Gonorrhea - symptoms, treatment, causes, diagnosis, complications and prevention. Gonorrhea

Gonorrhea is an infectious disease that is sexually transmitted. It is caused by gonococci of the genus Neisseria. The name of the disease literally means “semen”. It does not reflect the essence of the disease, but is firmly entrenched in medicine, displacing terms such as “gonorrhoea” and “blennorrhea”.

Gonorrhea has been known for centuries. But only in 1879, the German scientist Neisser discovered a microorganism that causes purulent inflammation of the urethra. Since that time, gonorrhea began to be considered an independent disease.

Causes and mechanisms of disease development

The causative agent of gonorrhea is called gonococcus. This bacterium is small in size (0.7 x 1.5 microns), oval in shape, and stains well with aniline dyes. In the acute phase of the process, there are a lot of gonococci in the secreted pus and they are easy to detect under microscopy. In the chronic course of the disease, the discharge becomes insignificant, the pathogen is rarely released. To determine it, you have to resort to additional diagnostic methods.

Under unfavorable conditions, gonococci form so-called L-forms, incapable of reproduction, but very resistant to damaging environmental factors. These forms penetrate deep into the mucous membrane, forming a focus of chronic infection.

Some of the gonococci produce penicillinase, an enzyme that sharply reduces the effect of penicillin antibiotics on them. As a result, drug resistance develops. This is one of the problems of modern venereology, a consequence of the irrational use of antibacterial drugs and self-medication.

Gonococci quickly die outside the human body under the influence of drying, heating, cooling, exposure to sunlight, and antiseptics.

A woman becomes infected with gonorrhea through sexual contact with a sick man or a healthy carrier. Both regular and anal and oral sexual intercourse are dangerous. This affects the rectum, tonsils, and mucous membranes of the mouth and nose.

Girls can become infected from their mother by sharing towels or underwear. When gonococcus is introduced into the eyes, conjunctivitis develops.

With gonorrhea, cellular and humoral immunity is activated. However, these reactions do not protect against reinfection. Patients very often become infected repeatedly, both after recovery (reinfection) and while the gonococcus remains in the body (superinfection). This is largely due to the fact that gonococci change the body’s reactivity, and re-infection develops easier and faster than the primary one.

There are cases of so-called familial gonorrhea, when both husband and wife have the pathogen, but do not cause serious clinical manifestations. When one of them comes into contact with “foreign” gonococci of another sexual partner, an acute picture of the disease occurs.

Gonorrhea in women occurs in the following variants:

• cervicitis (inflammation of the cervical canal);
• cystitis (inflammation of the bladder);
• urethritis (inflammation of the urethra);
• vulvovaginitis (inflammation of the vagina and vulva);
• inflammatory diseases of the pelvic organs – proctitis.

Complications

Complications of gonorrhea include pelvioperitonitis (inflammation of the peritoneum), gonococcal infection of the musculoskeletal system (arthritis). Organs such as the heart, brain, lungs, and skin are rarely affected. Cases of disseminated (widespread) gonococcal infection have been described.

In women, symptoms of gonorrhea most often are not expressed, so they rarely seek medical help. Diagnostic screening is necessary in high-risk patients (women who frequently change sexual partners). It is necessary to tell such women how the disease is transmitted, why it is dangerous and how to treat gonorrhea.

Clinical picture

The mucous membranes of the genital tract are affected by the pathogen immediately, but the first signs of the disease appear only after the incubation period has passed. At this time, the patient can already be contagious to her sexual partner, without experiencing any unpleasant sensations. The incubation period for gonorrhea ranges from one day to three weeks.

Gonorrhea is divided into fresh (up to two months), chronic (more than 2 months) and latent (of unknown duration, without symptoms). The fresh form can be acute, subacute and torpid.

Acute gonorrhea

It rarely occurs in women. It is accompanied by pain, itching, burning in the perineum, pain when urinating, and increased body temperature. Usually the vulva, vagina, urethra, and part of the rectum are affected. There is swelling and redness of the mucous membrane of these organs, mucopurulent discharge in a large volume, having an unpleasant odor. The mucous membrane is easily injured, and damage occurs on it - erosion. The surrounding skin is irritated. The inguinal lymph nodes may become enlarged.

The cervix and cervical canal are involved in the inflammatory process. The urethra is affected, its canal expands, and pus is released from it when pressed.

Subacute form

The subacute form is more common. All its signs are less clearly expressed than in acute cases. However, you can see slight swelling and redness of the labia, urethra, and vagina. There is a slight mucopurulent discharge from the cervical canal.

Chronic gonorrhea

Most often it is diagnosed only during an exacerbation. In this form, the urethra is always affected, but urination disturbances are mild. There is swelling and redness of the vaginal walls. Most often, the disease manifests itself only as white-yellow spots on the underwear. Exacerbation is associated mainly with menstruation, and the bloody discharge may acquire an unpleasant odor. The same effect can be caused by an error in diet - eating too fatty, spicy, salty foods or alcohol.

In many patients, rectal damage is detected. It is manifested by an admixture of blood and mucus in the stool.

One of the complications of gonorrhea is bartholinitis - inflammation of a large gland that opens into the vestibule of the vagina. This disease manifests itself as an enlarged, painful formation in the vulva area.

The infection often spreads upward, affecting the uterus, appendages and peritoneum. This may cause chills, fever, acute abdominal pain, and vomiting.

In women, disseminated gonococcal infection occurs, in which pathogens enter the bloodstream. This is facilitated by the long course of the disease, menstruation, pregnancy, and cervical injuries during instrumental interventions, including abortion.

There are two types of disseminated gonococcal infection. The first occurs as fulminant sepsis with chills, fever, sweating, severe general condition, damage to the skin and joints. In the second case, intoxication is mild; the main symptom of gonorrhea is gonococcal arthritis. However, even with this option, severe damage to the heart, brain and other organs is possible.

If gonorrhea is not treated, its complications can lead to a serious condition for the woman, causing infertility or even death with the development of fulminant sepsis. Therefore, if this disease is suspected, timely diagnosis should be carried out.

Diagnostics

Gonorrhea causes nonspecific symptoms that are also characteristic of other infectious processes. Therefore, the main role in its diagnosis belongs to microscopic examination of a smear from the urethra, vagina or cervical canal.

How is a smear taken for gonorrhea?

4-5 days before the study, all antibiotics are canceled. You should not urinate 3 hours before the test. The test for gonorrhea is taken with a special spatula and a smear is made on a laboratory glass slide. The discharge is treated with special dyes, dried, fixed and examined under a microscope. With gonorrhea, you can see a specific symptom that confirms the diagnosis - an arrangement of Gram-stained bean-shaped cells in pairs in the form of coffee beans. This sign does not occur in all patients, but its presence allows us to speak with confidence about gonorrhea.

Culture method

If the diagnosis is in doubt, the discharge is cultured on special nutrient media. After cultivation, gonococci multiply on them and are much easier to differentiate from other infectious agents.

Polymerase chain reaction

In addition to smear microscopy and the culture method, the determination of antibodies to gonococci in the blood is often used - polymerase chain reaction (PCR).

A rapid test shows the presence of a pathogen - gonococcus - in the urine of a patient. However, its result is often not confirmed by other research methods. On the other hand, using only a rapid test, the disease may not be detected.

PCR is highly accurate. It allows you to detect gonococcal antigens in discharge from the urethra or cervical canal. The disadvantage of such research is its high cost and the need for well-equipped laboratory.

Other methods of laboratory diagnosis of gonorrhea (immunofluorescence reaction, enzyme-linked immunosorbent assay, Bordet-Gengou reaction and others) are of auxiliary value.

When the process becomes chronic, gonococci form stable forms that penetrate deep into the mucous membrane. To activate them, so-called provocative tests are used using chemicals, gonococcal vaccine, thermal, food provocation, and research is carried out on the days of menstruation.

Treatment

Treatment of gonorrhea that affects only the lower genitourinary tract (urethra, vagina and vulva, cervix) is carried out with a single injection of antibiotics, most often cephalosporins or fluoroquinolones.

Treatment of gonorrhea with Ceftriaxone is one of the most common options. Ceftriaxone is an antibiotic from the cephalosporin group; it is administered intramuscularly in a single dose of 250 mg. Effective tablets for gonorrhea - Ciprofloxacin. Usually it is enough to take one 500 mg tablet.

If simultaneous detection occurs, Azithromycin is prescribed at a dose of 1000 mg once orally.

Amoxicillin and other penicillins are practically not used, since gonococci often have resistance to these drugs.

The likelihood of a combination of gonorrhea with syphilis, chlamydia and other sexually transmitted diseases should be taken into account and antibiotics should be selected that are effective against all possible pathogens.

Treatment with antibiotics should only be carried out as prescribed by a doctor. Irrational antibacterial therapy leads to a chronic course of the infection, contributes to the development of its complications and infection of sexual partners.

In chronic and latent forms of gonorrhea, before using antibiotics, a course of gonococcal vaccine is prescribed, which helps strengthen immune reactions and release microorganisms from a protected state. After 6-10 injections of the vaccine, antibacterial therapy is carried out according to the usual regimens.

Treatment for complications of the disease is carried out in a hospital. For this purpose, courses of antibiotics are used for intramuscular or intravenous administration. If necessary, treatment is supplemented with immunostimulating agents, physiotherapeutic procedures, and surgery (for example, for bartholinitis).

Treatment of gonorrhea detected during pregnancy is necessary to prevent infection of the child during childbirth. For this purpose, drugs are used that have minimal harmful effects on the fetus: Ceftriaxone, Azithromycin, Levomycetin. Fluoroquinolones, in particular Ciprofloxacin, are contraindicated. Treatment of gonorrhea in pregnant women should be carried out in a hospital.

10 days after completion of treatment, it is necessary to evaluate its effectiveness. To do this, repeat the smear analysis to make sure there are no symptoms. Then the same study is carried out after the next menstrual cycle. This helps ensure that there is no chronic form. If incomplete cure is suspected, a culture test is performed, the sensitivity of the microbes to antibiotics is determined, and the course of treatment is repeated.

The sexual partner of a woman with gonorrhea should be examined if he had contact with her within a month before the onset of symptoms of the disease. If the disease is chronic or latent, all partners of the woman need to be examined and, if necessary, treated over the past two months. If the patient is caring for children, it is necessary to exclude the disease in them as well.

Ways to increase the effectiveness of treatment:

• strict compliance with doctor's orders;
• refusal of sexual intercourse during treatment;
• examination of sexual partners;
• treatment of other sexually transmitted diseases.

Gonorrhea prevention

Prevention of this unpleasant disease consists of maintaining sexual hygiene, using barrier contraception (condoms), and marital fidelity.

To prevent household infection of family members, you should not share towels, linen and other hygiene items.

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 the 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 of 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

Pain when urinating

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, which is one of the main causes. At the same time, the intrauterine device and menstruation increase the risk of inflammatory diseases of the 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
or
- ciprofloxacin, 500 mg orally once
or
- 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, Cipropan, Ciprosan, Ciprofloxacin hydro chloride , 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
or
- 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, additional treatment is prescribed (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.

For preventive treatment for several days after contact, see section.

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.

– a sexually transmitted infection that causes damage to the mucous membranes of organs lined with columnar epithelium: urethra, uterus, rectum, pharynx, conjunctiva of the eyes. Belongs to the group of sexually transmitted infections (STIs), the causative agent is gonococcus. It is characterized by mucous and purulent discharge from the urethra or vagina, pain and discomfort during urination, itching and discharge from the anus. If the pharynx is affected - inflammation of the throat and tonsils. Untreated gonorrhea in women and men causes inflammatory processes in the pelvic organs, leading to infertility; Gonorrhea during pregnancy leads to infection of the child during childbirth.

General information

(grip) is a specific infectious and inflammatory process that mainly affects the genitourinary system, the causative agent of which is gonococci (Neisseria gonorrhoeae). Gonorrhea is a sexually transmitted disease, as it is transmitted mainly through sexual contact. Gonococci quickly die in the external environment (when heated, dried, treated with antiseptics, under direct sunlight). Gonococci mainly affect the mucous membranes of organs with columnar and glandular epithelium. They can be located on the surface of cells and intracellularly (in leukocytes, trichomonas, epithelial cells), and can form L-forms (insensitive to the effects of drugs and antibodies).

Based on the location of the lesion, several types of gonococcal infection are distinguished:

• gonorrhea of ​​the genitourinary organs;
• gonorrhea of ​​the anorectal region (gonococcal proctitis);
• gonorrhea of ​​the musculoskeletal system (gonarthritis);
• gonococcal infection of the conjunctiva of the eyes (blenorrhea);
• gonococcal pharyngitis.

Gonorrhea from the lower parts of the genitourinary system (urethra, periuretal glands, cervical canal) can spread to the upper parts (uterus and appendages, peritoneum). Gonorrheal vaginitis almost never occurs, since the squamous epithelium of the vaginal mucosa is resistant to the effects of gonococci. But with some changes in the mucous membrane (in girls, in women during pregnancy, during menopause), its development is possible.

Gonorrhea is more common among young people 20 to 30 years old, but can occur at any age. There is a very high risk of complications from gonorrhea - various genitourinary disorders (including sexual ones), infertility in men and women. Gonococci can penetrate the blood and, circulating throughout the body, cause joint damage, sometimes gonorrheal endocarditis and meningitis, bacteremia, and severe septic conditions. Infection of the fetus from a mother infected with gonorrhea during childbirth has been observed.

When the symptoms of gonorrhea are erased, patients aggravate the course of their illness and spread the infection further, without knowing it.

Gonorrhea infection

Gonorrhea is a highly contagious infection, in 99% it is transmitted sexually. Infection with gonorrhea occurs through different forms of sexual contact: vaginal (regular and “incomplete”), anal, oral.

In women, after sexual intercourse with a sick man, the probability of contracting gonorrhea is 50-80%. Men who have sexual contact with a woman with gonorrhea do not always become infected - in 30-40% of cases. This is due to some anatomical and functional features of the genitourinary system in men (narrow urethral canal, gonococci can be washed away with urine). The likelihood of a man contracting gonorrhea is higher if a woman has menstruation, sexual intercourse is prolonged and has a violent ending.

Sometimes there may be a contact route of infection of a child from a mother with gonorrhea during childbirth and household, indirect - through personal hygiene items (bed linen, washcloth, towel), usually in girls. The incubation (latent) period for gonorrhea can last from 1 day to 2 weeks, less often up to 1 month.

Gonorrhea infection of a newborn baby

Gonococci cannot penetrate intact membranes during pregnancy, but premature rupture of these membranes leads to infection of the amniotic fluid and the fetus. Infection of a newborn with gonorrhea can occur when it passes through the birth canal of a sick mother. The conjunctiva of the eyes is affected, and in girls the genitals are also affected. Half of the cases of blindness in newborns are caused by infection with gonorrhea.

Gonorrhea symptoms

Based on the duration of the disease, fresh gonorrhea is distinguished (from the moment of infection< 2 месяцев) и хроническую гонорею (с момента заражения >2 months).

Fresh gonorrhea can occur in acute, subacute, asymptomatic (torpid) forms. There is gonococcal carriage, which is not subjectively manifested, although the causative agent of gonorrhea is present in the body.

Currently, gonorrhea does not always have typical clinical symptoms, since a mixed infection is often detected (with trichomonas, chlamydia), which can change symptoms, lengthen the incubation period, and complicate the diagnosis and treatment of the disease. There are many oligosymptomatic and asymptomatic cases of gonorrhea.

Classic manifestations of acute gonorrhea in women:

• purulent and serous-purulent vaginal discharge;
• hyperemia, swelling and ulceration of the mucous membranes;
• frequent and painful urination, burning, itching;
• intermenstrual bleeding;
• pain in the lower abdomen.

• itching, burning, swelling of the urethra;
• copious purulent, serous-purulent discharge;
• frequent painful, sometimes difficult urination.

With the ascending type of gonorrhea, the testicles, prostate, seminal vesicles are affected, the temperature rises, chills occur, and painful bowel movements occur.

Gonococcal pharyngitis can manifest itself as redness and pain in the throat, increased body temperature, but more often it is asymptomatic. With gonococcal proctitis, discharge from the rectum and pain in the anal area, especially during defecation, may be observed; although usually the symptoms are mild.

Chronic gonorrhea has a protracted course with periodic exacerbations, manifested by adhesions in the pelvis, decreased libido in men, and disturbances in the menstrual cycle and reproductive function in women.

Complications of gonorrhea

Asymptomatic cases of gonorrhea are rarely detected at an early stage, which contributes to the further spread of the disease and gives a high percentage of complications.

The ascending type of infection in women with gonorrhea is facilitated by menstruation, surgical termination of pregnancy, diagnostic procedures (curettage, biopsy, probing), and the introduction of intrauterine devices. Gonorrhea affects the uterus, fallopian tubes, and ovarian tissue until abscesses occur. This leads to disruption of the menstrual cycle, the occurrence of adhesions in the tubes, the development of infertility, and ectopic pregnancy. If a woman with gonorrhea is pregnant, there is a high probability of spontaneous miscarriage, premature birth, infection of the newborn and the development of septic conditions after childbirth. When newborns are infected with gonorrhea, they develop inflammation of the conjunctiva of the eyes, which can lead to blindness.

A serious complication of gonorrhea in men is gonococcal epididymitis, a disorder of spermatogenesis, and a decrease in the ability of sperm to fertilize.

Gonorrhea can spread to the bladder, ureters and kidneys, pharynx and rectum, and affect the lymph glands, joints, and other internal organs.

You can avoid unwanted complications of gonorrhea if you start treatment in a timely manner, strictly follow the venereologist’s prescriptions, and lead a healthy lifestyle.

Diagnosis of gonorrhea

To diagnose gonorrhea, the presence of clinical symptoms in a patient is not enough; it is necessary to identify the causative agent of the disease using laboratory methods:

• examination of smears with material under a microscope;
• bacterial seeding of material on specific nutrient media to isolate a pure culture;
• ELISA and PCR diagnostics.

IN microscopy of smears stained with Gram and methylene blue, gonococci are determined by their typical bean-shaped shape and pairing, gram-negativity and intracellular position. The causative agent of gonorrhea cannot always be detected by this method due to its variability.

When diagnosing asymptomatic forms of gonorrhea, as well as in children and pregnant women, the more appropriate method is cultural (its accuracy is 90-100%). The use of selective media (blood agar) with the addition of antibiotics makes it possible to accurately detect even a small number of gonococci and their sensitivity to drugs.

The material for testing for gonorrhea is purulent discharge from the cervical canal (in women), urethra, lower rectum, oropharynx, and conjunctiva of the eyes. For girls and women over 60 years of age, only the cultural method is used.

Gonorrhea often occurs as a mixed infection. Therefore, a patient with suspected gonorrhea is additionally examined for other STIs. They carry out determination of antibodies to hepatitis B and HIV, serological reactions to syphilis, general and biochemical analysis of blood and urine, ultrasound of the pelvic organs, urethroscopy, in women - colposcopy, cytology of the cervical canal mucosa.

Examinations are carried out before the start of treatment for gonorrhea, again 7-10 days after treatment, serological examinations - after 3-6-9 months.

The doctor decides the need to use “provocations” to diagnose gonorrhea in each case individually.

Treatment of gonorrhea

Self-treatment of gonorrhea is unacceptable; 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 case of acute ascending type of gonorrhea, hospitalization, bed rest, and therapeutic measures are necessary. 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 of 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, magnetotherapy, 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 of laboratory tests (7-10 days after the end of treatment).

Currently, the need for various types of provocations and numerous control examinations after the end of treatment for gonorrhea, carried out with modern highly effective antibacterial drugs, is disputed. One follow-up examination of the patient is recommended to determine the adequacy of this treatment for gonorrhea. Laboratory monitoring is prescribed if clinical symptoms remain, there are relapses of the disease, or re-infection with gonorrhea is possible.

Gonorrhea prevention

Prevention of gonorrhea, like other STDs, includes:

• personal prevention (exclusion of casual sex, use of condoms, compliance with personal hygiene rules);
• timely identification and treatment of patients with gonorrhea, especially in risk groups;
• medical examinations (for employees of child care institutions, medical personnel, food workers);
• mandatory examination of pregnant women and pregnancy management.

To prevent gonorrhea, a solution of sodium sulfacyl is instilled into the eyes of newborns immediately after birth.

It is believed that sexually transmitted diseases appeared in the world at the same time as humans. For example, mention of gonorrhea can be found in the Bible and even in the treatises of ancient Greek scientists. The second popular name for this disease is gonorrhoea. Many are confident that this infection can only be contracted through sexual intercourse, and are more or less aware of what gonorrhea is. Not everyone knows what blennorrhea, urethritis, cervicitis, proctitis are. Meanwhile, all of these and a dozen more dangerous diseases with dire consequences can be called derivatives of gonorrhea, because it is their trigger.

Portrait of the pathogen

Properties in the external environment

The causative agent of gonorrhea feels at ease only in nutrient media, especially if there is native (not modified) human protein, and in the person himself. In the external environment its viability is low. Thus, gonococci die in a matter of seconds in an ordinary soap solution, quickly die under the influence of even weak antiseptics (silver salts, betadine, alcohol and others), and die as the mucus and pus in which they are located dry out. This feature is very useful for humans and is used as a prevention of gonorrhea. However, cases have been recorded when gonococci not only existed safely, but also multiplied on the surface of the epithelium, penetrating into the inner layers, blood and lymphatic vessels.

Properties of bacteria living in the human body

The fantastic vitality, unpredictability and virulence of the pathogen - this is what makes gonorrhea dangerous. What are gonococci in an environment favorable to them? These are quiet, secretive creatures that kill on the sly because, having penetrated the body of their victim (human), most often they do not flaunt their health-destroying activities for a long time. A sick person does not even realize that he has the disease and continues to actively infect others. In the meantime, gonococcus is expanding its colonies, capturing new territories and spreading from the mucous membranes (the place of primary penetration) into the internal organs. As they settle into their new place of residence, they produce a special enzyme, beta-lactamase, that protects them from drugs. The human body tries to fight the invaders and attacks them with bacteriophages. But gonococci are so tenacious that they not only do not die when eaten, but also continue to multiply. Another way of their survival is the ability to mutate, creating L-forms, which many antibiotics have no effect on.

"Accomplices" of gonorrhea

Methods of infection

Since gonorrhea is considered, the causes of its occurrence are mainly related to a person's sex life. However, there are also household routes of infection. So, you can catch gonorrhea if:

In public places (bathhouse, sauna, swimming pool), provided that individual hygiene items are used, the likelihood of contracting gonorrhea is so small that it is considered zero.

Classification

How quickly does the pathology develop? What are the stages of gonorrhea? The periods, or phases of the disease, are as follows:

• fresh (acute), in which up to 2 months have passed since infection;
• chronic, lasting for years.

Initially landing on the mucous membranes of the vagina in women, and on the head of the penis in men, gonococci spread further through the genitourinary organs, causing inflammation and all sorts of complications, including infertility and miscarriages. This is what makes gonorrhea most dangerous. The forms of the disease are as follows:

• genital;
• extragenital;
• metastatic.

Genital gonorrhea includes diseases of the genital organs and their parts. In women, these are salpingoophoritis (inflammation of the ovaries and fallopian tubes) and cervicitis (inflammation of the cervix).

In men, this is prostatitis, urethritis, viseculitis (inflamed seminal vesicle).

Extragenital gonorrhea includes diseases of the non-genital organs caused by gonococci. In addition to the above-mentioned gonorrheal diseases of the eyes and oral cavity, this can be proctitis (disease of the rectum), cystitis, gonorrhea of ​​the kidneys, gonococcemia (affected joints, skin) and sepsis. It should be said that gonococci really do not like blood serum, which kills them in seconds. Therefore, they are not carried by the bloodstream to the organs from the genitourinary system. But sometimes patients experience resistance to serum enzymes. In these cases, gonococci do not die, but spread throughout the body.

Metastatic gonorrhea is a complication and exacerbation of the previous two.

How does gonorrhea manifest in women and girls?

An amazing and very dangerous feature of this disease is that it may not manifest itself at all for months and even years. This occurs in approximately 10% of men and 80% of women. Moreover, all these patients are bacteria carriers. in case of acute gonorrhea, it can last from 1 day to 1 month after the moment of suspected infection. At the end of the incubation period, some women experience mild itching in the vestibule of the vagina and in the anus (with proctitis), sometimes short-term pain when urinating and notice a slight discharge in the form of leucorrhoea. When gonococci enter the oral cavity, a small percentage of women experience inflammation of the tonsils and a slight sore throat. Since gonorrhea manifests itself so weakly, treatment in women in the initial stages of the disease is rarely carried out. In most cases, mild symptoms are ignored and people try to cope with them with home remedies.

In girls, gonorrhea also manifests itself as itching and swelling of the genitals with purulent mucous discharge. The general condition of patients at the initial stage of the disease is always normal.

Manifestation of gonorrhea in men

The stronger half of humanity quickly notices that something is wrong with their genitourinary system. The first symptoms of gonorrhea in men are short-term pain when urinating, purulent (sometimes with an unpleasant odor) discharge, slight redness and slight swelling of the head of the penis. Since gonococci in men penetrate the urethra very quickly after infection, its inflammation, or so-called urethritis, begins.

At first, the symptoms are vague. In the morning, patients note some pain and a quickly passing burning sensation when urinating. The urine remains clear, there are very few purulent threads in it. Unpleasant symptoms intensify after sexual intercourse, drinking alcohol and certain types of food. After three weeks, the pronounced symptoms subside, and the disease enters the chronic stage - with periods of remission and exacerbations - the stage.

Diagnostics

Some “smart guys”, having discovered something from their genitals, do not rush to the doctor, but go to buy “gonorrhea pills.” This often leads to a person taking unnecessary antibiotics, temporarily eliminating unpleasant symptoms and transferring the disease to the chronic stage, during which the gonococci penetrate deeper into the body. For treatment to be effective, it is necessary to conduct a diagnosis. It includes:

• examination by a doctor;
• Analysis of urine;
• mandatory smear test;
• bacterial sowing (readiness time is about a week, but gives 100% accuracy of the result);
• PCR analysis (especially effective in the absence of pronounced symptoms).

A blood test is not taken if gonorrhea is suspected. The final diagnosis is established only when gonococci are detected in culture or smear.

Treatment

Gonorrhea is treated on an outpatient basis or in dermatovenous clinics, as determined by a venereologist. Referral of a patient to a hospital is possible in case of complications of the disease and in case of evasion of outpatient therapy. If the diagnosis of gonorrhea is absolutely certain, treatment in women and men is carried out with antibiotics of the penicillin group (Oxacillin, Amoxicillin and others). Unfortunately, it took so long to get rid of gonococci using these means that the bacteria have already developed resistance to them at their genetic level. Low sensitivity of gonococci is also noted to tetracycline, ampicillin, and spectinomycin groups of drugs. Ceftriaxone or Rocephin are used for particularly tenacious forms of bacteria. These antibiotics are capable of penetrating any tissue and organ. If a person who suspects they have gonorrhea sees a doctor right away, treatment can be quick. You will need a one-time intravenous administration of Rocephin in a volume of 250 mg.

There are no traditional methods of getting rid of gonorrhea. The only thing that can be taken from the advice of healers as a supplement to medications is washing the genitals with drugs that relieve inflammatory processes (a decoction of chamomile, celandine, dandelion roots and other herbs). Needless to say, such procedures are only an addition to drug therapy.

Complications

The ability of gonococci to adapt and resist drugs must be taken into account by a venereologist when prescribing medications. When a person self-medicates and takes “gonorrhea pills” on the advice of friends, complications are almost always observed. They, like the primary disease, do not manifest themselves immediately. At first, the patient has the impression that he has completely recovered. For women, complications of gonorrhea are fraught with infertility, ectopic pregnancy, and miscarriages. Another dangerous disease caused by untreated or undertreated gonorrhea is hydrosalpinx. With this pathology, pus accumulates in the fallopian tube, the external picture resembles a tumor. The woman experiences headaches, lumbar pain, and fever. If the tube ruptures and pus flows into the pelvic area, pelvioperitonitis begins, which can be fatal.

Bartholinitis (a purulent inflammatory process of the vestibular glands) is no less dangerous.

In men, the most dangerous consequences of gonorrhea are prostatitis, which can lead to impotence, and epididymitis (inflammation of the testicles), which causes infertility.

Important! No sexually transmitted disease, including gonorrhea, provides immunity, so you can be infected with them an infinite number of times.

Prevention

Specific preventive measures against this disease are determined. First on the list is the use of condoms during sexual intercourse in all cases if there is not 100% confidence in the partner. The second is maintaining personal hygiene.

An important point is observation by a venereologist for 3 months after the end of treatment and passing control tests.

Symptoms of gonorrhea in men

Symptoms of gonorrhea in women

Symptoms of gonorrhea in women usually appear during the menstruation closest to the time of infection. More often this disease manifests itself with symptoms of vulvovaginitis and urethritis.
Gonorrheal urethritis	Gonococcal urethritis has a number of symptoms similar to urethritis in men: Burning sensation that increases with urination Inflammation of the urethral mucosa Pain when urinating Copious or not very purulent pale yellow discharge
Vulvovaginitis - inflammation of the vulvar and vaginal mucosa	It often appears a few days after infection or during menstruation. Signs characteristic of gonococcal vulvovaginitis: Inflammation of the mucous membrane of the labia, vagina and external os of the urethra. Severe itching in the perineum Copious or not very discharge of a pale yellowish color and the consistency of cream. Pain during sexual genital contact

Complications of gonorrhea

Among women, complications such as:

Gonorrheal bartholinitis– inflammation of the Bartholin gland located in the posterior third of the labia majora and having excretory ducts that open into the external environment at the base of the labia majora. Their inflammation is accompanied by severe pain, a pronounced inflammatory reaction and swelling of the corresponding area.

Gonococcal endometritis– advancement of gonococcal infection in an ascending direction along the genital tract can lead to infection of the uterine mucosa. This complication may be accompanied by pain in the lower abdomen, profuse bloody and purulent discharge from the genital tract, and a sharp increase in body temperature. This condition requires immediate seeking help from a gynecologist, as it threatens the patient’s life.

Fallopian tube gonorrhea– when the infection moves from the uterine cavity into the lumen of the fallopian tubes, inflammation of the fallopian tube mucosa occurs. This process is accompanied by pain in the lower abdomen, pain during sexual intercourse, infertility and menstrual irregularities.

Gonorrheal peritonitis– inflammation of the pelvic peritoneum is possible when gonococci penetrate into the abdominal cavity. This condition is accompanied by a rise in body temperature and pain in the lower abdomen. An ultrasound examination reveals the presence of fluid and abscesses in the pelvic cavity can be visualized.
With the inflammatory process in the female genital organs of the small pelvis, infertility may develop. This can be caused by a number of factors: the formation of adhesions in the pelvic peritoneum, tubal obstruction, chronic inflammation of the endometrium of the uterus, menstrual irregularities.

If any of the above complications occur, treatment is possible only in a hospital setting under the supervision of the attending gynecologist. Unfortunately, with any of the listed complications (gonococcal bartholinitis), there is a high probability of developing female infertility.

Among the male population infected with gonorrhea, the following complications are possible:

Epididymitis- inflammation of the epididymis. This appendage is an enlarged seminiferous tubule in which sperm is stored before being released during ejaculation.

Inflammation of the vas deferens can lead to their subsequent obstruction and the development of male infertility.

Laboratory diagnosis of gonorrhea – rapid test, smear microscopy, immune fluorescence reaction (IF), enzyme-linked immunosorbent assay (ELISA), complement fixation reaction (Bordet-Gengou reaction), polymerase chain reaction (PCR), ligase chain reaction (LGC), cultural method, provocative tests.

Gonorrhea or gonorrhea

Gonorrhea can be acute or chronic. Chronication of acute gonococcal infection occurs when the immune system is not functioning properly. From a diagnostic point of view, identifying chronic gonorrhea is a great challenge. It should be remembered that in recent years, gonorrhea often occurs latently, and there are many resistant forms. In this situation, high-quality and comprehensive laboratory diagnosis of gonorrhea plays an invaluable role. Currently, the most widely used methods for diagnosing gonorrhea are microscopic examination of smears, culture and immunofluorescence reactions. The polymerase chain reaction method is also increasingly used.
So, let's look at the main types of laboratory diagnostics that are currently used to diagnose gonorrhea.
Methods by which it is possible to identify gonococcus:

1. rapid tests (immunochemical methods of counter electrophoresis)
2. bacteriological (cultural, bacteriological seeding)
3. microscopy of a smear of genitourinary organ discharge
4. immune fluorescence reaction (IF)
5. linked immunosorbent assay
6. serological method (Bordet-Gengou reaction or complement fixation reaction)
7. molecular genetic diagnostic methods (ligase chain reaction, polymerase chain reaction)
8. provocative tests (to detect chronic infection)

Rapid tests - sensitivity, specificity, advantages and disadvantages of the method

However, you should not completely rely on the results of such rapid tests, since an antigen + antibody complex may form not with the gonococcus, but with another similar microorganism. In this case, the result will be positive, but there will be no gonorrhea. Or in the opposite case, when the concentration of antigen + antibody complexes is too low, and the result will be negative, but gonorrhea is present. If you suspect a gonorrhea infection, you should undergo examination using more accurate diagnostic methods.

Microscopy of a smear of discharge from the genitourinary organs - sensitivity, specificity, advantages and disadvantages of the method

Sensitivity, specificity of the method. Advantages and disadvantages
The sensitivity of this method is very variable and ranges from 40-86%. This variation is due to the fact that there are different subspecies of gonococci, some of which are not stained by this method. The specificity of the method is quite high and reaches 92%. Also, when studying stained smears under a microscope, the qualifications of a laboratory technician are crucial. This method is widespread due to its availability, simplicity, speed and low cost.

If gonococci are detected in a Gram-stained smear, other diagnostic methods are impractical. Bacteriological culture can be performed to determine sensitivity to antibiotics.

Bacteriological method (cultural) - sensitivity, specificity, advantages and disadvantages of the method

The bacteriological or cultural method is considered to be the “gold standard” in identifying various infectious diseases, including gonorrhea. The essence of this method is that the secretions of the mucous membranes of the genitourinary tract are sown on special nutrient media and placed in an incubator with conditions suitable for the growth of gonococcus colonies (high carbon dioxide content 20-23%, temperature 37 ° C). A special medium is used on which gonococcus grows best. After some time (3-7 days), check whether the gonococcus colonies have grown. If the colonies have grown, then this is an undoubted result of the presence of gonococcal infection in the body. A huge advantage of this method is almost one hundred percent specificity and the absence of false positive results. A false positive result is a result in which microorganisms are detected where they are not present. The sensitivity of the culture method is also high and varies between 90-98%.

Today, standardized environments are used that give excellent results. A definite disadvantage of the cultural method is its duration. However, the duration pays off in accuracy, which is especially important when identifying chronic persistent infection.

Immune fluorescence reaction (IF) - sensitivity, specificity, advantages and disadvantages of the method

Enzyme-linked immunosorbent assay (ELISA) – sensitivity, specificity, advantages and disadvantages of the method

Serological method (complement fixation reaction, Bordet-Gengou reaction) - sensitivity, specificity, advantages and disadvantages of the method

Polymerase chain reaction (PCR)

Ligase chain reaction

Provocation of gonorrhea - tests to detect chronic gonococcal infection

To cause the appearance of gonococcus on the mucous membranes of the genitourinary tract, if it is present in the body in the form of a cyst, provocative tests are used. Provocation promotes the release of gonococcus onto the mucous membranes of the genitourinary tract, and then it can be detected in a smear or bacteriological culture.

Treatment of gonorrhea

1. Adequate treatment is possible only under the supervision of a gynecologist, urologist or venereologist.
2. Treatment should be preceded by a full diagnosis, including laboratory tests (microscopic, bacteriological smear examinations), instrumental studies (ultrasound of the pelvic organs to exclude possible complications).
3. Before prescribing treatment for gonorrhea, it is necessary to conduct laboratory tests for other sexually transmitted diseases - chlamydia, syphilis, mycoplasma, ureaplasma. As a rule, in our time, infection with only one sexually transmitted disease is rare - a bouquet of several infections is more often diagnosed. Only after identifying all concomitant infections will the attending physician be able to prescribe adequate treatment.
4. You cannot start treatment on your own, make your own changes to the treatment regimen and its duration, or interrupt it. This can lead to the development of chronic gonorrhea that is insensitive to certain types of antibiotics.
5. Treatment should be accompanied by a diagnosis of gonorrhea in all sexual partners.
6. During the treatment period, any sexual contact should be excluded.
7. After treatment, laboratory monitoring of cure is required. Only this study can confirm or refute the fact of recovery. The absence of purulent discharge or signs of inflammation does not mean the patient has recovered.

• Ceftriaxone 0.25 g once

• Ciprofloxacin 0.5 g Orally once

• Ofloxacin 0.4 g Orally once

• Lomefloxacin 0.6 g Orally once

Treatment of chronic and latent forms of gonorrhea:
The use of antibiotics must be preceded by the use of a special vaccine, which is administered intramuscularly. This vaccine contains fragments of gonococci and promotes the formation of specific immunity to gonococcal infection. The vaccine is administered in courses of 6-8-10 injections with a single dosage of 300-400 million microbial bodies and a total course dosage of 2 billion microbial bodies.
Along with vaccination, nonspecific simulation of immunity is performed using medications: pyrogenal, streptokinase, ribonuclease.
After stimulation of the immune system and provocation, it is possible to prescribe antibacterial drugs according to standard treatment regimens.

Treatment of gonorrhea during pregnancy
The state of pregnancy imposes a number of restrictions on the use of immunostimulating and antibacterial drugs. However, preference in treatment in this case is given to the following antibiotics: ceftriaxone, erythromycin, spectrinomycin, chloramphenicol.
Treatment of pregnant women is possible only under the strict supervision of the attending gynecologist.

Gonorrhea prevention

Among pregnant women, preparation for childbirth includes testing for the presence of sexually transmitted diseases.
Also, after birth, all newborns are instilled with antiseptic drugs that destroy gonococcus. These measures help minimize infection of the newborn.

The use of personal hygiene products, underwear and towels will help eliminate the household route of infection.

How long does treatment for gonorrhea take?

The main factors influencing the duration of treatment are:

• Features of the pathogen. Each microorganism, like each person, has its own unique characteristics. In particular, among microorganisms there are strains with different sensitivity to antibiotics. If a microbe came into contact with a certain drug, but was not destroyed, then there is a high probability that in the future it will no longer be susceptible to the same treatment. Such strains are called antibiotic-resistant. Currently, among gonococci they make up from 5 to 30% of all cases, depending on the area ( countries, cities). Thus, treatment for a sensitive strain will take less time than for a resistant strain. Doctors do not always prescribe sensitivity tests to certain drugs ( antibiogram). Because of this, the first course of antibiotic treatment may be ineffective and treatment will be delayed.
• Localization of infection. In most cases, gonorrhea occurs in the form of gonococcal urethritis ( inflammation of the urethra). In this case, her treatment will consist of a single injection of ceftriaxone or cefotaxime ( less often than other drugs). In more than 95% of patients this is enough for complete cure. If the gonococcal infection is localized in atypical places ( mucous membrane of the anus, pharynx, conjunctiva of the eyes), then along with the systemic use of an antibiotic, local antibiotics will also be required. Then the treatment may be delayed. Disseminated gonococcal infection is the most difficult to treat, when the pathogen enters the blood and spreads to various organs.
• Compliance with doctor's orders. With gonorrhea, this factor is of great importance. The fact is that interrupting treatment without laboratory confirmation of cure can lead to serious consequences. Firstly, the infection can become chronic. After this, you will have to artificially cause an exacerbation in order to cure it. Secondly, the patient's strain of microbes may develop resistance to the drug with which treatment was started. Then in the future, for a repeat course, you will have to select a new antibiotic. Finally, thirdly, the patient, who believes that he has recovered, begins to lead an active sex life. This leads to infection of his sexual partners. As a result, the infection circulates in a vicious circle, making it even more difficult to get rid of.
• Presence of other infections. Gonorrhea is often combined with urogenital chlamydia or trichomoniasis. This is explained by the fact that the first infection weakens the protective resources of the mucous membrane and, as it were, “opens the gates” for the second. For complete cure, a longer course of antibiotics is accordingly required.
• Presence of complications. Sometimes gonorrhea does not manifest itself with acute symptoms, but over time it leads to a number of unpleasant complications. In men it is balanoposthitis, acute and chronic prostatitis, and in women it is gonococcal bartholinitis and salpingitis. These complications, as a rule, complicate the treatment process and the patient has to spend more time and effort on it.
• Body condition. In immunocompromised patients, as well as in women during pregnancy, gonococcal infection may be more aggressive. It spreads faster and easier, and is often accompanied by complications. Because of this, treatment for these patients tends to take longer.

To minimize the duration of treatment for gonorrhea, regardless of its form, you need to follow a few simple rules:

• compliance with doctor's instructions regarding taking antibiotics ( timing, dose, frequency of use);
• simultaneous examination and treatment of all sexual partners of the patient;
• abstinence from sexual intercourse until a control bacteriological analysis is carried out;
• screening for other infections.

Is it possible to make love while treating gonorrhea?

Sexual intercourse during treatment is dangerous for the following reasons:

• Spread of infection. Until the course of treatment is completed and control tests are carried out, the patient poses a threat to the spread of infection. Despite the fact that 1 injection of an antibiotic is often enough for recovery, no doctor can say for sure whether gonorrhea is cured after this. Thus, there is a chance that the patient will simply infect his sexual partner. This is also dangerous because after the end of treatment ( receiving a negative control test result) he may come into contact with this partner again and become infected again. Thus, the infection will circulate between two people. If they have more than one sexual partner, gonorrhea will begin to spread in the community.
• Re-infection. Reinfection is dangerous during sexual contact with a partner who also has gonorrhea. In this case, the patient undergoing treatment receives a new portion of bacteria. Unlike their own, which die under the influence of antibiotics, these gonococci are more powerful. When the course of treatment is over, they will be able to reproduce again, and recovery will not occur, although the patient has completed the full course of treatment. In addition, you can become infected with another strain of gonococci. If he is not receptive to the treatment started, then all the tests will have to be repeated and the drug changed.
• Chronication of infection. Repeated infection contributes to chronic infection. If gonococci survive a course of antibiotics, they will not make themselves felt for a long time. Many patients consider this to be sufficient confirmation of recovery and do not conduct a follow-up test. Then, after some time, gonorrhea will worsen again, its treatment will be much longer and more complex, and the risk of complications will also increase.
• Development of antibiotic resistance. Antibiotic resistance ( resistance to certain antibacterial drugs) is one of the main problems in modern medicine. Among gonococci, it is recorded in approximately 5–15% of cases. If a patient infects his sexual partner with gonorrhea during treatment, then there is a high probability that in the future his partner will develop a disease that is resistant to the drug that was used in treatment. After all, the microorganism has already been in contact with this antibiotic, and genetic rearrangements in gonococci occur quite quickly. As a result, after some time, such patients have to spend money on stronger antibiotics in order to still defeat the resistant strain and be cured.
• Development of complications. During sexual intercourse, gonococcal infection can spread not only to the mucous membrane of the genitourinary tract, but also to other anatomical areas. Both the patient's partner and the patient himself may develop a number of complications or atypical forms of gonorrhea in the future. We are talking about anorectal and pharyngeal gonorrhea. In addition, during unprotected sexual intercourse, microtraumas of the mucous membrane often occur. Through such defects, the infection can enter the blood and spread throughout the body.
• Infection with other infections. In medical practice, patients often encounter several concomitant genitourinary infections. Their treatment requires a more careful selection of drugs, takes more time and is much more expensive. Sexual contact during treatment for gonorrhea can not only negate the treatment itself, but also lead to an “exchange” of infections. As a result, the patient may become infected with chlamydia, trichomoniasis, or other common diseases.

If sexual contact did occur during the treatment period, you must inform your doctor about this. In this case, the course of antibiotic treatment may be extended. Additional tests for other genitourinary infections may also be needed. At the same time, a sexual partner is found, examined and preventive treatment is started.

Sex becomes safe only after a special control analysis. It is carried out 7–10 days after the end of treatment. If bacteriological culture does not show the growth of gonococci, and the patient does not have any symptoms of the disease, he is considered healthy.

Is it possible to get pregnant after gonorrhea?

Problems with conceiving a child after gonorrhea can occur in the following cases:

• Incomplete recovery. If treated incorrectly or stopped prematurely, gonococcal infection can become chronic. In this case, there are no symptoms of the disease, but the pathogen still remains on the mucous membrane of the genitourinary tract. The problem is that its presence creates unfavorable conditions inside the vagina and uterus. The chance of getting pregnant is reduced partly due to insufficient lubrication, partly due to low motility and too rapid death of sperm after ejaculation ( ejaculation). In addition, the chance of chlamydia or trichomoniasis increases, which also reduce the likelihood of successful fertilization. In this case, no structural changes in the genitourinary system may be observed. Detection of such a hidden infection and full treatment usually restore reproductive function.
• Gonococcal salpingitis. Salpingitis is an inflammation of the fallopian tubes. It can occur during an acute infection with pronounced symptoms. During the period of illness, changes may appear in the mucous membrane lining the fallopian tubes. As a result, after a course of treatment, there is no more gonococcal infection, but the patency of the fallopian tubes for the egg decreases. The more severe the inflammatory process, and the longer the disease was ignored, the greater the chance of losing reproductive function. In severe cases, changes at the level of the fallopian tubes are irreversible. In addition to sterility, the risk of ectopic pregnancy increases.
• Gonococcal pelvioperitonitis. It is the most severe local complication of gonococcal infection, in which the inflammatory process spreads to the pelvic peritoneum. Then treatment can take quite a long time. During this period, the sensitive peritoneum forms adhesions. These are connective tissue bridges that do not disappear after the inflammatory process subsides. They deform the organs to which they are attached and disrupt their normal functioning. Thus, after this complication, the woman will have pelvic adhesive disease, which in some cases can manifest as infertility. However, here the problem can usually be solved by surgical dissection of the adhesions.
• Complications of gonorrhea in a sexual partner. Even if a woman has completely recovered from gonorrhea, this does not mean that her partner does not have the disease either. Urogenital infections usually circulate between sexual partners unless treated simultaneously. In men, this disease is usually more severe. Without adequate treatment, it is possible to develop prostatitis, purulent urethritis, damage to the glands and even testicles ( orchitis). Then the seminal fluid, for various reasons, may simply not contain sperm, or they will be unable to fertilize the egg.

What is the discharge from gonorrhea?

Gonorrhea discharge has the following characteristic features:

• In men, they usually appear 1 to 5 days after unprotected sexual contact with an infected person. Sometimes this period extends to 30 days ( depending on the state of immunity and characteristics of the pathogen). In a chronic case, there may be no discharge for months.
• In women, discharge is usually more scanty, even during the acute course of the disease.
• Externally, the discharge is white-yellow in color. Without appropriate treatment, after a few days they become white-green, which indicates impurities of pus.
• Most often, in men, discharge appears in the form of a “morning drop”. This is a symptom in which in the morning a large drop of mucopurulent mixture is released from the opening on the head of the penis. In women, this symptom is absent due to the different anatomical location of the urethra.
• In acute cases, a lot of pus forms in the urethra. Therefore, it can be mixed with the morning urine in the form of flakes.
• In a chronic open course, discharge can be observed continuously for several months. At the same time, the daily volume is small - only 1 - 2 small drops.
• Gonorrhea discharge has an unpleasant, pungent odor that appears 2–3 days after the onset of the symptom itself. In women, discharge may not be visible ( for example, during menstruation). But the menstrual flow itself becomes more abundant against the background of gonorrhea and also acquires an unpleasant odor.
• In acute cases of the disease, discharge can also be observed at night. This can be detected by small yellowish spots on the underwear.
• Discharge from the urethra ( urethra) are enhanced under certain conditions. Such a provoking factor can be alcohol, spicy food, excess caffeine, sex, drug provocation ( may be necessary to begin treatment for chronic disease).
• Discharge in men is almost always accompanied by a burning sensation and moderate pain.
• If left untreated, the discharge may decrease after 12 to 15 days. However, this sometimes only indicates the spread of infection up the urethra. Then, at the end of urination, patients may release 1–2 drops of blood, sometimes mixed with mucus and pus. This indicates an unfavorable course of the disease, the risk of complications and the need for urgent treatment.
• In rare advanced cases, hemospermia is possible as a variant of discharge - streaks of blood in the seminal fluid during ejaculation.

For extragenital forms of gonococcal infection ( conjunctivitis, pharyngitis) discharge is not so characteristic. They may appear as a whitish coating on the tonsils or accumulate along the edges of the eyelids in small children with blenorrhea.

In case of chronic latent course of the disease ( more typical for women) there may be no discharge at all. However, this does not mean that the disease has disappeared or the patient is recovering. Under the influence of the provoking factors listed above, an exacerbation occurs, and discharge appears ( sometimes for the first time months after the episode of infection itself).

Microscopic examination of gonorrhea discharge shows the presence of the following components:

• epithelial cells;
• pathogen cells ( Neisseria gonorrhoeae) – diplococci located inside epithelial cells;
• slime;
• red blood cells ( Rarely, they look like streaks of blood).

Can gonorrhea be cured at home?

To treat gonorrhea at home, you must go through the following steps:

• Consultation with a dermatovenerologist. A symptom specialist may suspect gonorrhea and order appropriate laboratory tests. The patient himself, based only on his own complaints, may confuse gonorrhea with another genitourinary infection.
• Lab tests. Typically, the doctor takes a swab from the urethral mucosa. Subsequently, the resulting material is inoculated onto nutrient media in a microbiological laboratory. Obtaining a gonococcal culture confirms the diagnosis. If necessary, the doctor also takes a smear from the mucous membrane of the rectum, conjunctiva or pharynx. With severe general symptoms ( temperature, general weakness, etc.) the patient’s blood is also taken for analysis. This is how the clinical form of the disease is determined.
• Treatment at home. If the gonococcal infection is localized only in the urethra, the doctor prescribes the necessary antibiotic. Most often, only one dose is needed ( injection or tablet). Less often, the course lasts 1 – 2 weeks. The patient independently treats the mucous membrane and skin with disinfectant solutions ( installations in the urethra in men, in the vaginal cavity in women). In this case, hospitalization is not required.
• Benchmark analysis. 7–10 days after finishing antibiotic treatment, the patient takes a smear again. If the result is negative, he is considered healthy. Women may need another test smear after their second menstrual cycle.

Self-medication of gonorrhea at home without contacting a specialist most often ends in chronic infection. Neither traditional medicine nor self-selection of an antibiotic usually completely eradicates the infection. They can only remove the symptoms of the disease. Then the patient believes that he has been cured and no longer consults a doctor. The problem is that in the future such advanced gonorrhea will worsen again and again, its treatment will require more time and effort, and the risk of complications will greatly increase.

Is gonorrhea transmitted through a condom?

However, there are two important exceptions that patients need to be aware of. First, condoms are highly effective in protecting against gonorrhea only when used correctly. In most cases, people who claim to have become infected through a condom simply did not know how to use it correctly.

To achieve maximum protection against infection, you must follow these rules:

• Compliance with the expiration date. Each condom package must have an expiration date. If it is exceeded, the lubricant inside begins to dry out, and the latex loses its elasticity. This increases the risk of rupture during use. Even if the condom does not break, microcracks will appear in it, which are larger than normal pores. Gonococci can already penetrate through them.
• Use for any sexual contact. Gonococci can affect not only the mucous membrane of the urinary tract, but also other tissues ( although less likely). Therefore, a condom should also be used for orogenital and anogenital contact. However, in these cases, the risk of rupture increases to 3–7%.
• Correct opening of the package. The thick-looking condom packaging is actually easy to open with your hands. To do this, you need to tear it from the side of the ribbed surface or in a specially indicated place. Opening with sharp objects ( knives, scissors) or teeth can cause accidental damage to the latex itself.
• Correct donning. When putting on a condom, the penis must be erect. Otherwise, it will subsequently slip and form folds, and during sexual intercourse the risk of rupture will increase.
• Release of air. When putting on a condom, you need to squeeze the special cavity at the top with your fingers so that the air comes out of it. This cavity is designed to collect sperm after ejaculation ( ejaculation). If you do not release the air from it in advance, there is a high risk of rupture.
• Use throughout the entire act. A condom should be worn at the stage of foreplay, before the first contact of the partner with the infected mucous membrane occurs. After the end of sexual intercourse, the condom is thrown away and the penis is washed with warm water to remove residual sperm.

The condom does not protect against the following forms of gonococcal infection:

• gonococcal conjunctivitis ( inflammation of the mucous membrane of the eye);
• pharyngitis ( damage to the pharyngeal mucosa);
• skin lesion.

In general, proper use of a condom provides almost one hundred percent guarantee of protection against gonorrhea. Still, doctors recommend that patients with this disease abstain from sexual intercourse until complete recovery.

Is gonorrhea transmitted through kissing?

In this disease, gonococci colonize the mucous membrane of the pharynx and, less commonly, the oral cavity. Then, during a kiss, it is theoretically possible to transmit the pathogen to a partner. However, the chance of such infection in practice is extremely small.

Transmission of pharyngeal gonorrhea through kissing is unlikely for the following reasons:

• Gonococci in the pharynx are in unusual conditions. The mucous membrane of the urethra, which differs in structure from the mucous membrane of the mouth and pharynx, is best suited for their reproduction. Because of this, the number of gonococci is smaller, they are weakened, and the likelihood of infection is reduced.
• Human immunity also plays a significant role in this form of gonorrhea. The likelihood of infection is slightly higher if the patient's immune system is weakened. In this case, the body does not fight the microbe well, and gonococci are activated. But for infection to occur, the immunity of the second person who kisses the patient must also be weakened. Otherwise, the gonococcus simply will not take root on its mucous membrane.
• The mucous membrane of the pharynx is better suited for gonococci than the mucous membrane of the oral cavity. When kissing, infections located higher up are more often transmitted.

How to treat gonococcal conjunctivitis?

Treatment of such conjunctivitis should begin before the first symptoms appear. If doctors know the mother’s diagnosis, but it was not possible to completely eradicate the infection before birth, it is necessary to carry out special prevention. To do this, immediately after the birth of the child, drugs are dripped into the eyes to destroy the causative agent of the disease.

The following remedies are used to prevent gonoblennorrhea:

• silver nitrate 1% ( drops);
• tetracycline ointment 1%;
• erythromycin ointment 1%;
• sulfacetamide 20% ( solution).

Antibiotics for the treatment of gonococcal conjunctivitis

If there is intense leakage of pus, it must be washed off. For this you can use potassium permanganate ( potassium permanganate) 0.2% or nitrofural ( furatsilin) in the form of a 0.02% solution.

In general, the treatment of gonococcal conjunctivitis in both children and adults should be carried out by an ophthalmologist. When concomitant with another localization of infection ( usually - urethritis) consultation with a dermatovenerologist is necessary. Self-medication can lead to further spread of the process to other structures of the eye, which can lead to irreversible vision loss.