Gonococcal infection. Gonorrhea urolithiasis Surgical treatment of gonorrhea

Gonorrhea is infection caused by gonococcus. People call this disease gonorrhoea. Gonococcus penetrates the mucous membranes and begins to develop in them. The most common sexual route of infection is when the infection affects the genitourinary system. However, there are other types of gonorrhea, such as oral and ocular. Despite the effectiveness of modern medications, the disease is constantly mutating and gradually acquiring immunity to the drugs.

Types of pathology

There are acute and chronic forms of gonorrhea.

Characteristic symptoms

Typically, men notice the first signs of the disease a week after infection. In some cases, this deadline is extended by three weeks.

Symptoms of gonorrhea in men are as follows:

It is worth remembering that gonorrhea often occurs without any symptoms. At this time, a man may not know about the disease and expose his sexual partners to the risk of infection.

Causes of infection

The main and most common cause of infection is unprotected sexual contact with a carrier of the disease. In second place is the oral method of infection from a partner suffering from oral or genitourinary gonorrhea. Sometimes gonorrhea is passed on to a baby during birth from an infected mother.

In extremely rare cases, gonorrhea is transmitted from an infected person through household items or personal use. Such items include: towel, underwear, washcloth. There are very few cases of infection with gonorrhea through domestic means, because the infection quickly dies outside the human body. Therefore, do not be afraid of public swimming pools, toilets or shared utensils.

Consequences and complications

The chronic form of the disease is the most dangerous due to its consequences, since it is not clearly expressed. Men often do not pay attention to minor ailments. Meanwhile, the infection spreads throughout the internal organs and causes inflammation. One of the most common complications is the appearance of secondary infections, namely: candidiasis, ureaplasmosis, chlamydia. Moreover, unlike gonorrhea, they can occur quite brightly, thereby preventing the correct diagnosis.

Among the most dangerous and complex consequences are prostatitis and orchiepididymitis (inflammation of the testicle and epididymis). With the latter, the man is worried about fever, swelling and pain in the groin, and hyperemia in the scrotum. If the disease develops in one testicle, this leads to disruption of sperm production in it. If the disease affects both testicles, it leads to infertility. Gonorrheal prostatitis is characterized by a chronic course of the disease. It is difficult to treat and therefore often leads to impotence and infertility.

The urinary system of the body also suffers from gonorrhea. The development of infection can lead to a narrowing of the lumen of the urethra. Also among the complications is gonorrheal conjunctivitis, which leads to the death of eye tissue and blindness. Inflammation in internal organs can lead to hepatitis, meningitis, myocarditis and skin diseases.

Diagnostic measures

During the appointment, the doctor will listen to all the patient’s complaints, but he will not be able to make a diagnosis without additional smears and tests. When diagnosing gonorrhea, the microscopy method is most often used. Bacterial culture is commonly used to identify advanced and chronic cases. It has an advantage over other methods, allowing one to determine the sensitivity of gonococcus to medications. This is very important for prescribing the correct treatment regimen for the chronic form of the disease.

Directions of therapy

To get rid of gonorrhea, doctors usually prescribe a course of treatment that includes the following groups of drugs:

1. Antibiotics. The basis for the treatment of gonorrhea, which allows you to suppress gonococci and their activity. Among these drugs: Azithromycin, Ceftriaxone, Ofloxacin, Cefixime. The duration of treatment is determined by the doctor. In acute stages it is at least two weeks.
2. Anti-inflammatory drugs. Prescribed to relieve inflammatory processes.
3. Analgesics. They allow you to cope with pain.
4. Antipyretic. Prescribed in case of elevated body temperature.
5. Immunomodulators and vitamins. Prescribed to boost immunity, which may weaken after taking antibiotics.

After the course of treatment, swabs are taken from the man again. This is necessary to analyze the treatment regimen and edit it if necessary.

Treatment in a hospital is quite rare. To indications for inpatient treatment include:

6. complications from infection (presence of conjunctivitis, prostatitis, epididymitis);
7. gonorrhea with constant relapses;
8. refusal of outpatient therapy.

During treatment, a man must completely abstain from sexual activity. Heavy physical activity, cycling, and hypothermia are excluded. The advantage would be refusal bad habits at least for the duration of treatment. Of course, we should not forget that both partners must undergo treatment.

You should not self-medicate, because this can lead to serious consequences and the development of gonococcus resistance to the drugs taken.

Prevention measures

The disease can be avoided. You just need to follow simple rules.

9. Avoid unprotected sex. This is especially true for one-time relationships with casual partners. A condom will help prevent unpleasant consequences.
10. Maintain personal hygiene.

Gonorrhea is dangerous disease which can be easily avoided. To do this you need to use the tools personal protection during sexual intercourse. In addition, you should not delay going to the doctor if you notice the first symptoms of the disease.

Bibliography

Why does a burning sensation occur in the penis?

Men often suffer from various diseases genitourinary system. It could be infectious pathology(urethritis, STDs, cystitis) and non-infectious (trauma, urolithiasis). Almost all of these diseases have symptoms such as pain, itching or burning in the penis during urination. They need to be distinguished. A burning sensation in the penis is a common occurrence. When such signs appear, some men ignore what is happening, hoping that everything will go away. Others try to cure the burning sensation on their own with the help of various ointments and creams, which often only worsens the condition of the sick person.

It is important that if a burning sensation occurs, you need to wait a little. If it goes away on its own after some time, then it is not dangerous. If new symptoms appear (discharge, pain), then this is a reason to consult a doctor. An interesting fact is that, unlike women, men have a longer and thinner urethra, so it is difficult for infections to penetrate from the outside. In most cases, burning occurs due to the spread of infection within the body. This often occurs with prostatitis or cystitis. Let's take a closer look at why burning in the penis occurs, the main predisposing factors, and treatment.

Burning sensation with urethritis

Urethritis (inflammation of the urethra) develops as a result of the entry and proliferation of microorganisms. It can be divided into specific and nonspecific. In the first case, the pathogens are microorganisms that are characteristic of the genitourinary system. These include chlamydia, trichomonas, gonococci. Nonspecific pathogens are streptococci, staphylococci, E. coli, microscopic fungi, that is, opportunistic microflora. Urethritis can be non-infectious in nature (due to injuries, medical procedures). Predisposing factors for the development of pathogenic flora are the following: unprotected sexual intercourse, poor nutrition, stressful situations, irregular sex, changes in hormonal levels and others.

A characteristic symptom of urethritis is a burning sensation on the head of the penis. Instead of burning, there may be itching. A burning sensation is observed when urinating. Additional signs of urethritis are pain, discharge that is greenish or mixed with blood. The discharge often has an unpleasant odor and is observed in the morning. Another common symptom- adhesion of the urethral canal. Urethritis is treated with antibacterial drugs. Drugs from the fluoroquinolone group have a good effect. Urethritis is dangerous due to its complications. These include the development of prostatitis, narrowing of the urethra, acute urinary retention, orchitis, and vesiculitis.

Penile irritation

The presence of a burning sensation in the head of the penis may indicate an allergic reaction.

This is very often observed when using various cosmetics and care products. Some components of shampoos, creams, shower gels can cause a burning sensation in the head of the penis. This happens during hygiene procedures or immediately after them. With such a burning sensation in the head, you don’t need to see a doctor. It goes away within a few hours or the next day. Interestingly, even simple low-quality toilet paper can cause a burning sensation in the penis or perineum.

The result of this effect is irritation of the penile mucosa. In more rare cases, this phenomenon may result from the use of spermicides, as well as regular condoms. A burning sensation can be triggered by a salt bath. If there is a burning sensation in the genitals long time does not go away, you should consult a doctor for advice. Irritation can be caused by dirty underwear if personal hygiene rules are not followed.

Burning sensation with prostatitis

A burning sensation in the penis is very often a symptom of prostatitis. Prostatitis is inflammation of the prostate gland. The main reason for its development is a violation of the blood flow entering this organ. This occurs with physical inactivity and excess body weight. Great importance have unprotected sexual intercourse, during which various bacteria first enter the bloodstream and then penetrate the prostate. Predisposing factors for the development of prostatitis and burning sensation are hypothermia, hormonal imbalance, urinary retention, and irregular sex life. The reason may be the presence of foci chronic infection.

With prostatitis, a burning sensation is observed in the perineum and urethra. This feeling occurs because the gland is located next to the urethra, so symptoms include difficulty urinating. Currently, prostatitis is a very common pathology; it is detected in almost every tenth man. Burning pain most often accompanies the chronic course of the disease.

Burning of the head with urolithiasis

Another disease that causes a burning sensation in the penis is urolithiasis. This is a metabolic pathology in which a large number of various salts: urates, oxalates, phosphates. Unpleasant sensations in the head of the genital organ in men are one of many symptoms. It is important that in development urolithiasis External and internal factors play a big role. External refers to poor nutrition(consumption of large amounts of animal proteins or salt, foods containing a lot of oxalic acid, excess calorie intake), unfavorable environmental conditions, physical inactivity, harmful production factors (increased physical activity).

Endogenous factors include hereditary predisposition, the presence of foci of chronic infection, gout, traumatic lesions, diseases gastrointestinal tract. The main symptoms of the disease: pain (renal colic), impaired excretion of urine, the presence of blood or pus in it, dyspeptic disorders, pollakiuria, urge to urinate and burning. Treatment of urolithiasis involves the use of drugs that break down stones. Surgery is also indicated. The most commonly used method is stone crushing (lithotripsy).

Chlamydia and gonorrhea

A special group of diseases, which is characterized by the presence of burning or itching in the penis, are sexually transmitted diseases. It includes herpetic infection, syphilis, gonorrhea, chlamydia, trichomoniasis and others. Chlamydia is a very common disease today. Millions of people around the world suffer from it every year. Chlamydial infection manifests itself various symptoms. It is characterized by burning and itching when urinating, in some cases an increase in temperature, cloudy urine, pain in the penis area, radiating to the perineum.

Glassy discharge from the penis may be observed. In some cases, blood or pus is found in the urine. Burning and itching may be absent, like many other manifestations. Itching is a variable symptom. Chlamydia is often asymptomatic. When the first signs appear, you should contact a dermatovenerologist. In addition to itching and dysuria, chlamydia is dangerous due to its complications. These include urethral constriction, Reiter's disease, chronic prostatitis, conjunctivitis.

Gonorrhea and trichomoniasis

Itching of the glans penis is observed not only with chlamydia. Itching in the penis is a sign of gonorrhea. It occurs acutely or chronically. In the first case, the patient complains of itching or burning of the penis, the presence of mucus or purulent contents. In addition, there is stranguria (pain when passing urine) and frequent urge to go to the toilet. A man becomes infected through sexual contact from a sick partner. Most often this happens in the absence of a condom. Almost half of patients do not experience any symptoms. It is important that gonococcus can infect the epididymis, causing epididymitis, as well as the kidneys and bladder. Treatment includes the use of antibacterial agents.

As for trichomoniasis, it is similar to the infections described above. The difference is that the symptoms are scant or may be completely absent. There is itching or burning in the head of the penis, difficulty in urinating, the urge to go to the toilet, and pain. White, foamy discharge often comes out of the penis, sometimes mixed with pus. Trichomoniasis lasts 1-2 weeks, the incubation period is about 2-4 weeks. Trichomoniasis can develop into chronic form. At the same time, it causes urethritis or prostatitis.

How to get rid of burning sensation in the penis

To ensure that burning and itching no longer bother a man, it is necessary to eliminate etiological factor. If the issue is not an infection, but a lack of personal hygiene or irritation, then it is necessary to replace personal hygiene products with others. As for diseases, etiological treatment is carried out first. In most cases, it involves the use of antibiotics. If the patient suffers from urolithiasis, then surgical intervention is indicated. Equally important is compliance with diet, drinking regimen, and increasing the level of motor activity, avoiding stress and alcohol intake.

Thus, burning and itching in the head of the penis in men can be observed at the most various diseases. Often the cause is irritation of the urethral mucosa of the penis. To recognize a particular disease, you need to know its main manifestations.

Gonorrhea

Gonorrhea is a classic sexually transmitted disease (sexually transmitted disease). The causative agent is gonococcus ( Neisseria gonorrhoeae).

Fig 1 Gonococcus - Neisseria gonorrhoeae, photo. © Illustration provided with permission from BINOM publishing house

This disease can affect the urethra (urethra), rectum, pharynx, cervix and eyes.

Gonorrhea infection

In most cases, gonorrhea infection occurs through sexual contact in the vagina and rectum. It is possible to become infected through oral sex.

When passing through birth canal the newborn may become infected and develop gonococcal conjunctivitis.

Household infection is unlikely. This is due to the fact that (1) gonococcus quickly dies outside the human body; (2) for infection it is necessary that a sufficient number of gonococci enter the body. The household method of infection cannot provide the required number of gonococci. Therefore, the cause of infection cannot be toilet seats, swimming pools, baths, shared utensils and towels.

The probability of infection during one-time sexual contact without a condom with a patient with gonorrhea

The probability of infection through unprotected sexual contact (vaginal, anal) with a patient with gonorrhea is about 50%.

With oral sex, the likelihood of infection is lower. Given the prevalence of asymptomatic gonococcal pharyngitis among prostitutes, unprotected oral sex with a prostitute cannot be considered safe.

Incubation period gonorrhea

The incubation period for gonorrhea in men is usually from 2 to 5 days; for women – from 5 to 10 days.

Gonorrhea symptoms

Symptoms of gonorrhea in men:

- yellowish-white discharge from the urethra

Fig 2 Gonorrhea, photo. © Illustration provided with permission from BINOM publishing house

Symptoms of gonorrhea in women:

- yellowish-white vaginal discharge

- pain when urinating

- intermenstrual bleeding

- lower abdominal pain

Gonococcal pharyngitis (pharyngitis) is often asymptomatic. Sometimes it manifests itself as a sore throat.

Gonococcal proctitis (rectal damage) is usually asymptomatic. Possible pain in the rectum, itching and discharge from the rectum.

Gonococcal pharyngitis and gonococcal proctitis occur in both men (mainly homosexual and bisexual orientation) and women.

Features of gonorrhea in women

In women, gonorrhea is often asymptomatic. Even if symptoms occur, they are not always correctly assessed. For example, yellowish-white vaginal discharge from a woman is usually associated with candidiasis (thrush); pain when urinating - with cystitis.

Complications of gonorrhea

In men, the most common complication is inflammation of the epididymis - epididymitis.

In women, the most common complication of gonorrhea is inflammatory diseases of the uterus and appendages. which are one of the main causes of female infertility. Wherein intrauterine device and menstruation increase the risk inflammatory diseases uterus and appendages.

When gonococci spread to other organs, disseminated gonococcal infection occurs. This affects the joints, skin, brain, heart and liver.

When gonococci get into the eyes, gonococcal conjunctivitis occurs.

Diagnosis of gonorrhea

Symptoms alone are not enough to diagnose gonorrhea. Confirmation of the diagnosis by laboratory methods is necessary.

Diagnosis of acute gonorrhea in men is usually based on the results of a general smear. For chronic gonorrhea in men, as well as for any form of the disease in women, more accurate research methods are needed - PCR or culture.

Treatment of gonorrhea

Considering that in 30% of cases gonorrhea is combined with chlamydial infection, treatment of gonorrhea should include: (1) a drug active against gonococci; (2) a drug active against chlamydia.

Drugs active against gonococci:

- cefixime, 400 mg orally once

- ciprofloxacin, 500 mg orally once

- ofloxacin, 400 mg orally once

Commercial names of cefixime: Suprax, Cefspan

Commercial names of ciprofloxacin: Aquacipro, Vero-Ciprofloxacin, Ificipro, Quintor, Liproquin, Medociprin, Microflox, Procipro, Recipro, Siflox, Tseprova, Ciloxan, Ciplox, Ciprinol, Ciprobay, Ciprodox, Ciprolet, Ciprolon, Cipromed, Cipropane, Ciprosan, Ciprofloxacin hydrochloride read , Citeral, Cifran

Commercial names of ofloxacin: Vero-ofloxacin, Zanotsin, Oflo, Ofloxin, Oflocsid, Tarivid, Tariferid, Taricin, Floxal

Drugs active against chlamydia:

- azithromycin, 1 g orally once

- doxycycline, 100 mg 2 times a day for 7 days

Commercial names of azithromycin: Azivok, Azitral, Azitrox, Zitrolide, Sumizid, Sumamed, Hemomycin

Commercial names of doxycycline: Apo-Doxy, Vibramycin, Doxal, Doxycycline hydrochloride, Doxycycline Nycomed, Doxycycline-Rivo, Medomycin, Unidox Solutab

Treatment regimens for acute uncomplicated gonorrhea are given. In case of chronic gonorrhea (especially complicated ones), antibiotic therapy is longer, often combined (several antibiotics are used). In addition, they prescribe additional treatment(immunotherapy, urethral instillations, physiotherapy, etc.).

This information is provided for informational purposes only and should not be used for self-treatment.

Gonorrhea prevention

You can read about ways to reduce the risk of infection in the section How to protect yourself from sexually transmitted diseases.

For preventive treatment within a few days after contact, see the section Prevention after casual relationships.

Sexual partners

If you are cured but your sexual partner is not, you can easily become infected again.

It is very important to tell your sexual partners about the disease, even if they are not worried, and to encourage them to get tested and treated. After all, being asymptomatic does not reduce the risk of complications.

Our site has existed since 2002. During this time, we have accumulated vast experience in the diagnosis and prevention of gonorrhea. We actively use this experience in our daily work to ensure that our assistance is effective and safe. We will be happy to help you!

Urolithiasis of the kidneys. otherwise called kidney stone disease, urolithiasis or nephrolithiasis, in the official traditional medicine- a disease that is associated with the formation of stones both in the kidneys and in other urinary organs. Urolithiasis can affect any age group, including newborns and the elderly. The type may vary depending on age. urinary stone. People of the elderly age group mainly develop uric acid stones, and much less frequently - protein stones. Over 60% of all stones are mixed in composition. They can appear in the kidneys, bladder and ureter. Their size can reach 15 cm, and their weight can be several kilograms.

According to experts, a number of factors predispose to the occurrence of kidney stones, including:

11. chronic diseases of the genitourinary system (prostatitis, pyelonephritis, cystitis, prostate adenoma, etc.) and gastrointestinal tract ( peptic ulcer, gastritis, colitis, etc.);
12. osteoporosis, osteomyelitis, as well as trauma or other bone diseases;
13. lack of vitamins in the body, especially group D;
14. geographical location. The likelihood of developing urolithiasis in people living in hot climates is much higher;

How are the symptoms of urolithiasis expressed?

15. Pain in the lumbar region
16. One- or two-sided debilitating dull pain, aggravated by tension, physical activity or changes in body position. This sign is one of the most typical, indicating the presence of stones in the urinary organs. A stone entering the ureter from the kidney causes pain in the lower abdomen. genitals, groin - sometimes with impact in the leg. After an intense attack of pain during urination, stones may pass
17. Extremely severe pain in the lumbar region. Renal colic can continue for several days, subsiding and then returning again. The cessation of colic occurs when the stone moves or exits the ureter
18. Cloudy urine
19. High pressure
20. Temperature rises to 38-40C
21. Edema

Treatment of kidney stones

Large stones or small stones in patients with complications can be removed endoscopically (surgery without an incision) or with an incision Bladder. In certain cases, stone crushing using a cystoscope is used to crush stones in the bladder. The most gentle and one of the most effective methods today is remote litripsia - crushing stones using electromagnetic waves.

Diet for kidney stones

If urates are present, by-products are excluded; the presence of phosphate stones in the genitourinary system suggests a meat diet, allowing the consumption of flour and pasta, as well as vegetable fats, against the backdrop of a strict restriction of dairy products, fruits and vegetables.

If you have oxalate stones, spinach and lettuce are excluded from the diet, and milk and potatoes are allowed in strictly dosed quantities. A urologist will advise you on diet and nutrition in more detail.

Taken by surprise renal colic can be partially pacified by taking a warm bath or applying a heating pad to the lumbar area. In this situation, you need to call a doctor and take antispasmodics.

The key to good health for many years can be correct image nutrition. Try to eat fatty, spicy, fried and salty foods as little as possible. One of the important rules is not to overeat. Drink at least two liters of clean water during the day. Avoid hypothermia in the lumbar region.

Information: gonorrhea is a sexually transmitted disease caused by gonococcus. It is transmitted mainly through the priestly route. The extra-popular route of infection is rare (in children who share towels and underwear with their sick mother). The causative agent of the infection primarily affects parts of the genitourinary system lined with single-layer epithelium: the mucous membrane of the urethra, the excretory ducts of the Bartholin glands, the cervical canal, the body of the uterus, and the fallopian tube. Often the process involves the paraurethral ducts, the integumentary epithelium of the ovaries, the mucous membrane of the rectum, and the pelvic peritoneum. Inflammation of the vaginal mucosa (gonorrheal colpitis) is possible in special conditions female body: V childhood, during pregnancy and menopause. Inflammatory exudate contains a large amount of fibrinogen, which quickly precipitates into fibrin and thereby contributes to the delimitation of inflammatory process with the formation of numerous adhesions. The spread of infection occurs mainly through pre-existing channels. The incubation period is 3-4 days. Immunity to gonococcus is practically not developed. The following forms of the disease are distinguished: fresh REF="des516.htm"> gonorrhea (acute, subacute, torpid); chronic and latent. The torpid (asymptomatic) form is characterized by minor clinical manifestations when a pathogen is detected in patients. For latent gonorrhea, a typical condition is when gonococci are not detected in smears and cultures, there are practically no symptoms of the disease, and the woman is nevertheless an obvious source of infection. Gonorrheal urethritis. In the acute stage, patients complain of pain and pain when urinating, in chronic stage no complaints. A gynecological examination revealed redness and swelling in the area of ​​the external urethral opening and mucopurulent discharge from the urethra. The paraurethral tracts are often involved in the inflammatory process. With chronic urethritis, only thickening of the walls of the urethra is noted (on palpation through the anterior wall of the vagina). Gonorrheal endocervicitis, along with urethritis, is the most common localization of the disease. In the acute stage - mucopurulent leucorrhoea and slight pain in the lower abdomen. When examining the cervix with the help of vaginal speculum, redness and loosening of the mucous membrane in the area of ​​the external uterine os, cervical mucopurulent leucorrhoea hanging in the form of a ribbon are detected. In the chronic stage, the discharge becomes mucous, patients do not complain. erosion. Gonorrheal bartholinitis. Inflammation always begins with the excretory duct of the gland (canaliculitis); it is expressed by hyperemia in the area of ​​​​the external openings excretory ducts(gonorrhea spots). When a secondary infection occurs, a pseudoabscess of the gland occurs with a characteristic clinical picture(see Bartholinitis). Gonorrheal proctitis is observed relatively rarely, with the flow of infected discharge from the buttocks. The acute stage is characterized by a burning sensation in the rectum and tenesmus; in the chronic stage these symptoms are not expressed. Gonorrheal endometritis. The rise of infection (beyond the area of ​​the internal uterine pharynx) is facilitated by menstruation, abortion, childbirth, intrauterine interventions (diagnostic curettage, hysterosalpingography, etc.). Both the basal and functional layers of the endometrium are involved in the inflammatory process in gonorrheal endometritis. During the next menstruation, the rejection of the mucous membrane is delayed, which is manifested by typical hyperpolymenorrhea (menorrhagia). Acute stage: pain in the lower abdomen, low-grade fever, serous-purulent discharge. On vaginal examination, the uterus is slightly painful on palpation. For chronic gonorrheal endometritis, only the symptom of menorrhagia is typical. Gonorrheal salpingoophoritis is usually bilateral, while with salpingoophoritis caused by other microbes, the inflammatory process is often unilateral. In the acute stage of the process, patients are bothered by abdominal pain, fever, dysuria, disorders menstrual cycle (see Dysfunctional uterine bleeding). Vaginal examination reveals enlarged, swollen uterine appendages, sharply painful on palpation. The phenomena of pelvic peritonitis are often associated. In the chronic stage, patients complain of periodic pain in the lower abdomen, often recurrent under the influence of nonspecific factors (hypothermia, flu, etc.). Typically tubal infertility (primary or secondary). Gonorrheal pelvioperitonitis is the result of the transition of the inflammatory process from the uterine appendages to the pelvic peritoneum. Inflammation has a pronounced tendency to be limited (diffuse peritonitis is an exception). The onset of the disease is often acute. Characterized by severe abdominal pain, dyspeptic disorders, tachycardia, fever, symptoms of peritoneal irritation in the lower abdomen. The delimitation of the process occurs quickly, as evidenced by the groove located above the pelvic area (a conglomerate of intestinal loops and omentum). Vaginal examination reveals the phenomena of bilateral salpingoophoritis and bulging of the posterior vaginal vault, which is sharply painful on palpation. When puncturing the posterior fornix in the acute stage of the process, a serous effusion is obtained. In the chronic stage: pain caused by scar-adhesive changes in the pelvic organs; often infertility due to endo- and perisalpingitis. Symptoms and diagnosis of gonorrhea. Recognition is facilitated by anamnesis: illness shortly after the onset of sexual activity, casual sexual intercourse. During the examination, urethritis, endocervicitis in a primarily infertile woman, bilateral salpingoophoritis, and proctitis are detected. Bacteriological and bacterioscopic diagnostics - smears and cultures from the urethra, cervical canal, vagina (before starting the use of antibiotics!). In chronic stages, provocation is indicated: 1) lubricating the mucous membrane of the urethra and cervical canal with a solution of silver nitrate (0.5% solution for the urethra, 2% solution for the cervix); 2) intramuscular administration of gonovaccine (500 million microbial bodies); 3) physiotherapeutic procedures (diathermy, etc.). Bacteriological and bacterioscopic examination is carried out on the 3rd day after provocation. Menstruation is a provocation, so you can take smears and do a culture on the 2-3rd day of menstruation. Serological reactions with antibodies and antigen do not have much diagnostic value. During the cytobacteriological examination of smears, the following pictures are distinguished: K., - there is a large number of leukocytes in the smear, there is no flora, intra- and extracellular gonococcus is visible (gram-negative); K2 - a large number of leukocytes, no flora, no gonococci (smear is suspicious for gonorrhea); K3 - a small number of leukocytes and a diverse microbial flora (a smear is not typical for gonorrhea). Treatment. For fresh and ascending gonorrhea, treatment is carried out in a hospital setting. Bed rest, antibacterial and symptomatic treatment. Assign antibacterial therapy, while the course of treatment depends on the stage and localization of the inflammatory process. Course doses of antibiotics for lower gonorrhea genitourinary organs should be 2 times lower than for ascending gonorrhea (for ascending gonorrhea, antibacterial therapy is carried out for 5-7 days). Penicillin and semi-synthetic penicillins are prescribed in the following doses: 1) benzylpenicillin or its potassium salt - a single dose from 500,000 to 2,000,000 units intramuscularly, daily - from 2,000,000 to 20,000,000 units intramuscularly; 2) oxacillin 0.5 g 4 times a day IM; 3) ampicillin 0.4 g 6 times a day IM; Ampiox 1 g 3-4 times a day IM. Other antibiotics used include cephalosporins (kefzol - 0.5-1 g 2-4 times a day IM), tetracycline (0.25 g 4 times a day orally), erythromycin (0.5 g 3-4 times a day orally). Sulfonamides are prescribed for intolerance to antibiotics (1 g 5 times a day for 4 days). Vaccine therapy is carried out when chronic course diseases (200-300 million microbial bodies intramuscularly in 2-3 days or 50-100 million microbial bodies into the lesion - only in the hospital). Local treatment is used for chronic gonorrhea of ​​the lower genital organs (in the acute stage, these procedures are contraindicated). For urethritis: rinsing the urethra with a solution of potassium permanganate 1:5000-1:10,000; instillation of a 1-2% solution of protargol, lubrication of the urethral mucosa with a 1% solution of silver nitrate. For cervicitis: lubricate the cervical canal with a 2% solution of silver nitrate; vaginal baths with 3-5% protargol solution. For bartholinitis: in the acute stage - sitz baths, UHF; in case of suppuration - opening of the abscess; in the chronic stage - enucleation of the gland (in case of pseudoabscess formation). Criteria for cure for gonorrhea. After completion of treatment, a gynecological examination of the patient is performed and smears are taken for 3 months. Smears from the urethra, cervix and vagina are taken after drug and physiological (menstruation) provocation (see above). The absence of gonococci during this period allows the woman to be considered cured of gonorrhea.

Unacceptable self-treatment gonorrhea, it is dangerous due to the transition of the disease to a chronic form and the development of irreversible damage to the body. All sexual partners of patients with symptoms of gonorrhea who have had sexual contact with them in the last 14 days, or the last sexual partner if contact occurred earlier than this period, are subject to examination and treatment. If there are no clinical symptoms in a patient with gonorrhea, all sexual partners over the past 2 months are examined and treated. During the period of treatment of gonorrhea, alcohol and sexual relations are excluded; during the period of clinical observation, sexual contacts using a condom are allowed.
Modern venereology is armed with effective antibacterial drugs that can successfully fight gonorrhea. When treating gonorrhea, the duration of the disease, symptoms, location of the lesion, absence or presence of complications, and concomitant infection are taken into account. In acute ascending type of gonorrhea, hospitalization, bed rest, therapeutic measures. In case of purulent abscesses (salpingitis, pelvioperitonitis), emergency surgery is performed - laparoscopy or laparotomy. The main place in the treatment of gonorrhea is given to antibiotic therapy, taking into account the resistance of some strains of gonococci to antibiotics (for example, penicillins). If the antibiotic used is ineffective, another drug is prescribed, taking into account the sensitivity of the gonorrhea pathogen to it.
Gonorrhea of ​​the genitourinary system is treated with the following antibiotics: ceftriaxone, azithromycin, cefixime, ciprofloxacin, spectinomycin. Alternative treatment regimens for gonorrhea include the use of ofloxacin, cefozidime, kanamycin (in the absence of hearing diseases), amoxicillin, trimethoprim.
Fluoroquinolones are contraindicated in the treatment of gonorrhea for children under 14 years of age; tetracyclines, fluoroquinolones, and aminoglycosides are contraindicated for pregnant women and nursing mothers. Antibiotics that do not affect the fetus are prescribed (ceftriaxone, spectinomycin, erythromycin), and prophylactic treatment is carried out for newborns of mothers with gonorrhea (ceftriaxone - intramuscularly, washing the eyes with a solution of silver nitrate or applying erythromycin ophthalmic ointment).
Treatment of gonorrhea can be adjusted if there is a mixed infection. For torpid, chronic and asymptomatic forms of gonorrhea, it is important to combine primary treatment with immunotherapy, local treatment and physiotherapy.
Local treatment gonorrhea includes the introduction into the vagina, urethra of 1-2% protorgol solution, 0.5% silver nitrate solution, microenemas with chamomile infusion. Physiotherapy (electrophoresis, ultraviolet irradiation, UHF currents, magnetic therapy, laser therapy) is used in the absence of an acute inflammatory process. Immunotherapy for gonorrhea is prescribed outside of exacerbation to increase the level of immune reactions and is divided into specific (gonovacin) and nonspecific (pyrogenal, autohemotherapy, prodigiosan, levamiosole, methyluracil, glyceram, etc.). Immunotherapy is not given to children under 3 years of age. After treatment with antibiotics, lacto- and bifid drugs are prescribed (orally and intravaginally).
A successful result of treatment for gonorrhea is the disappearance of symptoms of the disease and the absence of the pathogen according to the results laboratory tests(7-10 days after the end of treatment).
The need for various types provocations and numerous control examinations after the end of treatment for gonorrhea, carried out with modern highly effective antibacterial drugs. One follow-up examination of the patient is recommended to determine adequacy this treatment gonorrhea. Laboratory control is prescribed if they remain clinical symptoms, there are relapses of the disease, perhaps reinfection gonorrhea.

Gonorrhea is an infectious disease caused by gram-negative diplococcus (gonococcus lat. Neisseria gonorrhoeae), sexually transmitted and characterized by damage to the mucous membranes of the genitourinary organs. Refers to venereal diseases.

Epidemiology

Diseases caused by gonococcus: urethritis, cervicitis, salpingitis, proctitis, bacteremia, arthritis, conjunctivitis (blennorrhea), pharyngitis. Inflammation of the pharynx and rectum occurs less frequently.

Source of infection- a sick man. The pathogen is transmitted sexually, less commonly through household items (underwear, towels, washcloths). With blenorrhea, infection of the newborn occurs through the infected birth canal of the mother.

The genus Neisseria includes more than 20 species: N. canis, N. cinerea, N. denitrificans, N. elongata, N. flavescens, N. gonorrhoeae, N. lactamica, N. macacae, N. meningitidis, N. mucosa, N. polysaccharea, N. sicca, N. subflava, etc. Gonococci are gram-negative diplococci (from the Greek diplo - double) bean-shaped, arranged in pairs, adjacent to each other with the concave side (size 1.25- 1.0 x 0.7-0.8 microns). They have a soft capsule and drink. In purulent discharge, the location of gonococci inside and outside the phagocytic cells - leukocytes (incomplete phagocytosis) is characteristic.

Clinical picture of gonorrhea

The disease manifests itself 3-7 days after infection and occurs acutely or chronically.

Acute gonorrhea characterized by the release of mucus, pus, a sensation of tickling, burning and pain in the terminal part of the urethral canal, frequent urge to urinate, which is very painful. About half of infected people show no symptoms, especially early in the illness. Women are most prone to oligosymptomatic or asymptomatic course of the disease.

From the urethra, the microorganism penetrates to the epididymis and causes its inflammation (epididymitis, orchiepididymitis - inflammation of the entire structure - testicle + epididymis), manifested by enlargement, extreme pain, and a general feverish state. After 3-4 weeks, this inflammation can go away safely, or become chronic, or end in necrosis of the appendage. The spermatic cord sometimes becomes inflamed.

The disease sometimes spreads to the bladder, spreads further to the ureters and causes disease of the kidneys themselves. Inflammation of the mucous membrane can spread deep into the tissue. The lymph nodes also affected by gonorrhea and become swollen. The outer coverings become inflamed and swell. Sometimes even necrosis of the foreskin occurs.

Acute gonorrhea in women has the same course as in men. The symptoms and course of the disease are the same. Skin lesions (eczema) develop from irritation of the outer integument with pus. Bartholin's glands suppurate. Diseases of the bladder, inner lining and lining of the uterus (para- and perimetritis) appear to be severe complications of gonorrhea. Very often, gonorrhea is the cause of infertility.

Diagnostics

Microbiological diagnostics
Bacterioscopic method- coloring two strokes:

• according to Gram;
• 1 % aqueous solution methylene blue and 1% alcohol solution eosin.

Bacteriological method:

inoculation on nutrient media containing native proteins of blood, serum or ascitic fluid; use ascites-free media (for example, KDS-1 medium with casein hydrolyzate, yeast autolysate and native whey); optimal growth in an atmosphere of 10-20% carbon dioxide, at a pH of 7.2-7.4 and a temperature of 37 °C.

Serological diagnosis

• RSK (Bordet-Gengou reaction) or RIGA with the patient’s blood serum.
• Molecular biological method - test with a DNA probe (nucleic acid amplification method - NAAT).

Treatment

Treatment of gonorrhea is reduced to the use of a course of antibiotics. The drug of choice for acute uncomplicated gonorrhea is cefixime (in the Russian Federation - Ceforal Solutab) dispersible tablet, taken orally, once, in a dose of 400 mg. For complicated gonorrhea, as well as for gonococcal pharyngitis, the use of ceftriaxone 250 mg (eg Rocephin) is indicated.

Due to the high frequency of combination of gonorrhea with chlamydia and mycoplasma infection (Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum), it is recommended to use simultaneous use of doxycycline 100 mg 2 times a day - 7 days (the safest form is doxycycline monohydrate - Unidox Solutab) or azithromycin (Sumamed) 1 g. once.

For chlamydial urethritis in men, doxycycline is most effective, including when compared with azithromycin.

Prevention

To prevent gonorrhea, as well as other STIs, it is recommended to use latex, and if they are intolerant, polyurethane, but not natural membrane condoms.

In case of unprotected sexual intercourse, antibacterial prophylaxis is not recommended, except in cases of contact with a partner who has a high probability of infection. To prevent goorrhea, it is possible, although not described in any guidelines, to use antibacterial drugs before or shortly after sexual intercourse. The main condition that to some extent justifies the use of antibacterial prophylaxis is contact with a presumably infected partner and the impossibility, for a number of reasons, of waiting for the development/absence of infection. The main tablet drug, the use of which is possible for gonorrhea or the risk of its development, is cefixime, preferably a dispersible tablet 400 mg once.

The systematic use of antibiotics after each unprotected contact is fraught with the development of resistance of microorganisms, which will subsequently lead to treatment failures and severe complications. Previously effective, azithromycin is currently not used in the treatment of gonorrhea and, of course, for its prevention. Despite the low level of resistance compared, for example, with fluoroquinolones (ciprofloxacin, ofloxacin and others), the latter exceeds the WHO recommended for social dangerous infections 5% threshold. Preventive use of azithromycin may be justified as a prophylaxis for genital chlamydial infection, however, a small number of studies cannot prove this potentially useful property macrolides.

Clinical symptoms of gonorrhea in men are characterized by discharge from the urethra, as well as itching and burning during urination. Upon objective examination, the urethral sponges are sharply hyperemic and edematous, the urethra itself is infiltrated, and pain is noted on palpation. Copious purulent yellowish-green discharge flows freely from the urethra, which often macerates the inner layer of the foreskin. With late treatment, hyperemia and swelling of the skin of the glans penis and foreskin can be observed. Superficial erosions may form on the glans penis. With rectal infection, discharge from the anus or pain in the perineum are observed. In men under 40 years of age. and also in persons with reduced resistance, epididymitis occurs due to the penetration of gonococci into the appendage from the prostatic part of the urethra through the vas deferens. The disease begins suddenly with pain in the epididymis and groin area. Patients experience an increase in body temperature to 39-40°C, chills, headache, weakness. On palpation, the appendage is enlarged, dense and painful. The skin of the scrotum is tense, hyperemic, and there is no folding of the skin. Gonococcal infection of the epididymis leads to the formation of scars in the ducts of the epididymis. As a result, azoospermia and infertility occur. An asymptomatic course can be observed in 10% of cases with lesions of the urethra, 85% with lesions of the rectum, and 90% with lesions of the pharynx. Disseminated gonococcal infection (DGI) most often manifests as an increase in body temperature. damage to joints (one or more) and skin. The manifestation of gonococcal dermatitis is accompanied by the formation of necrotic pustules on an erythematous base, and erythematous and hemorrhagic spots, papulopustules, and blisters may also be observed. The most common location of the rash is distal to the extremities or near the affected joints. The tendon sheaths, mainly of the hands and feet, are also affected (tenosipovitis). DHI occurs more often in women than in men. The risk of developing DHI increases during pregnancy and during the premenstrual period. The manifestation of gonococcal infection in the form of meningitis or endocarditis is very rare.

Clinical symptoms of gonorrhea in women are almost asymptomatic, which leads to late detection of the disease and the development of complications. The primary localization of the lesion is the cervical canal, and inflammatory changes develop both in the integumentary epithelium and in the stroma of the uterine mucosa. Damage to the urethra (urethritis) is observed in 70–90% of patients, and lesions of the vulva and vagina usually develop secondary. Upon examination, the discharge is mucopurulent in nature, and contact bleeding may be observed. Lesions of the basal layer of the endometrium occur as a result of the penetration of gonococci into the uterine cavity during menstruation or after childbirth and abortion. Penetration of gonococci from the endometrium into the muscular layer of the uterus (endometritis) is most often observed after abortion and childbirth. Characteristic of ascending gonorrhea is the rapid spread of infection from the uterus to the fallopian tubes, ovaries, and peritoneum. When the purulent process spreads into the cavity of the gas peritoneum, pelvioperitopitis occurs; fibrin-rich transudate causes the formation of adhesions and adhesions fallopian tube and the ovary with neighboring organs. This is accompanied by acute pain in the lower abdomen and pain on palpation, increased body temperature to 39° C.

In 50% of cases with damage to the cervix, 85% of cases - rectum and 90% - pharynx, asymptomatic infection is observed.

The infection often occurs as a mixed infection (gonorrheal-trichomoniacal, gonorrheal-chlamydial, etc.). As a rule, several organs are infected (multifocal damage).

Gonococcal conjunctivitis in newborns

Damage to the conjunctiva of the eyes in newborns occurs during passage through the birth canal of a mother with gonorrhea and is accompanied by redness, swelling, and sticking of the eyelids. Pus flows out from under their edges or the inner corner of the eye, the conjunctiva of the eye becomes hyperemic and swells. If appropriate treatment is not started in a timely manner, ulceration of the cornea up to its perforation is possible, which can subsequently lead to complete blindness. Gonococcal eye damage in adults can be the result of gonococcal sepsis or, most often, direct transmission of the infection by hands, “contaminated secretions from the genitourinary organs. When the conjunctiva becomes inflamed, purulent discharge appears, and its partial or even complete destruction.

Indications for testing

• symptoms or signs of urethral discharge;
• mucopurulent cervicitis;
• the presence of a sexually transmitted infection (STI) or PID in a sexual partner;
• screening for STIs at the request of the patient or with the recent appearance of a new sexual partner;
• vaginal discharge in the presence of risk factors for STIs (age under 25 years, recent sexual partner);
• acute orchiepididymitis in men under 40 years of age;
• acute PID;
• casual sexual intercourse without protection;
• purulent conjunctivitis in newborns.

Laboratory diagnostics

Verification of the diagnosis of gonorrhea is based on the detection of Neisseria gonorrhea in materials from the genitals and rectum. pharynx, eyes using one of the methods.

A rapid diagnostic test (microscopy of Gram-methylene blue-stained smears from the urethra, cervix, or rectum) quickly identifies typical Gram-negative diplococci.

All samples must be examined using culture and antigen amplification methods (nucleic acid amplification).

Additional Research

• staging a set of serological reactions for syphilis;
• determination of antibodies to HIV, hepatitis B and C;
• clinical analysis of blood, urine;
• Ultrasound of the pelvic organs;
• urethroscopy, colposcopy;
• cytological examination of the mucous membrane of the cervix;
• 2-glass Thompson test;
• examination of prostate secretions.

The advisability of provocation is decided individually by the attending physician. Indications, volume and frequency of conduction additional research determined by the nature and severity clinical manifestations gonococcal infection.