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 (STIs - sexually transmitted infections). Gonorrhea in women has certain features of the course 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 the carrier of the infection. In rare cases, it is possible for a woman to become infected with gonorrhea by household means, usually when using towels or washcloths shared with the carrier of the pathogen. Younger girls (2-6 years old) are most often infected by gonorrhea in the household, and in the vast majority of cases, the infected mother is the source of infection.
The causative agent of gonorrhea is gonococcus. Gonococcus is a type of bacteria that is sensitive to desiccation, antiseptics, heat treatment (death occurs at temperatures exceeding 55 ° C), as well as direct sunlight. Gonococcus refers to a microorganism with high contagiousness. This means that the chances of a woman contracting 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 the early symptoms of gonorrhea in women, as a rule, are absent. This is the main difference between gonorrhea in women and gonorrhea in men, because due to the erased clinical picture, gonorrhea in women often spreads to the internal organs of the genitourinary system and acquires a chronic course.
Signs of gonorrhea in women in the initial stage of the acute form, with lesions of the lower genital tract (labia, vagina, cervical canal, urethra), are not expressed. There may be a slight burning sensation when urinating, vaginal itching, and white, thick discharge. If treatment is not undertaken at this stage, gonococci spread further along 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 disorders.
With the transition of the inflammatory process into a chronic one, the signs of gonorrhea in women are again erased. The leading symptoms of gonorrhea in women in this case are menstrual irregularities and infertility.
In addition, in some cases, any signs of gonorrhea in women may be absent, and the disease will proceed in a latent form until it is discovered either when building a chain from an infected partner, or during examination for another reason.
It should be noted that gonococcus affects the epithelium mainly at the site of infection. Therefore, if sexual contact with the carrier of the infection was carried out by the oral or anal route, then the 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 contents of the vagina. A diagnostic sign is the detection of gonococcus in a smear. Doctors note that in recent years, gonococcus almost never occurs in isolation, but polyinfection occurs when other STIs are present along with gonococcus.
Treatment of gonorrhea in women
Treatment of gonorrhea in women, however, as well as gonorrhea in men, should be started immediately after the diagnosis is confirmed. The later the treatment of gonorrhea in women is started, the more likely it is to develop 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 affect the gram-negative flora, which includes gonococcus. It must be borne in mind that gonococcus can be resistant to antibiotics, and that the treatment of gonorrhea in women at different stages requires different dosages, so self-medication is unacceptable.
The use of antibiotics leads to dysbacteriosis, both of the intestines and the vagina, so the treatment of gonorrhea in women is completed by taking drugs that help restore microflora. An important condition for the treatment of gonorrhea in women is the refusal to drink alcohol and sexual intercourse. The therapy is carried out under bacteriological control. Gonorrhea in a woman is considered cured only when the control bacteriological examination shows the absence of gonococci in smears or scrapings.
The consequences of gonorrhea in women
As already mentioned, chronic gonorrhea in women can cause adhesions in the uterine appendages, which is the cause of 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, pregnancies in women with gonorrhea end in miscarriage or premature birth. The child, passing through the birth canal of a woman with gonorrhea, is in direct contact with the pathogen, resulting in gonorrheal blepharitis and neonatal conjunctivitis.
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Gonorrhea in women is a disease that is transmitted sexually or transplacentally. The causative agent is the pathogenic organism gonococcus. With vaginal sex, the risk of infection is 100%, somewhat less with oral sex, but only due to the antibacterial properties of the salivary fluid.
The household method of transmission of such a disease is impossible, therefore it is impossible to get infected from a sick person, for example, through common household items or in the bathroom. However, if the mother has such a disease, then at the birth of a child there is a fairly high probability that he will be infected.
Symptoms of gonorrhea in women are quite pronounced, but are somewhat non-specific. 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 lead a promiscuous sex life.
The final diagnosis is made based on the results of diagnostic measures. It is impossible to independently compare symptoms and treatment. Any drugs and the duration of their administration are prescribed only by a doctor.
Provided that the treatment of 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 allowed, but this is unlikely. Also, infection of the child during passage through the birth canal is not excluded.
The pathogenic organism itself is unstable to the external environment, 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;
- the presence of other infectious diseases;
- the presence of such a disease in history.
At risk are women who lead an immoral lifestyle. This should include those who provide sex services, drink alcohol in excessive quantities, take drugs, and do not have a permanent place of residence.
Classification
The disease is classified according to the duration of the course:
- fresh - the prescription of infection and the development of the infectious process is not more than two months;
- chronic - more than two months have passed since the infection.
In the fresh form of the disease, there are:
- acute;
- subtly form.
Chronic gonorrhea in women is also divided into several subspecies:
- asymptomatic;
- latent;
- hidden;
- acute;
- subacute.
In addition, depending on the localization of the infectious process, a fresh form and a chronic ascending form are isolated. In the latter case, the infectious process can affect:
- pelvic peritoneum;
- fallopian tubes;
- ovaries.
Inflammation of the endometrium of the uterus is not excluded.
The shape affects how gonorrhea manifests itself in women. However, it is not necessary to start treatment on your own, even if there is complete confidence in the diagnosis. The treatment regimen, the selection of drugs - all this lies in the competence of a qualified doctor.
Symptoms
The incubation period of 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 can appear as early as 48 hours after infection.
Asymptomatic course, as a rule, is observed in cases where the patient took antibacterial drugs due to another disease, or started treatment on her own at home. As in the first, and in the second case, this does not guarantee the complete elimination of the disease. It should also be noted that it does not grant immunity.
In women, the first signs of the disease will depend on what form it takes place. So, with the defeat of the genitourinary system in women, the possible symptoms of gonorrhea will be of the following nature:
- discharge with gonorrhea in women is white-yellow in color, purulent in consistency, with a sharp 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;
- pulling pain in the lower abdomen;
- bleeding of a viscous consistency, not related to menstruation;
- pain and discomfort during intercourse, decreased sexual desire.
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 course of the clinical picture, the disease is often confused with a 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;
- release of mucopurulent exudate from the anus;
- pain during the act of 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. Periodically, the "morning drop syndrome" may appear - 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 the course of the 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 swab is taken from the vagina for gonorrhea in women;
- antibiotic sensitivity test;
- inoculation of biological material on a nutrient medium.
It should be noted that the analysis 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.
How a smear is taken from the vagina correctly will be shown by the doctor who will conduct the tests. In this case, 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 a few days of taking the drugs prescribed by the doctor.
Since the pathogenic organism has many strains, more than one antibiotic drug can be used in the treatment, but several at once - the dosage regimen is determined individually.
In general, drug therapy may include:
- antibiotics;
- candles for gonorrhea;
- vitamin and mineral complexes to strengthen the immune system;
- probiotics or prebiotics.
A complete recovery can be said only when the woman stops taking various drugs prescribed by the doctor, and the test results show the complete absence of gonococcus in the female body. Also, for the period of treatment, complete sexual rest is indicated.
Possible Complications
For women, such a disease is extremely dangerous, since when it becomes chronic, the following complications may develop:
- frigidity;
- miscarriage;
- complications during childbirth;
- development of adhesive process 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 should consult a doctor immediately - as soon as the first symptoms appear, and not prescribe drugs to yourself.
Prevention
- prevention of infectious diseases;
- use of barrier contraceptives;
- exclusion of frequent change 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 by 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 a few 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 the development of complications. But the signs of the disease are not uncommon. In this case, the medication becomes untimely. What does it threaten 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 the lesion, and the addition of dysuric disorders. The lack of timely treatment leads to the transition of inflammation to the overlying departments, and non-compliance with the recommended schemes ends with a chronic process. Gonorrhea is no exception. Chronic forms are no less dangerous than acute gonorrhea.
Disease history
The first mention of gonorrhea appeared in the XVI 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, Celsus. Galen called this disease "semen flow", although he pointed out the need to distinguish it from true ejaculation during sexual arousal. But the name is firmly entrenched and has survived to this day.
The 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 up to seven days after the end of the disease;
- isolation - each patient with gonorrhea;
- personal belongings - the bed, the chair of the patient and the 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 proved 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: a 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 made it possible in 1879 for the German physician Albert Ludwig Neisser to isolate the causative agent of gonorrhea. These are cocci that resemble coffee beans in shape and are arranged in pairs. They have the following features.
- incomplete phagocytosis. In pus, diplococci can be located inside leukocytes, but at the same time they remain viable. This property explains the ability of the disease to become chronic. It also allows the pathogen to elude the action of drugs, spread to other parts of the genital organs.
- Low stability. In the external environment, bacteria quickly die. When heated to 40 ° C, they die after three to six hours, and at 56 ° C - after five minutes. Can't stand refrigeration. In pus, they can persist for a day. They die under the influence of silver salts. Sensitive to penicillins, streptomycin, but during treatment they become resistant to them.
- Antigenic structure. In the course of treatment, it can seriously change and form L-shapes. The latter have a different structure, which allows them to remain in the body for a long time, to avoid the action of antibiotics.
- Immunity. There is no inherent resistance to gonorrhea. And the transferred 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 is able to persist in pus, so there is a possibility of infection through a common towel, washcloth, linen. But this method is more relevant for girls.
- Penetration method. Bacteria are often attached to spermatozoa, epithelial cells, and also inside Trichomonas. They act as carriers that help the pathogen to penetrate into the overlying parts of the genitourinary tract.
- Areas affected. The sections of the genitourinary system lined with cylindrical epithelium are affected - this is the urethra, cervical canal, fallopian tubes. Oral contact develops stomatitis, pharyngitis, tonsillitis. With rectal - gonorrheal proctitis. In children after childbirth from an infected mother - 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 with its thinning or loose structure, conditions are created for fixing the microbe. Such features in the epithelium appear during pregnancy, postmenopause, and also in girls before puberty.
- Penetration into the blood. Gonococci are able to enter the bloodstream, but most of them die. The rest are carried throughout the body and form extragenital foci. Joints are most often affected, gonococcal endocarditis and meningitis develop less frequently.
- Incubation period. Usually lasts 3-15 days, very rarely up to a month. It is longer in women than in men.
For infection, it is necessary that a sufficient number of pathogens enter the vagina. That is, not always a single contact leads 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 gonorrhea manifests itself depends on the number of gonococci and the reactivity of the body. At the end of the incubation period, symptoms may not appear or be unexpressed.
- Urination disorders. Dysuric disorders are manifested in the form of burning sensation and frequent urge to go to the toilet. In men, the expiration of pus, hyperemia of the urethra is expressed (in women, this sign is invisible). Some pus may ooze out and stick together 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 scarce. 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 is visible only in the mirrors.
- Bleeding. With advanced gonorrhea, intermenstrual bleeding may occur.
- Lower abdominal pain. This is an unexpressed symptom, which in most cases may be absent.
In women, the process is often multifocal, the urethra and internal organs are affected. Cervical lesions cannot be recognized from the outside. On examination, it looks swollen and inflamed. Pus flows from the cervical canal.
Gonococcal goes into. This worsens the condition, 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, hurts on palpation and during intercourse.
From the uterus, gonorrhea quickly spreads to the fallopian tubes and ovaries. Salpingo-oophoritis develops. If gonococci enter the abdominal cavity through the ampullar end of the tube, peritonitis is formed.
Gonorrhea is dangerous during pregnancy by the possibility of infection of the child during childbirth. In this case, the eyes are affected, gonorrheal blepharitis develops. Since the disease can have a latent course and be undiagnosed before childbirth, all newborns are given prophylaxis: immediately after birth, the eyes are instilled with a 30% solution of Albucid. Girls also bury it in the genital slit.
Rash in gonorrhea is not typical. This is a mandatory sign of syphilis. Therefore, if spots appear on the skin, it is necessary to inform the doctor about it.
Risks in girls
Before puberty, the vulvar ring and labia are involved in the inflammatory process. In children infected with gonorrhea, a tendency to relapse, multifocal lesions, as well as post-gonorrhea complications are characteristic.
It should be remembered that in modern conditions, latent gonorrhea is often observed, which is detected only by laboratory tests.
Diagnostic approaches
Dermatovenerologists are involved in the examination and treatment of patients with gonorrhea. Diagnosis includes a mandatory examination and history taking. The doctor finds out the following points:
- time of sexual contact;
- timing of symptoms;
- whether the person who infected is a family member;
- Has he been examined?
A woman is offered to take a swab for gonorrhea. This is the most reliable way to diagnose. Material for research is taken from the following places:
- urethra;
- cervical canal;
- lateral vaults of the vagina;
- large vestibular glands;
- paraurethral glands.
A smear is necessary for microscopic examination. Cultural analysis is carried out according to the results of sowing on special nutrient media. In this case, decoding helps to determine the sensitivity of the pathogen to certain antibiotics.
The following studies are also relevant.
- Analysis of urine . It is necessary for the detection of concomitant diseases of the urinary system.
- Colposcopy. Inspection of the vagina and cervix with a colposcope. Gonorrhea can 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 distribution of the inflammatory process to the uterus, appendages. This determines the further tactics of treatment.
According to indications, in the presence of purulent lesions in the rectum, oral cavity, eyes, consultations of a proctologist, ENT doctor, ophthalmologist are prescribed.
In connection with the peculiarities of the physiology of the organs of the genitourinary system in girls, in case of illness of the mother or father, an examination of the child is mandatory.
Medical tactics
Treatment of gonorrhea in women is based on the protocols of the Ministry of Health. They determine the list of drugs 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 | Evidence level of effectiveness |
|---|---|---|---|
| "Ceftriaxone" | 250 mg per muscle | once | A |
| "Ciprofloxacin" | 500 mg orally | once | A |
| Ofloxacin | 400 mg orally | once | A |
| "Spectinomycin" | 2.0 g per muscle | once | A |
| Benzylpenicillin sodium and potassium salt | - Initial dose of 60 thousand IU per muscle; - every 3 hours for 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 may be chlamydia, Trichomonas. Then drugs are added depending on the type of pathogen. In chronic gonorrhea, a vaccine is added to the regimen. The treatment of gonorrhea is supplemented by the following recommendations.
- Alcohol . For the entire period of treatment until negative results of crops are obtained, a strict ban on the use of alcohol is introduced. It acts as a provocateur. Sometimes it is recommended to drink a glass of beer before taking the next analysis in the evening. If gonorrhea is undertreated, it will make itself felt in the tests.
- Nutrition . You need a balanced diet enriched with protein, with an increased amount of fluid. Hot spices and seasonings are not recommended.
- Sex life. At the time of treatment and before receiving normal tests - complete rest. Otherwise, further spread of the infection will occur.
ethnoscience
Many prefer evidence-based medicine folk remedies. At the same time, they independently make candles, ointments, decoctions based on herbs, various chemicals. But it should be remembered that the causative agent of gonorrhea is a bacterium, which is surrounded by a special protective layer and is able to hide inside the 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 turn into infertility.
Preventive measures
The disease is much easier to prevent than to treat later. To do this, pay attention to the following rules.
- Personal safety. The most reliable means of protection is a condom.
- Link control. Do not engage in casual sex. Strangers may not show signs of overt infection or may simply remain silent about having recently received treatment.
- Emergency prevention. After accidental unprotected sexual contact, be sure to immediately urinate, wash with soap, and treat the genitals with Miramistin or Chlorhexidine solution. You can also enter 1 ml of the drug into the urethra.
Prevention after sexual intercourse is effective in the first 2 hours. If more time has passed, then you can consult a doctor for recommendations on taking preventive drugs. 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 an adhesive process in them. This is one of the causes of infertility, which is very difficult to treat. Reviews of survivors of the disease confirm this. With obstruction of the tubes for pregnancy, there is only one way - in vitro fertilization.
In Western countries, it is predominantly common among homosexuals, as well as among men (and, accordingly, their partners) who have had sex in developing countries.
Causes of gonorrhea in women
The causative agent of gonorrhea is a gram-negative diplococcus (gonococcus), which is localized in the cells of the cylindrical epithelium. 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 a 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.
Newborn children from mothers with gonorrhea during childbirth can become infected extrasexually. Gonococcus, getting into the eyes of an infant, causes blennorrhea, which is manifested by suppuration from the eyes. In girls, the microbe can be in the genital gap.
Infection can also occur through a common bed contaminated with secretions, toiletries, etc. Pathogenesis. Gonococcus affects mucous membranes covered with cylindrical epithelium (urethra, cervical canal, excretory duct of the Bartholin 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 by the hematogenous route. There are gonorrhea of the lower sections (up to and including the cervix) and upper sections (the 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 those who have given birth. The primary lesion of organs covered with stratified squamous epithelium (vagina, vaginal vestibule) is possible only in girls, elderly women and pregnant women.
Gonorrhea in 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 latently, 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 the 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 the disease, carriers of gonococcus are usually unaware of the 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 ascending order, affecting the uterus, appendages, urethra, ovaries and even the peritoneum.
The consequences of chronic gonorrhea in women are manifested in the fact that the fallopian tube becomes impassable for sperm and eggs due to adhesions formed, which leads to infertility.
Recognition of gonorrhea in women
Women with urethritis, bilateral bartholinitis, bilateral inflammation of the uterine appendages, endocervicitis in primary infertility, with 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 a special examination for gonorrhea.
The diagnosis is established on the basis of an assessment of the totality of anamnesis data, clinical, bacterioscopic, bacteriological and immunological examinations. When collecting an anamnesis, attention is paid to the presence of symptoms of the disease, their connection with sexual intercourse. During a clinical examination, the excretory ducts of the Bartholin glands, the external opening of the urethra, the Skenian passages, the external pharynx of the cervix, and appendages are subjected to a thorough examination and palpation. During the examination, after a preliminary massage with a sharp spoon, discharge from the urethra and from the cervical canal is taken for bacterioscopic examination. Gonococcus is a Gram-negative bacterium.
There are three bacterioscopic pictures: K 1 - in the smear there are a large number of segmented leukocytes, there is no flora, but gonococci are determined intra- and extracellularly; K2 - a large number of segmented leukocytes, cells of desquamated epithelium, no flora - a smear is very suspicious for gonorrhea; K3 - a small number of leukocytes and a diverse flora, which is not typical for gonorrhea. To detect gonorrhea of the rectum, lumps of mucus from the washings are examined.
The bacteriological method of growing 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, on the bottom of which pour a little water to moisten. 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 sufficient nutrient medium it degenerates and loses its germination. The bacteriological method is especially useful for asymptomatic, chronic and latent forms of gonorrhea.
An increase in the number of detected cases is facilitated by various methods of provocation aimed at exacerbating the course of local processes, increasing exudation, washing out of the cracks and detecting gonococci in the increased secretions.
Provocation methods:
- biological - taking smears during menstruation;
- immunobiological - taking smears after the introduction of gonovaccine;
- chemical - lubrication of foci of inflammation with 1-2-3% solution of lapis;
- mechanical - bougienage, massage;
- thermal - abdominal-sacral diathermy for 30-40 minutes;
- combined method, including various methods. For example, after the introduction of gonovaccine, chemical methods are used, etc.
The gonovaccine is administered in the 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 the act of urination, swelling and eversion of the mucous membrane of the urethra, the release of pus with a light massage from the vagina. In the chronic form, the clinical picture is blurred.
Gonorrhea of the paraurethral passages. The result of a secondary lesion from the urethra. It manifests itself in the form of swelling, purulent plugs in the region of the small glands of the vestibule, infiltration. In the chronic stage, periurethral infiltrates and abscesses are often found.
Gonorrhea of the vagina. Puffiness, hyperemia of the mucous membrane, copious flow of pus, the formation of genital warts. The mucous membrane is rough, bleeds easily. Patients complain of itching, burning, pulling pains in the lower abdomen.
Gonorrhea of the rectum. The disease develops a second time when secretions from the genital tract enter during the act of defecation. Usually occurs 2-3 weeks after the primary lesion of the genital area.
Patients complain of itching, burning in the anus, pain during defecation. On examination, edema, hyperemia, purulent raids, and ulceration of the rectum are determined. In the chronic stage, the picture is more blurred, infiltrates may occur.
Gonorrhea of the cervical canal of the uterus. Patients complain of the appearance of lingering pains, mucopurulent discharge, a feeling of pressure in the lower abdomen. In the acute stage, on examination, hyperemia and swelling of the external pharynx, the expiration of pus are determined. In the chronic stage, erosions, 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 cervical hypertrophy.
Gonorrhea of the uterine mucosa. In the acute stage, symptoms of a general disease appear: chills, high fever, general deterioration, severe pain in the lower abdomen. During a gynecological examination, an enlarged, painful, pasty uterus, serous-purulent or purulent-bloody discharge are determined; the menstrual cycle is often disturbed.
Gonorrhea of the uterus. The acute period is manifested by chills, high fever, severe pain in the lower abdomen, mild symptoms of peritoneal irritation in the lower abdomen. Bilateral lesion of the appendages is characteristic. Tuberculosis develops primarily as endosal-ingitis. In the future, the muscle layer is also affected with the formation of infiltrates. The outcome of tube damage is the formation of closed chambers along the tube and its thickening (nodous salpingitis), accumulation of exudate in its lumen and saccular expansion (sactosalpinx) with serous (hydrosalpinx) or purulent (pyosalpinx) contents. In 75% of cases of gonorrhea, the tubes develop obstruction and infertility. The transition of gonorrhea to the ovary and its defeat occur either by the lymphogenous route, or by the introduction of the gonococcus into the ovulated follicle with the formation of purulent inflammation (oophoritis). Often there is an adhesive process between the tubes and the ovaries (periadnexitis) with the formation of a common inflammatory tumor (andex-tumor). A significant role in the occurrence and development of gonorrheal adnexitis is played by the addition of pyogenic microbes. Involvement in the inflammatory process of the ovary, as a rule, leads to menstrual dysfunction. Perforation of abscesses is possible.
Gonorrhea fiber and peritoneum. It occurs when the infection is transferred through the lymphatic tract and is characterized by severe pain, high fever, chills, severe peritoneal symptoms in the lower abdomen. In the acute stage, vaginal examination is sharply painful. The general conglomerate of pelvic organs and their infiltration are determined. Numerous adhesions of the genital organs with the rectum, bladder, large intestine, closed cavities with purulent contents are formed, especially often in the region of the posterior Douglas space.
gonorrhea during pregnancy. The disease is manifested by very bright clinical symptoms: frequent, painful urination, abundant purulent discharge, rapid formation of cervical erosion, 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, delayed involution of the uterus, prolonged discharge of purulent-bloody or serous-purulent lochia.
Gonorrhea girls. The vulva is affected first, followed by 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 a different flora, the disease is accompanied by cracks, dermatitis of the external genitalia, intergluteal folds, and inner thighs. Girls complain of pain, itching, burning, copious discharge. An adhesive process of the labia minora, vagina may develop. The disease often acquires a protracted course.
Treatment of gonorrhea in women
There are several treatments for gonorrhea:
- ciprofloxacin;
- ofloxacin;
- ampicillin and probenicide (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 a double injection of bicillin at 600,000 IU 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) with 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) with bartholinitis - warm semi-sitting baths. The development of an abscess or retention cyst dictates the need for surgical treatment.
Immunotherapy is used as an auxiliary method of treatment and is designed to increase the reactivity of the body. The gonovaccine is injected into the buttock 3-5 times, 200-300 million microbial bodies with an interval of 2-3 days. It is possible to introduce into the thickness of the cervix, into the submucosa of the rectum. The reaction to the introduction should not be expressed by chills, very high fever, malaise. If such a reaction develops, the dose should be reduced.
Contraindications: pregnancy, tuberculosis, diseases of the liver, kidneys, heart.
Lactotherapy pursues the same goals. Milk is prepared ex tempore and injected intramuscularly in 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 is allowed to begin 10 days later, and the cervix - 1 month after birth.
In the treatment of girls under 3 years of age, immunotherapy is not carried out. At an older age, gonovaccine is administered, starting with 50 million microbial bodies. Otherwise, when choosing a dose of medications (antibiotics, sulfonamides), it is necessary to take into account the age of the child.
Cured criterion. 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, cervical canal. The absence of gonococci allows us to consider the patient cured and remove her from the register.
Prevention personal. After sexual intercourse, suspicious 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 1% lapis solution into the urethra, treat the cervix with 2% lapis solution.
Prevention in children. The girl needs to have a separate bed, a separate chamber pot, an individual sponge for washing. In children's institutions, staff should be hired after being examined by a venereologist and then subjected to monthly checks. Children are also subject to medical examination. Each child is given an individual dish. Washing is allowed only with a stream of water, without sponges.
Physiotherapy gives good results - electrophoresis of copper and zinc, ultraviolet irradiation, UHF. Be sure to observe personal hygiene.
Traditional healers offer their own healing methods, but, again, 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 dried and crushed calamus roots, leave for 2 hours, then simmer for 10 minutes, strain immediately. Add a decoction to water heated to 37-38 ° C.
Mode of application. Take warm baths for 20 minutes every other day. The course of treatment - 15 baths.
gonorrhea in women
The content of the article:Gonorrhea is most common in women during their reproductive years. This sexually transmitted infection can lead to infertility or problems with pregnancy, so gonococcal infection requires immediate treatment of both sexual partners. This sexually transmitted disease is also called gonorrhea or gonorrhea.
According to WHO statistics, gonorrhea is a very common infection. Approximately 200 million people are diagnosed with the disease each year. In the Russian Federation in the 90s there was a slight decrease in the growth in 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 organs of the urogenital area. 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 detected, it is necessary to examine people who had sexual contact with the patient within a month before the onset of symptoms of infection in the patient. 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 household 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 Neisseria gonorrhoeae, a gram-negative bacterium that belongs to paired cocci and has a bean-shaped form. Gonococci are located inside the cells, within the cytoplasm of leukocytes. These organisms are highly sensitive to various external factors. They die when the temperature rises to only 55 degrees. They are also detrimental to exposure to sunlight and drying. Treatment with antiseptic solutions gives a good effect. The bacterium remains viable while in fresh pus. After it dries, the gonococcus dies.
The causative agents of gonorrhea are not able to move, they do not form a spore. These organisms have very thin filaments, thanks to which they can be held on the surface of epithelial cells, erythrocytes, male germ cells - spermatozoa.
From above, each bacterium is covered with a layer of a special substance and, as it were, is in a capsule. Therefore, the destruction of such organisms is difficult. Treatment is complicated by the fact that it is possible to place the pathogen inside the cells of the epithelium, 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 form of a ball, their color and size can be different. To the antibacterial drug that provoked their formation, such gonococci do not show sensitivity. 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 antibiotic therapy. The infection remains in the body due to the transformation into vegetative forms. After many years of use of antibiotics for the treatment of gonorrhea, many strains have formed that are capable of producing lactamase. They have become resistant to drugs that contain a lactam ring.
Ways of transmission of gonorrhea
The most common 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 transmission of the infection by household means are not recorded so often. In everyday life, towels, linen, washcloths, etc. are usually rare causes of infection. Girls are more at risk of household infection than boys. The facts of intrauterine infection were not confirmed. During natural childbirth, infection of the child from a mother infected with gonococcus can occur.
Most often, the infection develops in the mucous membrane of the cervical canal, fallopian tubes, urethra, large vestibular and paraurethral glands. That is, the areas that line the cylindrical epithelium are affected.
After oral-genital sexual intercourse, the development of gonorrheal stomatitis, tonsillitis or pharyngitis is possible. As a result of anal contact, gonorrheal proctitis is not excluded. If the infection gets into the eyes (for example, during childbirth, when the child 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 a multilayered epithelium. However, in children, women of mature age and pregnant women, the epithelium may become thinner or become loose. In such cases, there is a risk of gonorrheal vaginitis.
Due to the presence of filaments (pilae), pathogens that enter the body are attached 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 infection spreads from the lower sections to the upper ones. With fixation of gonococci on spermatozoa and with enterobiasis inside Trichomonas, advancement occurs more quickly.
There are times when gonococcus enters the bloodstream. But this happens infrequently, since the serum has a bactericidal effect. If this happens, then the infectious process is generalized and foci of the disease appear 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 gonorrhea infection enters the human body, antibodies begin to be produced. But immunity is not lifelong and not very effective. You can get 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 stretch for a whole month. If the lower urinary tract is affected, asymptomatic development of the disease is possible. With a pronounced infectious process, reddening 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). There are discharges that look like pus.
Patients with ascending gonorrhea (with involvement of the upper sections) have other complaints. In such cases, the general well-being noticeably worsens. The temperature can rise to 39 degrees, chills are felt. Nausea and vomiting appear, the stool becomes liquid, severe discomfort is observed during urination. The menstrual cycle may also be disrupted. The spread of gonorrhea infection can be triggered by certain medical procedures. These include: curettage of the uterus, abortion, biopsy, aspirate taking, probing of the uterine cavity, inside the uterine spiral. Often, acute inflammation occurs after childbirth or menstruation.
An objective examination shows a discharge of a purulent nature, an increase and soreness of the uterus, its soft consistency (in patients with endomyometritis). With gonorrheal salpingo-oophoritis, swelling and soreness of the appendages are observed. If peritonitis has developed, abdominal pain is observed during palpation, there are symptoms of peritoneal irritation. The acute course of 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 has developed against the background of the use of intrauterine contraceptives.
The scientific literature indicates such features of the course of the disease with ascending gonorrhea:
Discharges with blood.
Involvement in the process of both appendages.
Dependence of the inflammatory process on childbirth, gynecological procedures, abortions.
The onset of the effect of treatment in a short time. After the start of therapy, the level of leukocytes decreases, the temperature returns to normal. ESR remains elevated.
Recently, the development of the disease without pronounced symptoms has been increasingly noted. It 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 the inflammation takes on a chronic character, the woman's cycle is disrupted, and the adhesive process begins in the small pelvis. In the future, such changes can cause dangerous complications: infertility, miscarriage, ectopic pregnancy. Chronic pelvic pain syndrome develops.
With gonorrheal proctitis, there are no pronounced symptoms. Only in some cases, the disease can manifest itself as a burning sensation in the anus, severe itching, discomfort during defecation, tenesmus.
In pregnant women, gonorrhea is manifested by cervicitis and vaginitis. The membranes may open prematurely. During and after childbirth in patients with gonorrhea, the temperature rises greatly. Septic abortion is not 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 prescribed. The causative agent of infection is detected using bacterioscopic and bacteriological methods. Gonococcus is identified according to the following basic criteria: it is gram-negative, diplococcus, is inside the cells.
This organism is able to mutate 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%. In order to timely identify asymptomatic forms, it is better to use the method of bacterioscopy. Also, this method is recommended for examination of children and pregnant women. Sowing is carried out in a special nutrient medium. Since the material is contaminated with foreign forms of flora, the identification of the causative agent of gonorrhea can be difficult. To make it easier to detect, use a selective medium with antibiotics. If the analysis cannot be carried out immediately, the material is left in a special transport medium. When cultures grow, microscopy is performed to determine the sensitivity of organisms to antibiotics. The bacteriological method has high sensitivity and specificity (90-100% and 98%, respectively). The sampling of biological material for research is carried out with a bacteriological loop or Volkmann's spoon from the urethra, vagina, cervical canal, rectum or other place where an infectious process can develop. To take material from the rectum, a scraping is performed or a flush is performed using an isotonic sodium chloride solution.
Other laboratory methods include: DNA research, enzyme immunoassay, immunofluorescence. But they are rarely used.
The procedure for performing 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 detected extracellularly. In the acute course of infection, the pathogen is inside the cells.
2. Bacteriological analysis, which assesses the sensitivity of the pathogen to antibiotics. The indications for such a study are repeated negative bacterioscopic results, the detection of dubious organisms in smears, and suspicion of gonorrhea.
3. RIF (immunofluorescence reaction).
4. ELISA (immunofluorescent analysis).
5. PCR and LCR methods.
6. Provocative tests. If smears and cultures did not allow to identify the pathogen, they resort to provocative tests using thermal, chemical immunological methods. In such studies, care must be taken and all possible complications should be taken into account.
- Chemical. It involves the treatment of the urethra with a solution of silver nitrate to a depth of 2 cm, the cervical canal - up to 1.5 cm, the rectum - up to 4 cm with Lugol's solution in glycerin.
- Biological. Intramuscularly administered gonovaccine (500 million microbial bodies). It is also possible to co-administer gonovaccine and pyrogenal (dosage - 200 MPD).
- Thermal. Diathermy is carried out 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. An arc option is a three-day course of inductothermy once a day for 15 minutes. After each session of physiotherapy, the discharge is taken for analysis.
- Physiological. The smear is taken during menstruation.
- Combined test. Thermal, chemical and biological tests are carried out within one day. Material for analysis is taken in a day, two and three days. Crops are performed after three days.
Methods of differential diagnosis of gonorrhea
Gonorrhea must be distinguished from other sexually transmitted infectious diseases. With an 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 basic treatments for gonorrhea. At the same time, it is important to observe the following rule: the sexual partner of the patient is also subject to treatment. Non-acute forms of gonorrhea are treated on an outpatient basis, and the presence of an acute course suggests hospitalization. In the hospital, bed rest should be observed, injectable antibacterial drugs are prescribed, cold on the lower abdomen, infusion therapy (rheopolyglucin, reogluman, reamberin, isotonic solutions of glucose or sodium chloride, glucose-procaine mixture, trisol) and antihistamines (suprastin, tavegil).
Treatment of gonorrhea in women with antibiotics
Antibiotics are used to fight the pathogen. But positive results are not always achieved. There are strains that are resistant to antibiotics. It is also possible the appearance of L-forms of gonococci. When prescribing treatment, it is necessary to take into account the form of the disease, the prevalence of inflammation, its localization, the presence of concomitant infectious processes. In addition, the possibility of complications and side effects must be taken into account.
Medicines for the treatment of gonorrhea in women
Antibiotics of the penicillin series
Benzyl-penicillin - from 4 to 8 million units (course 10-15 days);
Ampicillin - tablets of 2-3 g per day at regular intervals for 4-6 doses (course from 7 to 20 days);
Oxacillin - tablets of 3 g per day after an equal period of time for 4-6 doses, a course of 10-14 days;
Ampiox - tablets 0.5-1 g 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, a course of 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, roxid, roxibid) 300 mg 2 times a day, course 10-14 days;
Erythromycin - 500 mg 4 times a day before meals inside, course 10-14 days;
Erythromycin ethyl succinate 800 mg 2 times a day, course one week;
Clindamycin (dalacin C) 300 mg 4 times a day after meals, a course of 7-10 days or intramuscularly 300 mg 3 times a day, a course of 7 days.
Aminoglycosides
Kanamycin 1 g 2 times a day intramuscularly, the course will require 6 g. Oto and nephrotoxic, should not be given 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;
Cefalexin 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 (ciprofloxacin, ciprobay, cipro-bid) 500 mg 2 times a day, course 7 days;
Pefloxacin (abaktal) 600 mg 1 time per 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; cefodizyme 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. |
A contraindication for the use of fluoroquinolones is the age of up to 14 years, pregnancy, lactation. If an alternative scheme is used, then constant monitoring for changes in the sensitivity of 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 medication: 500 mg every 12 hours; ofloxacin 400 mg every 12 hours. |
During treatment, you should refrain from sexual intercourse, you can not drink alcohol. If there is no effect from therapy, you need to connect 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, a course of 7 days; josamycin 200 mg orally for 7-10 days. |
Antibiotics for gonorrhea are added to drugs for the treatment of chlamydia. |
| Combination of trichomoniasis and gonorrhea | metronidazole 250 mg orally 2 times a day for 10 days; secnidazole 2 g orally once; ornidazole 500 mg in the morning and evening with an interval of 12 hours, a course of 10 days. |
If there is a suspicion of trichomoniasis in women, then antibiotics that kill Trichomonas are added to the usual treatment regimen. |
Together with a course of antibiotics or after it, vaginal eubiotics are prescribed to restore the normal microflora of the vagina. These are drugs that contain lactobacilli, bifidumbacterium bifidum or acidophilic lactobacilli.
Local treatment of gonorrhea in women
Local therapy of gonorrhea in women consists in restoring the damaged mucous membrane of the vagina and urethra, for this, a 1–2% solution of silver proteinate, a 0.5% solution of silver nitrate, as well as microclysters with chamomile infusion (for 1 tablespoon of chamomile flowers, 1 cup of boiled water).
Immunotherapy for gonorrhea in women
Immunomodulatory drugs for gonorrhea are used quite rarely, since their appointment must be realistically justified. Immunotherapy for gonorrhea should be given after symptomatic relief during antibiotic treatment or before antibiotic therapy when the disease is subacute, torpid, or chronic. Immunotherapy is allowed for children only after 3 years.
Immunotherapy can be:
Specific (use of gonococcal vaccine)
Nonspecific (pyrogenal, prodigiosan, autohemotherapy).
Physiotherapy treatment of gonorrhea in women
Sick women undergo physiotherapy sessions (inductothermy, magnetotherapy, laser therapy, ultraviolet, electrophoresis and phonophoresis of medical preparations).
Surgery for gonorrhea
With salpingitis and pelvioperitonitis, patients are treated with conservative methods. If therapy does not give the desired effect within a day or two, a laparoscopic procedure is necessary. It makes it possible to conduct an accurate diagnosis, as well as to open and sanitize the focus of purulent inflammation. Patients with diffuse or diffuse peritonitis perform laparotomy. The volume of such an intervention is determined based on age, the degree of pathological changes in the pelvis, and the reproductive history is also taken into account.
Treatment of gonorrhea in pregnant women
Treatment of gonorrhea during pregnancy can be carried out at any time. Drugs approved during pregnancy include:
Ceftriaxone 250 mg intramuscularly once;
spectinomycin 2 g intramuscularly once.
Pregnant women should not use tetracyclines, fluoroquinolones, aminoglycosides for the treatment of gonorrhea, as they negatively affect the development of the fetus.
With the development of complications of gonorrheal chorionamnionitis, the pregnant woman should be hospitalized and treated according to the following scheme: ampicillin 0.5 g 4 times a day for 7 days or benzylpenicillin 20 million units per day until the symptoms disappear. Topical therapy, physiotherapy and immunotherapy should be added to antibiotic therapy, especially in the chronic course of gonorrhea.
To prevent the development of gonorrhea in newborns, infants instill 1-2 drops of a solution of sulfacetamide (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 eligibility criteria are:
Absence of symptoms
Disappearance of gonococcus in smears during bacterioscopic examination. For the purpose of diagnosis, 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, as well as the rectum (three times with an interval 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 propose to reduce the duration of observation after adequate therapy. According to these specialists, modern methods are highly effective, and the ongoing control measures have become inappropriate.
The European guidelines note the need for at least one follow-up examination to assess the correctness of the treatment. And control laboratory tests are indicated only with a protracted course of the disease, the likelihood of re-infection, and suspicions of the resistance of the pathogenic organism.
If the disease is acute, affecting the internal organs, there is a need for examination by related specialists (urologist, surgeon). Laparoscopic techniques may be used. If there are extragenital lesions, patients are referred for a consultation with an ophthalmologist, an ENT specialist, an 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;
The development of hydrosalpinx (pus in the fallopian tubes);
Pelvioperitonitis;
Spontaneous abortion;
premature birth;
Retardation of intrauterine development of the fetus;
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 time and provide adequate therapy to such patients. Of particular importance are regular medical examinations of employees of children's institutions and catering workers.
Examination 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 ways of personal prevention that each person must follow in order to prevent infection. First of all, you need to carefully adhere to the rules of personal hygiene and try to avoid casual sexual contact. When having sexual intercourse, it is recommended to use reliable means of protection. These include condoms or vaginal application of chemicals (chlorhexidine, miramistin). If suspicious symptoms appear (pathological discharge, discomfort), you should immediately consult a doctor.
