Gonorrhea

Gonorrhea in men is the most common venereal disease, characterized mainly by purulent inflammation of the urethra.

Etiology. The causative agent is gonococcus (gram-negative diplococcus). In pus is often located intracellularly (in the protoplasm of leukocytes). Quickly perishes in an acidic environment, when dried, from the effects of even weak solutions of antiseptics. It affects the cylindrical epithelium of the genitourinary organs and conjunctiva, rarely - the flat epithelium.

Infection in men occurs exclusively sexually, and the urethra is primarily affected. Gonococci spread through the mucous membrane of the urogenital organs, penetrate the subepithelial connective tissue, into the lymphatic vessels, sometimes into the bloodstream. In the breakdown of gonococci, endotoxin is released, causing mild general phenomena and sensitization of the body. The spread of the gonococcus along the tissue causes in it an inflammatory reaction (hyperemia, edema, infiltration, suppuration, destruction of the epithelium, scarring) of varying degrees of severity. Congenital immunity with gonorrhea is not, the acquired does not form, and therefore multiple re-infections are possible. With complicated gonorrhea, the effects of non-sterile immunity are intensified, which is expressed by the positive reaction of Borde-Gangu.

Depending on the prescription of the process, fresh (up to 2 months) and chronic (more than 2 months) gonorrhea are isolated. According to the manifestation of manifestations, fresh gonorrhea is divided into acute, subacute and torpid. The variability of gonorrhea depends on the resistance and reactivity of the organism, usually associated with the age of the patient and the presence of concomitant diseases. Occurrence of complications of gonorrhea in men is facilitated by frequent sexual arousals, prolonged and interrupted sexual intercourse, spicy food, physical overstrain, alcoholism.

The incubation period lasts from one day to 2-3 weeks (usually 3-5 days).

The clinical picture is characterized primarily by phenomena of urethritis of varying severity. Acute gonorrheal urethritis begins by burning and itching in the anterior part of the urethra and mucous secretions. After 3-4 days, the process is most acute. There is a sharp hyperemia and swelling of the sponges of the external orifice of the urethra, its denseness and tenderness in palpation, abundant suppuration from the urethra, painful urination. In acute gonorrhea, the process is usually localized in the anterior urethra: with a two-glassed sample, the first portion of urine is turbid, the second - transparent. When the process spreads to the posterior urethra, frequent urge to urinate and increase soreness at the end of urination are added to the described symptoms. With a two-glassed sample, the urine is turbid in both portions. Subacute gonorrheal urethritis is characterized by the same signs, but much less pronounced. Torpid fresh gonorrhea is characterized by a weak manifestation of the described clinical symptoms or their absence in the presence of gonococci in smears from the urethra.

Chronic gonorrhea occurs as a result of inadequate or untimely treatment of fresh gonorrhea, with a weakened state of the patient and a violation of the rational regime. Symptoms of chronic gonorrhea depend on the prevalence of the process. In chronic gonorrheal urethritis, only a small discharge from the urethra (usually in the form of a "morning drop") is usually observed. In the urine, purulent filaments and flakes are found. Sluggish flow of chronic gonorrheic urethritis under the influence of provoking factors may be accompanied by periodic exacerbations simulating acute urethritis.

In chronic gonorrhea, various complications occur (epididymitis, prostatitis, vesiculitis, etc.). Less common complications develop with acute gonorrheal urethritis. The infection enters the appropriate organs by extension or by a lymphohematogenous pathway. Gonorrheal epididymitis (inflammation of the epididymis) is manifested by high fever, swelling and sharp soreness of the affected appendage, reddening and swelling of the scrotum. In the outcome, cicatricial narrowing of the vas deferens can lead to infertility. Gonorrheal prostatitis can be acute or chronic. With acute prostatitis, pain in the perineum and anus, urination, frequent urination, pain at the end of urination. There may be a fever, a violation of the general condition. With a chronic prostatitis, a sense of heaviness in the perineum, weakening of the erection, premature ejaculation, frequent pollutions are noted. Palpation is the increase and soreness of the prostate gland. As a result of prostatitis, impotence may develop. A severe complication of gonorrheal urethritis is cicatricial narrowing of the urethra.

Diagnostics. Regardless of the typical clinical symptoms, the diagnosis of gonorrhea can be made only after the detection of gonococci in laboratory studies: a bacterioscopy of the urethra to be separated (the color of smears in Gramui is methylene blue), and negative results are the diagnosis of cerebrospinal fluid (sowing on ascites).

Treatment is carried out mainly by antibiotics, usually groups of penicillin. Benzylpenicillin sodium or potassium salt at the first injection is administered 600,000 units, followed by 300,000 units in isotonic sodium chloride solution or in 0.5% novocaine solution at 4-hour intervals. The course dose for acute and subacute gonorrhea is 3,000,000 units. In the remaining forms, up to 6 000 000 units or more, depending on the severity of the disease. Bicillins (1,3,5) - durant preparations of penicillin - in acute and subacute gonorrhea, 600,000 units are administered after 24 hours or 1,200,000 units at 48 hours; Course doses as in the treatment of benzylpenicillin. Other antibiotics are used for intolerance to penicillin drugs. Less commonly used sulfanklamidami. In torpid, chronic and complicated gonorrhea, in addition to antibiotics, immunostimulants (gonovaccine, pyrogenal), as well as local disinfectant and resorptive therapy (washing, installation, bougie, diathermy, phonophoresis, etc.) are used. Prohibited acute and salty foods, alcohol (including beer).

The patient is considered cured with negative results of control studies on gonococci, carried out repeatedly after combined provocations.

The prognosis with timely and correct treatment of fresh gonorrhea is favorable. With chronic and especially complicated gonorrhea, the prognosis worsens.

Public prophylaxis corresponds to that of syphilis. Personal prophylaxis: use of a condom, after accidental sexual intercourse - urination and washing of the genitals with warm water and soap, instillation of a 10% protargol solution into the urethra, use of gibitane or cidipole, visiting an individual prevention point in the first 2 hours after accidental sexual intercourse.