GONORRHEA

Gonorrhea is a venereal disease caused by gonococcus. The mucous membranes of the urino-genital organs are affected mainly. It is also possible to damage the conjunctiva, mucous membranes of the pharynx, rectum.

Gonococcus is a gram-negative coccus (diplococcus). Outside the human body, gonococci are not very stable and die as the substrate dries up, in which they are found, almost instantly, they die in soapy water, weak solutions of antiseptic and antibacterial agents are destructive to them. In the human body, gonococci relatively quickly acquire resistance to antibiotics and sulfonamide preparations.

Gonorrhea is transmitted, as a rule, sexually from a patient with gonorrhea or from a bacterium carrier. During sexual intercourse, the gonococcal enters the mucous membrane of the genital organs and the urethra and causes local inflammation in them. In anal intercourse, gonococcal damage to the rectum may occur, with oral - nasopharyngeal. Infection of the eyes in adults is occasionally observed when gonococci enter the conjunctiva from the hands contaminated with secretions of the urogenital organs, and in the newborn - when passing through the birth canal, a patient with gonorrhea of ​​the mother. It is also possible to infect girls in everyday situations when hygiene rules are violated ("potion" infection, use of common personal hygiene items, etc.).

Because of the commonness of the pathways of transmission of the pathogen, a mixed infection is possible, in which, in addition to gonococci, chlamydia, trichomonads, herpes viruses, etc. are found. In such cases, after the death of gonococci, the inflammatory process may be supported by these microorganisms. Gonorrhea is often noted in patients with syphilis.

Clinical picture. The incubation period is from 1 day to 1 month, usually 2 to 4 days. With the flow, acute (fresh) and chronic gonorrhea is isolated. In men, gonorrhea manifests more often in the form of urethritis, which is characterized by burning pain in the urethra at the beginning of urination, the presence of mucopurulent discharge from the urethra, hyperemia and clumping (especially in the mornings) of its outer orifice. However, in many patients subjective disorders (pain, burning) are poorly expressed, and the amount of discharge from the urethra is small.

Discharge from the urethra first scanty, gray. After 1-2 days, there are purulent, abundant, thick, yellowish-green discoloration that dirty the laundry. At night, painful erections occur. When the process spreads to the neck of the bladder, there are frequent, urgent urges, pains and end of urination, sometimes an admixture of blood in the urine. The general condition does not change significantly, sometimes the body temperature rises slightly, general weakness, lack of appetite.

Without treatment or with the wrong treatment, gonorrheal urethritis passes into a chronic form (prescription of infection more than 2 months). At the same time there is a slight symptomatology - a slight reddening of the urethral sponges, scant excretions, the absence of subjective disorders. Gonorrheic urethritis can be complicated by paraurethritis, phimosis, paraphimosis, epididymitis, prostatitis, cystitis, and inflammation of the seminal vesicles. The chronic course of gonorrhea is characterized by periodic exacerbations arising under the influence of sexual arousal, alcohol intake, spicy food, etc.

In women, gonorrhea, even in the acute course, flows sluggishly, hardly noticeable. Almost all cases develop gonorrheal urethritis, accompanied by frequent urges and a cutting pain when urinating. Appears purulent discharge from the vagina, itching and burning in the area of ​​the external genitalia. However, these phenomena quickly pass. Not feeling sick, a woman does not go to the doctor and leads a normal life, being the source of the causative agent of the infection. At the same time the inflammatory process continues to spread, often affecting almost all parts of the genitourinary system. With the passage of pathogens from the uterine cavity into the uterine 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. Fallopian tube becomes impassable for spermatozoa and ovum, which leads to infertility. Gonorrheal salpingitis is accompanied by constant pain in the lower abdomen and in the lumbar region, bloody discharge from the vagina. Violated menstruation (prolonged, 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 at the age of 2 - 8 years. Typically, the infection occurs by household means through toiletry and household items, contaminated with discharge of the patient. Usually the source of the infection is the mother, less often other relatives and personnel caring for the child. Due to age-related anatomical and physiological features in young girls, gonococci cause inflammation of the vulva, vagina, urethra. The internal genitalia are extremely scarce. There are bright red hyperemia and edema of the labia majora, vestibule of the vagina and perineum, abundant purulent or mucopurulent discharge from the vagina (gonorrheal vulvovaginitis). Those who are ill worry about burning and itching in the area of ​​the external genitalia, soreness with urination.

Diagnosis of gonorrhea is carried out only on the basis of detection of gonococci in smears or crops. Material for microscopic examination and sowing in men is taken from the urethra, with massage of the prostate gland, seminal vesicles, in women - from the urethra, canal of the cervix, rectum.

Treatment is carried out at the dermatovenerologic dispensary (outpatient or inpatient). Indications for hospitalization are complications of gonorrhea (salpingoophoritis, prostatitis, arthritis , etc.), relapse and reinfection of gonorrhea, as well as evasion from outpatient treatment, lack of permanent residence, chronic alcoholism and other social motives.

The results of treatment largely depend on the behavior of the patient himself. During sex, sexual activity is prohibited. It is necessary to strictly comply with the rules of personal hygiene, after urination and toilet of genital organs, wash hands with soap and water. Do not squeeze pus from the urethra due to the danger of spreading the infection. One should refrain from using sharp and spicy poverty, alcohol. It is forbidden to ride a bicycle, swimming in the pool, great physical activity. An abundant drink is recommended.

The main in the treatment of gonorrhea is the use of antibiotics (penicillin, cephalosporin, tetracycline, macrolides, etc.).

It should be borne in mind that the cessation of secretions from the genitals and the disappearance of subjective sensations 1-2 days after the start of taking medications does not yet mean a complete cure, as the gonococci can persist for a long time in isolated foci. In order to control the results of treatment, 7-10 days after the end of the treatment, so-called provocation is performed by various methods (urethral massage on bougie, intramuscular injection of gonococcal vaccine, intake of salt, spicy food, beer, etc.) and then take smears for bacterioscopy. Provocation and clinical examination is repeated after 1 month. Persons who undergone gonorrhea are under clinical supervision 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's glands in men, pain, menstrual irregularities and obvious palpable changes in the internal genital organs in women - those who underwent gonorrhea , Are recognized as healthy and are removed from the register. With gonorrhea, there is no immunity, preventing from repeated infection.

The prognosis in cases of timely and correct treatment of acute gonorrhea is usually favorable. Violation of the terms of treatment, its insufficient effectiveness can lead to the transition of the disease into a chronic form and various complications. Consequences of chronic gonorrhea in men may be constriction of the urethra, chronic prostatitis , sexual dysfunction, in women - chronic adnexitis, infertility .

Prevention. The basis of the fight against gonorrhea is the measures of public prevention, which consist in the identification and rehabilitation of people who are sources of infection, monitoring the completeness and quality of treatment, conducting sanitary education work among the population, mandatory examination of all family members ill with gonorrhea.

The best preventive tool is a condom, which equally protects against gonorrhea infection both male and female. Men with a view to personal prevention are advised after a casual intercourse immediately urinate, wash with soap penis. The most effective method of preventing gonorrhea is an extensive washing of the anterior urethra with a solution of potassium permanganate (1: 6000), mechanically removing from the surface of the gonococcal mucosa and creating unfavorable conditions for their reproduction. Such washing can be repeated. Washings are effective within 1-2 hours after intercourse.

Personal prophylaxis in women is less reliable than in men. Before sexual intercourse, a gauze swab impregnated with a solution of mercuric chloride (1: 3000) or protargol (1: 100) can be inserted into the vagina, vaginal vestibule and urethra should be lubricated with petroleum jelly. Immediately after the intercourse, the woman is recommended to remove the tampon, urinate, wash the genitals with soap and rinse with a solution of potassium permanganate (1: 5000).

To prevent gonorrhea, children should sleep separately from their parents, have separate care items (towel, night pot, etc.). Children entering the children's collective should be examined by a pediatrician, and if they suspect a gonorrhea, they should be examined by a venereologist. Servicing staff before going on to work in a children's institution and subsequently every 3 months also undergoes an examination of the venereologist.