HORNOREA is a venereal disease caused by gonococcus. It affects mainly the mucous membranes of the urinary organs. It is also possible damage to the conjunctiva, mucous membranes of the pharynx, rectum.
Gonococcus - gram-negative paired cocci (diplococcus). Outside the human body, gonococci are little stable and die as the substrate dries, in which they are found, almost instantly die in soapy water, weak solutions of antiseptic and antibacterial agents affect them destructively. In humans, gonococci relatively quickly become resistant to antibiotics and sulfa drugs.
Gonorrhea is usually transmitted sexually from a patient with gonorrhea or from a carrier of bacteria. During intercourse, gonococcus enters the mucous membrane of the genital organs and urethra and causes local inflammation in them. With anal intercourse, gonococcal lesion of the rectum may occur, with oral intercourse - nasopharynx. Infection of the eyes in adults is occasionally observed when gonococci hit the conjunctiva from the hands contaminated with secretions of the urogenital organs, and in the newborn when the mother gonorrhea passes through the birth canal. It is also possible household infection of girls in violation of hygienic rules ("pottery" infection, use of common personal hygiene items, etc.).
Due to the common pathways of transmission of the pathogen, mixed infection is possible, in which, in addition to gonococci, chlamydia, trichomonads, herpes viruses, etc. are detected. In such cases, after the death of gonococci, these microorganisms can be maintained by the inflammatory process. Gonorrhea is often noted in patients with syphilis.
Clinical picture. The incubation period from 1 day to 1 month, usually 2 - 4 days. With the flow emit acute (fresh) and chronic gonorrhea. In men, gonorrhea manifests more often in the form of urethritis, which is characterized by burning pains in the urethra at the beginning of urination, the presence of mucopurulent discharge from the urethra, hyperemia and adhesion (especially in the morning) of its external orifice. However, in many patients, subjective disorders (pain, burning) are mild, and the amount of discharge from the urethra is small.
Discharge from the urethra, first scanty, gray. After 1-2 days, there are purulent, copious, thick, yellowish-green discharge, which stain the laundry. At night, painful erections occur. When the process spreads to the bladder neck, there is a frequent urge to urge, pain, and the end of urination, sometimes a mixture of blood in the urine. The general condition does not change significantly, sometimes the body temperature rises slightly, there is general weakness, lack of appetite.
Without treatment or with improper treatment, gonorrheal urethritis becomes chronic (the infection is older than 2 months). At the same time, mild symptoms are noted - slight reddening of the sponges of the urethra, scanty discharge, the absence of subjective disorders. Gonorrheal urethritis may be complicated by paraurethritis, phimosis, paraphimosis, epididymitis, prostatitis, cystitis, inflammation of the seminal vesicles. Chronic gonorrhea is characterized by periodic exacerbations that occur under the influence of sexual arousal, alcohol intake, spicy foods, etc.
In women, gonorrhea, even with an acute course, proceeds sluggishly, hardly noticeable. Almost all patients develop gonorrheal urethritis, accompanied by frequent urging and cutting pain when urinating. There are purulent discharge from the vagina, itching and burning in the region of the external genital organs. However, these phenomena quickly pass. Without feeling sick, the woman does not go to the doctor and leads a normal life, being the source of the infectious agent. In this case, the inflammatory process continues to spread, often affecting almost all parts of the urogenital system. When the pathogens pass from the uterus to the fallopian tubes, an inflammatory process develops in them, characterized by edema, infiltration and thickening of the mucous membrane with the formation of adhesions and subsequent obturation of the lumen. The fallopian tube becomes impassable for sperm and egg, leading to infertility. Gonorrheal salpingitis is accompanied by constant pain in the lower abdomen and in the lumbar region, bloody vaginal discharge. Violated menstruation (delays, accompanied by pain, become abundant). Chronic gonorrhea in women occurs with periodic exacerbations, which occur under the influence of hypothermia, during menstruation, etc.
Girls get gonorrhea most often between the ages of 2 and 8 years. As a rule, infection occurs in a household way through articles of the toilet and household goods contaminated by the patient’s secretions. Usually, the source of infection is the mother, less often other relatives and staff caring for the child. Due to the age-related anatomical and physiological characteristics of younger girls, gonococci cause inflammation of the vulva, vagina, and urethra. Internal genital organs are rarely affected. There are bright red hyperemia and swelling of the labia majora, vestibule of the vagina and perineum, abundant purulent or mucopurulent discharge from the vagina (gonorrheal vulvovaginitis). Sick worried about burning and itching in the region of the external genital organs, pain when urinating.
Diagnosis of gonorrhea is carried out only on the basis of the detection of gonococci in smears or crops. Material for microscopic examination and culture in men is taken from the urethra, with massage of the prostate gland, seminal vesicles, in women from the urethra, the cervical canal, the rectum.
The treatment is carried out in the dermatovenerologic dispensary (on an outpatient basis or in a hospital). Indications for hospitalization are the complications of gonorrhea (salpingoophoritis, prostatitis , arthritis , etc.), recurrence and reinfection of gonorrhea, as well as evasion from outpatient treatment, lack of a permanent residence, chronic alcoholism and other social motives.
The results of treatment depend largely on the behavior of the patient. During treatment, sex is prohibited. It is necessary to strictly observe the rules of personal hygiene, after urinating and toilet of the genitals, it is necessary to wash hands with soap and water. Do not squeeze pus from the urethra because of the risk of spread of infection. It is necessary to refrain from the use of spicy and spicy beggar, alcohol. It is forbidden to ride a bike, swimming in the pool, heavy exercise. Drink plenty of water.
The main treatment for gonorrhea is the use of antibiotics (penicillin, cephalosporin, tetracycline, macrolides, etc.).
It should be borne in mind that the cessation of discharge from the genital organs and the disappearance of subjective sensations 1-2 days after the start of medication does not mean a complete cure, since gonococci can persist for a long time in separate basalized foci. In order to monitor the results of treatment, 7-10 days after it is completed, so-called provocation is performed by various methods (massage of the urethra on the bougie, intramuscular injection of the gonococcal vaccine, taking salty, spicy food, beer, etc.) and then taking smears for bacterioscopic examination. The provocation and clinical examination is repeated after 1 month. Persons who have suffered gonorrhea, are under dispensary observation for 2 months. In cases where gonococci are not detected in crops and smears, there are no inflammatory changes in the urethra, prostate gland, seminal vesicles and Cooper glands in men, pain, menstrual disorders and obvious palpation changes of the internal genital organs in women - those who have suffered gonorrhea recognized as healthy and deregistered. When gonorrhea does not arise immunity, which protects against reinfection.
The prognosis for timely and correct treatment of acute gonorrhea is usually favorable. Violation of the terms of treatment, its lack of effectiveness can lead to the transition of the disease into a chronic form and various complications. Consequences of chronic gonorrhea in men can be narrowing of the urethra, chronic prostatitis , impaired sexual function, in women - chronic adnexitis , infertility .
Prevention. The basis of the fight against gonorrhea consists of measures of public prevention, which consist in identifying and rehabilitating persons who are the sources of the infectious agent, monitoring the completeness and quality of treatment, carrying out sanitary and educational work among the population, and compulsory examination of all family members with gonorrhea.
The best prophylactic is a condom, equally protecting both men and women from contracting gonorrhea. For the purpose of personal prophylaxis, men are recommended, after casual intercourse, to immediately urinate, wash the penis with soap and water. The most effective method of preventing gonorrhea is abundant washing of the anterior urethra with potassium permanganate solution (1: 6000), which mechanically removes the gonococci from the mucosal surface and creates unfavorable conditions for their reproduction. Such washings can be repeated. Washing effective for 1-2 hours after intercourse.
Personal prevention in women is less reliable than in men. Before intercourse, a gauze tampon soaked in mercuric chloride solution (1: 3000) or protargola '(1: 100) can be inserted into the vagina, and it is necessary to lubricate the vagina and urethra with vaseline. Immediately after intercourse, a woman is recommended to remove the swab, urinate, wash the genitals with soap and syringe with potassium permanganate solution (1: 5000).
To prevent gonorrhea, children should sleep separately from their parents, have separate items of care (a towel, a potty, etc.). Children entering the children's team should be examined by a pediatrician, and if a gonorrhea is suspected, a venereologist. The attendants before going to work at the children's institution and subsequently every 3 months also undergo an examination of the venereologist.