides. Penicillin can be replaced by two doses of bicillin, 600,000 units, with an interval of 4-5 days. Local procedures in the acute stage are prohibited.
When the process subsides, local procedures are used: a) for urethritis, washing the urethra with a solution of potassium permanganate and installing a 1-2% solution of protargol, in the chronic stage - lubricating the urethra with a 1% solution of lapis, injection under the mucous membrane of penicillin; b) for skeneitis, vulvovaginitis, endocervicitis, proctitis - baths with a 3-5% solution of protargol, lubrication of the cervical canal, crypts of the mucous membrane with a 2% solution of lapis, injections into the thickness of the mucous membrane of antibiotics; c) for bartholinitis - warm semi-sitz baths. The development of an abscess or retention cyst dictates the need for surgical treatment.
Immunotherapy is used as an auxiliary treatment method and is designed to increase the body's reactivity. Gonovaccine is injected into the buttock 3-5 times, 200-300 million microbial bodies each with an interval of 2-3 days. It is possible to introduce it into the thickness of the cervix, into the submucous membrane of the rectum. The reaction to administration should not be expressed by chills, very high fever, or malaise. If such a reaction occurs, the dose should be reduced.
Contraindications: pregnancy, tuberculosis, liver, kidney, heart diseases.
Lactotherapy pursues the same goals. Milk is prepared ex tempore and administered intramuscularly, 1-2 ml 5-7 times at intervals of 1 day.
Autohemotherapy - 5 ml at intervals of 2-3 days.
Treatment of gonorrhea in pregnant women is fundamentally the same as in non-pregnant women; excludes only local procedures and the use of gonovaccine.
In the postpartum period, local treatment of the urethra and rectum can begin after 10 days, and for the cervix - 1 month after birth.
When treating girls under 3 years of age, immunotherapy is not performed. At older ages, gonovaccine is administered starting with 50 million microbial bodies. Otherwise, when choosing the dose of medications (antibiotics, sulfonamides), it is necessary to take into account the child’s age.
Criterion cured. At the end of treatment, the patient is examined: gynecological examination, taking smears. In the absence of gonococci, a provocation is carried out (see) and smears are taken again within 3 days. In the absence of gonococci, treatment is stopped and in the next three menstrual cycles, on the 1st, 2nd and 4th day of menstrual bleeding, smears are taken from the urethra and cervical canal. The absence of gonococci allows the patient to be considered cured and removed from the register.
Personal prevention. After sexual intercourse that is suspected of infection, it is necessary to wash the external genitalia with warm water and soap, douche the vagina with a solution of potassium permanganate, inject a 1% solution of lapis into the urethra, and treat the cervix with a 2% solution of lapis.
Prevention in children. The girl needs to have a separate bed, a separate chamber pot, and a separate sponge for washing. Personnel in children's institutions must be hired after examination by a venereologist and then undergo monthly checks. Children are also subject to medical examination. Each child is given individual dishes. Washing is allowed only with a stream of water, without sponges.
Physiotherapy gives good results - electrophoresis of copper and zinc, ultraviolet irradiation, UHF. Personal hygiene must be observed.
Traditional healers offer their own healing methods, but, we repeat, first of all you should remember about personal hygiene.
Decoction of calamus rhizomes for hot baths
Required: 70 g of calamus rhizomes, 1 liter of water.
Cooking method. Pour boiling water over the dried and crushed calamus roots, leave for 2 hours, then simmer over low heat for 10 minutes, strain immediately. Add the decoction to water heated to 37-38 °C.
Mode of application. Take warm baths for 20 minutes every other day. The course of treatment is 15 baths.
Gonorrhea in women
The content of the article:Gonorrhea in women most often occurs during their reproductive years. This sexually transmitted infectious disease can lead to infertility or problems with pregnancy, so gonococcal infection requires immediate treatment for both sexual partners. This sexually transmitted disease is also called gonorrhoea or gonorrhoea.
According to WHO statistics, gonorrhea is a very common infection. Each year, approximately 200 million people are diagnosed with the disease. In the Russian Federation in the 90s, there was a slight decrease in the growth of the number of cases, but after a few years the situation began to worsen. And now the incidence reaches more than 100 cases per 100 thousand people.
What is gonorrhea in women
Gonorrhea is a sexually transmitted disease caused by gonococcus and primarily affects the genitourinary organs. The mucous membranes of the mouth, rectum and conjunctiva of the eyes may also be affected. According to ICD-10 code A54 - Gonococcal infection.
How is gonorrhea diagnosed in women?
When a case of gonorrhea is identified, it is necessary to examine people who had sexual contact with the patient within a month before the patient developed symptoms of infection. If there is an asymptomatic course of the disease, it is necessary to examine those who had sexual intercourse with the patient in the last two months before diagnosis. Also, everyone who was in everyday contact with the patient should be involved in the examination. In addition, it is necessary to pay special attention to the health status of children of sick women. Sick personnel are not allowed to work.
The causative agent of gonorrhea is the gram-negative bacterium Neisseria gonorrhoeae, which belongs to paired cocci and has a bean-shaped shape. Gonococci are located inside cells, within the cytoplasm of leukocytes. These organisms are characterized by increased sensitivity to various external factors. They die when the temperature rises to just 55 degrees. Also harmful to them is exposure to sunlight and drying out. Treatment with antiseptic solutions gives a good effect. The bacterium remains viable in fresh pus. After it dries, the gonococcus dies.
The causative agents of gonorrhea are not able to move, they do not form spores. These organisms have very thin threads, thanks to which they can be held on the surface of epithelial cells, red blood cells, and male germ cells - sperm.
On top, each bacterium is covered with a layer of a special substance and is, as it were, located in a capsule. Therefore, the destruction of such organisms is difficult. Treatment is complicated by the fact that the pathogen can be located inside epithelial cells, Trichomonas and leukocytes.
If the course of treatment was prescribed incorrectly, special forms of the pathogen may appear - L-forms. They differ from typical organisms in a number of biological and morphological characteristics. L-shapes have the appearance of a ball, their color and size can vary. Such gonococci do not show sensitivity to the antibacterial drug that provoked their formation. This is due to the fact that they have partially lost their antigenic properties. The presence of such forms interferes with correct diagnosis and greatly complicates antibacterial therapy. The infection remains in the body due to its transformation into vegetative forms. After many years of using antibiotics to treat gonorrhea, many strains have emerged that are capable of producing lactamase. They have become resistant to drugs that contain a lactam ring.
Ways of transmission of gonorrhea
Most often, infection with gonorrhea occurs through sexual contact. Moreover, for men the contagiousness is 25-50%, and for women this figure is higher (up to 50-70%).
Cases of household transmission of infection are not recorded very often. In everyday life, rare causes of infection are usually towels, linen, washcloths, etc. Girls are at greater risk of household infection than boys. Facts of intrauterine infection have not been confirmed. During natural childbirth, the child may become infected from a mother infected with gonococcus.
Most often, the infection develops in the mucosa of the cervical canal, fallopian tubes, urethra, large vestibular and paraurethral glands. That is, areas that are lined by columnar epithelium are susceptible to damage.
After oral-genital sexual intercourse, the development of gonorrheal stomatitis, tonsillitis or pharyngitis is possible. As a result of anal contact, gonorrheal proctitis cannot be ruled out. If the infection gets into the eyes (for example, during childbirth, when the baby passes through the birth canal of a sick mother), gonorrheal conjunctivitis is possible.
The walls of the vagina are less susceptible to the development of an infectious process, since they are covered with stratified epithelium. However, in children, mature women and pregnant women, the epithelium may thin out or become loose. In such cases, there is a risk of gonorrheal vaginitis.
Thanks to the presence of threads (piles), pathogens that enter the body attach to epithelial cells. Then the bacteria penetrate into the cells, intercellular gaps and the space under the epithelium. Because of this, the epithelium begins to collapse and an inflammatory process occurs.
In the genitourinary tract, the spread of infection goes from the lower to the upper sections. When gonococci are fixed on sperm and with enterobiasis inside Trichomonas, progress occurs more quickly.
There are cases when gonococcus penetrates the bloodstream. But this happens infrequently, since the serum has a bactericidal effect. If this happens, then the infectious process generalizes and foci of the disease arise in other parts of the body. The joints are usually affected. Complications in the form of gonorrheal meningitis or gonorrheal endocarditis are also possible.
When a gonorrheal infection enters the human body, antibodies begin to be produced. But immunity is not lifelong and is not very effective. You can become infected and get sick again. This is most likely due to the fact that gonococcus is characterized by antigenic variability.
Symptoms of gonorrhea in women
The incubation period in most cases is 3-15 days. Sometimes it can last for a whole month. If the lower urinary tract is affected, the disease may develop asymptomatically. With a pronounced infectious process, redness of the mouth of the urethra and cervical canal, as well as their swelling, is observed. Patients complain of dysuric symptoms, discomfort in the vagina (burning, itching). A discharge similar to pus appears.
Patients with ascending gonorrhea (involving the upper sections) have other complaints. In such cases, general well-being noticeably worsens. The temperature can rise to 39 degrees, chills are felt. Nausea and vomiting appear, stool becomes liquid, and severe discomfort occurs when urinating. The menstrual cycle may also be disrupted. The spread of gonorrheal infection can be triggered by certain medical procedures. These include: uterine curettage, abortion, biopsy, aspirate collection, probing of the uterine cavity, intrauterine device. Often acute inflammation occurs after childbirth or menstruation.
An objective examination shows purulent discharge, an enlarged and painful uterus, and a soft consistency (in patients with endomyometritis). With gonorrheal salpingoophoritis, swelling and tenderness of the appendages are observed. If peritonitis has developed, abdominal pain is observed during palpation, and symptoms of peritoneal irritation are present. Acute infection in the appendages can lead to a serious complication - inflammatory tubo-ovarian formations and even abscesses. First of all, this happens if the infection develops during the use of intrauterine contraceptives.
The scientific literature indicates the following features of the course of the disease in ascending gonorrhea:
Discharge with blood.
Involvement of both appendages in the process.
Dependence of the inflammatory process on childbirth, gynecological procedures, and abortions.
The onset of the effect of treatment in a short time. After the start of therapy, the level of leukocytes decreases, the temperature normalizes. ESR remains elevated.
Recently, the development of the disease without pronounced symptoms has become increasingly common. This is associated with mixed infections. With mixed infections, the incubation period becomes very long. Relapses in such cases become more frequent. Timely diagnosis and proper treatment are difficult.
When inflammation becomes chronic, a woman’s cycle is disrupted, and an adhesive process begins in the pelvis. In the future, such changes can cause dangerous complications: infertility, miscarriage, ectopic pregnancy. Chronic pelvic pain syndrome develops.
With gonorrheal proctitis, no pronounced symptoms are observed. Only in some cases can the disease manifest itself as a burning sensation in the anus, severe itching, discomfort during bowel movements, and tenesmus.
In pregnant women, gonorrhea manifests itself as cervicitis and vaginitis. The membranes may rupture prematurely. During and after childbirth, patients with gonorrhea have a very high temperature. Septic abortion cannot be ruled out. Sometimes in the first trimester of pregnancy, gonorrhea can develop in the form of gonococcal salpingitis.
Gonorrhea is manifested by the following diseases:
Gonorrheal cervicitis or endocervicitis;
Gonorrheal urethritis;
Gonorrheal endometritis;
Gonorrheal salpingitis and salpingoophoritis;
Gonorrheal pelvioperitonitis.
Diagnosis of gonorrhea in women
Diagnosis begins with a history and physical examination of the patient. Then laboratory tests are ordered. The causative agent of infection is detected using bacterioscopic and bacteriological methods. Gonococcus is identified by the following basic criteria: it is gram-negative, diplococcus, and is located inside the cells.
This organism is capable of mutating under the influence of external factors, so bacterioscopy does not always identify it. The sensitivity of the method is 45–80%, and the specificity is 38%. To promptly identify asymptomatic forms, it is better to use the bacterioscopy method. This method is also recommended for examining children and pregnant women. Sowing is carried out in a special nutrient medium. Since the material is contaminated with foreign forms of flora, identifying the causative agent of gonorrhea can be difficult. To make it easier to detect, a selective medium with antibiotics is used. If the analysis cannot be carried out immediately, the material is left in a special transport medium. When the cultures grow, microscopy is performed to determine the sensitivity of the organisms to antibiotics. The bacteriological method has high sensitivity and specificity (90-100% and 98%, respectively). Biological material is collected for research using a bacteriological loop or a Volkmann spoon from the urethra, vagina, cervical canal, rectum or other place where an infectious process may develop. To collect material from the rectum, scraping or rinsing is performed using an isotonic sodium chloride solution.
Other laboratory methods include: DNA research, enzyme immunoassay, immunofluorescence. But they are rarely used.
The order of diagnostic procedures
1. Bacterioscopic examination colored material, which was taken from three points - U, V, C. In the case of chronic gonorrhea, gonococcus is usually found extracellularly. In acute infection, the pathogen is located inside the cells.
2. Bacteriological analysis, in which the sensitivity of the pathogen to antibiotics is assessed. Indications for such a study are repeated negative bacterioscopic results, detection of questionable organisms in smears, suspicion of gonorrhea.
3. RIF (immunofluorescence reaction).
4. ELISA (immunofluorescence analysis).
5. PCR and LCR methods.
6. Provocative tests. If smears and cultures do not reveal the pathogen, they resort to provocative tests using thermal, chemical immunological techniques. During such studies, care must be taken and all possible complications must be taken into account.
- Chemical. It involves treating the urethra with a solution of silver nitrate to a depth of up to 2 cm, the cervical canal - up to 1.5 cm, the rectum - up to 4 cm with Lugol's solution in glycerin.
- Biological. Gonovaccine (500 million microbial bodies) is administered intramuscularly. It is also possible to administer gonovaccine and pyrogenal together (dosage – 200 MTD).
- Thermal. Diathermy is performed for three days in a row. The first day is half an hour, the second day is 40 minutes, and the last day is 50 minutes. Another option is a three-day course of inductothermy once a day for 15 minutes. After each physiotherapy session, the discharge is taken for analysis.
- Physiological. A smear is taken during menstruation.
- Combined test. Thermal, chemical and biological tests are carried out within one day. Material for analysis is taken every other day, two and three days. Crops are performed after three days.
Methods for differential diagnosis of gonorrhea
Gonorrhea must be distinguished from other sexually transmitted infectious diseases. In the ascending form, differential diagnosis is necessary with diseases that are accompanied by symptoms of an acute abdomen.
Treatment of gonorrhea in women
There are several main ways to treat gonorrhea. It is important to follow this rule: the sexual partner of the sick person is also subject to treatment. Non-acute forms of gonorrhea are treated on an outpatient basis, but the presence of an acute course requires hospitalization. In the hospital, bed rest should be observed, injection antibacterial drugs, cold applied to the lower abdomen, infusion therapy (reopolyglucin, reogluman, reamberin, isotonic solutions of glucose or sodium chloride, glucose-procaine mixture, Trisol) and antihistamines (suprastin, tavegil) are prescribed.
Treatment of gonorrhea in women with antibiotics
Antibiotics are used to combat the pathogen. But positive results are not always achieved. There are strains that are resistant to antibiotics. The appearance of L-forms of gonococci is also possible. When prescribing treatment, you need to take into account the form of the disease, the prevalence of inflammation, its localization, and the presence of concomitant infectious processes. In addition, the possibility of complications and side effects must be taken into account.
Drugs for the treatment of gonorrhea in women
Penicillin antibiotics
Benzyl penicillin - from 4 to 8 million units (course 10-15 days);
Ampicillin - tablets 2-3 g per day at equal intervals for 4-6 doses (course from 7 to 20 days);
Oxacillin - tablets 3 g per day at equal intervals for 4-6 doses, course from 10-14 days;
Ampiox - tablets of 0.5-1 g every 4-6 times a day (course 5-7 days);
Carbenicillin disodium salt 4-8 g per day for 4-6 doses intramuscularly;
Unazine (sulacillin) 1.5-12 g per day for 3-4 doses intramuscularly or intravenously;
Amoxicillin with clavulanic acid (Augmentin) 1.2 g 3 times a day intravenously for 3 days, and then 625 mg 3 times a day orally for 5 days.
Tetracyclines
Tetracycline tablets 250 mg 4 times a day, course 14-21 days;
- (, vibramycin) 1 capsule (0.1 g) 2 times a day, course 10 days.
Macrolides and azalides
- (sumamed) 0.5 g, two tablets once, then for 4 days, 1 tablet (0.5 g) 1 time per day.
Midecamycin (macropen) 400 mg 3 times a day, course 6 days;
- (rovamycin) 3 million units 3 times a day, course 10 days;
Josamycin (vilprafen) 500 mg 2 times a day, course 10-14 days;
Rondomycin 0.2 g once, then 0.1 g once a day, course 14 days;
Clarithromycin (clacid, fromilid) - 300-500 mg tablets 2 times a day, course 10-14 days;
Roxithromycin (rulid, roxide, roxibid) 300 mg 2 times a day, course 10-14 days;
Erythromycin - 500 mg 4 times a day before meals orally, course 10-14 days;
Erythromycin ethyl succinate 800 mg 2 times per day, course one week;
Clindamycin (Dalacin C) 300 mg 4 times a day after meals, course 7-10 days or intramuscularly 300 mg 3 times a day, course 7 days.
Aminoglycosides
Kanamycin 1 g 2 times a day intramuscularly, the course will require 6 g. Oto is also nephrotoxic and cannot be prescribed with antibiotics with similar complications.
Cephalosporins
Cefazolin 0.5 g 4 times a day intramuscularly or intravenously, course 5-7 days;
- ceftriaxone 1.0-2.0 g 2 times a day, diluted in 2 ml of lidocaine, injected intramuscularly, course 3 days;
Cefatoxime (claforan) 1.0 g 2 times a day, course 5 days;
Cefaclor capsules 0.25 g 3 times a day, course 7 days;
Cephalexin 0.5 g 4 times a day, course 7-14 days.
Fluoroquinolones
Ofloxacin (zanocin, tarivid, ofloxin) 200 mg 2 times a day after meals, course 7 days;
Ciprofloxacin (Tsifran, Tsiprobay, Cipro-bid) 500 mg 2 times a day, course 7 days;
Pefloxacin (abactal) 600 mg once a day after meals, course 7 days;
Levofloxacin 400 mg 2 times a day, course 7-10 days;
Lomefloxacin (Maxaquin) 400 mg once a day, course 7-10 days;
Gatifloxacin (Tebris) 400 mg once a day for 7-10 days.
Treatment regimens for gonorrhea in women
| Features of the course of the disease | Drugs and treatment regimen | Note |
| Fresh gonorrhea of the lower genitourinary system without complications | 2 g orally once; ciprofloxacin 500 mg orally once; cefixime 400 mg orally once; Alternative treatment regimens for gonorrhea: ofloxacin 400 mg orally once; cefodisime 500 mg intramuscularly once; kanamycin 2.0 g intramuscularly once; trimethoprim + sulfamethoxazole (80 mg + 400 mg) 10 tablets orally once a day for three days. |
Contraindications for the use of fluoroquinolones are age under 14 years, pregnancy, and lactation. If an alternative regimen is used, then constant monitoring for changes in the sensitivity of the gonococcus is necessary. |
| Gonorrhea of the lower genitourinary system with complications or gonorrhea of the upper and pelvic organs | tceftriaxone 1 g intramuscularly or intravenously every 24 hours for one week; spectinomycin 2.0 g intramuscularly every 12 hours for 7 days. Alternative treatment regimens for complicated gonorrhea: cefotaxime 1 g intravenously every 8 hours; kanamycin 1 million units intramuscularly every 12 hours; 500 mg intravenously every 12 hours. The course lasts 48 hours, when the symptoms of acute gonorrhea disappear, you can switch to oral administration of drugs: 500 mg every 12 hours; ofloxacin 400 mg every 12 hours. |
During treatment, you should abstain from sexual intercourse and do not drink alcohol. If there is no effect of therapy, you need to use another antibiotic taking into account sensitivity. |
| Combination of chlamydial infection and gonorrhea | 1.0 g orally once; doxycycline 100 mg 2 times a day orally, course 7 days; josamycin 200 mg orally, course 7–10 days. |
In addition to antibiotics for gonorrhea, drugs for the treatment of chlamydia are added. |
| Combination of trichomoniasis and gonorrhea | metronidazole 250 mg orally 2 times a day, course 10 days; secnidazole 2 g orally once; ornidazole 500 mg morning and evening with an interval of 12 hours, course 10 days. |
If there is a suspicion of trichomoniasis in women, then antibiotics that kill Trichomonas are added to the usual treatment regimen. |
Vaginal eubiotics are prescribed together with or after a course of antibiotics to restore normal vaginal microflora. These are drugs that contain lactobacilli, bifidumbacteria bifidum or lactobacilli acidophilus.
Local treatment of gonorrhea in women
Local therapy for gonorrhea in women consists of restoring damaged mucous membranes of the vagina and urethra; for this purpose, use a 1–2% solution of silver proteinate, a 0.5% solution of silver nitrate, as well as microenemas with chamomile infusion (for 1 tablespoon of chamomile flowers, 1 glass of boiled water).
Immunotherapy for gonorrhea in women
Immunomodulatory drugs for gonorrhea are used quite rarely, since their prescription must be realistically justified. Immunotherapy for gonorrhea should be carried out after the disappearance of symptoms during antibiotic treatment or before antibiotic therapy, when the disease is subacute, torpid or chronic. Immunotherapy is allowed for children only after 3 years of age.
Immunotherapy can be:
Specific (use of gonococcal vaccine)
Nonspecific (pyrogenal, prodigiosan, autohemotherapy).
Physiotherapeutic treatment of gonorrhea in women
Sick women undergo physiotherapeutic sessions (inductothermy, magnetic therapy, laser therapy, ultraviolet light, electrophoresis and phonophoresis of medications).
Surgery for gonorrhea
For salpingitis and pelvioperitonitis, patients are treated with conservative methods. If therapy does not produce the desired effect within a day or two, a laparoscopic procedure is necessary. It makes it possible to carry out an accurate diagnosis, as well as to open and sanitize the focus of purulent inflammation. Patients with diffuse or diffuse peritonitis undergo laparatomy. The scope of such intervention is determined based on age, the degree of pathological changes in the pelvis, and reproductive history is also taken into account.
Treatment of gonorrhea in pregnant women
Treatment of gonorrhea during pregnancy can be carried out at any stage. Drugs allowed during pregnancy include:
Ceftriaxone 250 mg intramuscularly once;
Spectinomycin 2 g intramuscularly once.
Pregnant women should not use tetracyclines, fluoroquinolones, or aminoglycosides to treat gonorrhea, as they negatively affect fetal development.
If a complication of gonorrheal choriamnionitis develops, the pregnant woman should be hospitalized and treated according to the following regimen: ampicillin 0.5 g 4 times a day for 7 days or benzylpenicillin 20 million units per day until symptoms disappear. Local therapy, physiotherapy and immunotherapy should be added to antibacterial therapy, especially for chronic gonorrhea.
To prevent the development of gonorrhea in newborns, infants are instilled with 1-2 drops of sulfacetamide solution (30%) into the conjunctival sac.
Rehabilitation after treatment of gonorrhea in women
At this stage, it is necessary to evaluate the effectiveness of the therapy (7-10 days after its completion). The treatment criteria are:
No symptoms
Disappearance of gonococcus in smears during bacterioscopic examination. For diagnostic purposes, it is possible to perform provocative tests, including combined ones.
The second control is carried out during the next menstruation. Material for bacterioscopy is taken from the urethra, cervical canal, and rectum (three times at intervals of a day).
The third control involves a combined provocative test after menstruation with bacterioscopic and bacteriological analysis. If the pathogen is not detected, the patient can be removed from the register.
Today, many doctors question the need for multiple provocative tests. They suggest shortening the duration of observation after adequate therapy. According to these experts, modern methods are highly effective, and ongoing control measures have become impractical.
The European guidelines note the need for at least one follow-up examination to assess the correctness of treatment. And control laboratory tests are indicated only in case of protracted course of the disease, the likelihood of re-infection, or suspicion of resistance of the pathogenic organism.
If the disease is acute, affecting internal organs, there is a need for examination by related specialists (urologist, surgeon). It is possible to use laparoscopic techniques. If there are extragenital lesions, patients are referred for consultation to an ophthalmologist, ENT specialist, or orthopedist.
Prognosis for gonorrhea
With timely diagnosis and adequate therapy, the prognosis is favorable.
Complications of gonorrhea in women
Tubal obstruction;
Infertility;
Ectopic pregnancy;
Bartholinitis;
Development of hydrosalpinx (pus in the fallopian tubes);
Pelvioperitonitis;
Spontaneous abortion;
Premature birth;
Intrauterine growth retardation;
Intrauterine fetal death;
Intrauterine infection of the fetus;
Gonoblenorrhea, otitis, gonococcal sepsis in a newborn;
Postpartum purulent-septic complications in a woman in labor.
A common gonococcal infection can cause damage to the skin and other organs (joints, heart, brain, liver, etc.).
Prevention of gonorrhea in women
To reduce the incidence rate, it is very important to detect cases of infection in a timely manner and provide such patients with adequate therapy. Of particular importance are regular medical examinations of employees of child care institutions and catering workers.
Testing for gonococcal infection is mandatory for all pregnant women, as well as for women who go to the gynecological department for termination of pregnancy.
In addition, there are personal prevention methods that every person must follow to prevent infection. First of all, you need to carefully adhere to the rules of personal hygiene and try to avoid casual sexual contacts. When having sexual intercourse, it is recommended to use reliable means of protection. These include condoms or vaginal use of chemicals (chlorhexidine, miramistin). If suspicious symptoms appear (pathological discharge, discomfort), you should immediately consult a doctor.
