Gonorrhea – An infectious, sexually transmitted disease.

The causative agent

Gonococcus – Neisseria gonorrhoeae, a Gram-negative, 1.25 µm long, 0.7-0.8 µm across, with an outer capsule. Discovered by Neisser in 1879.

Features of the pathogen

The gonococcus is covered by a thick six-layer shell that is resistant to various environmental factors, and because of this capsule, the gonococcus is not destroyed by the host’s immune system.

Leukocytes recognize the pathogen and even absorb it internally to destroy it. But they can’t digest it because of the dense outer shell. The result is a condition in which the cells of the pathogen practically LIVE in human immune cells (leukocytes). This fact explains the resistance of the pathogen to antibiotics, the presence of chronic or stubborn forms of gonorrhea, which are difficult to treat.

Gonococcus affects the sections of the genitourinary tract lined by the cylindrical epithelium

• Mucous membrane of the cervical canal,
• fallopian tubes,
• The covering epithelium of the ovaries,
• urethral mucosa,
• rectum.

Classification

According to the duration of the disease are distinguished

• Fresh
• Chronic.

Fresh gonorrhea is subdivided into

• Acute,
• subacute,
• Torpid forms of the disease.

When diagnosing gonorrhea, the localization of the process is clarified: urethritis, endocervicitis, paraurethritis, adnexitis, etc. A special notification is filled out for each case of gonorrhea on record form #281.

Suggested classification of gonorrhea:

• Lower genitourinary tract gonorrhea without complications.
• Lower genitourinary tract gonorrhea with complications
• Upper genitourinary tract gonorrhea without complications
• Upper genitourinary tract gonorrhea with complications

Gonorrhea – it is a common an infectious disease with intense multifocal local manifestations.

In men, gonorrheal infection usually immediately after unprotected intercourse leads to the development of subjective symptoms. The word gonorrhea Denotes a course of pus. It causes men to seek medical attention.

In women after infection, gonococcal infection is often asymptomatic. In the female genital tract there are Biological barriers, Which prevent the infection from entering the internal genital tract. Perhaps under the influence of these factors gonorrheal infection for a long time after infection does not manifest itself in any way.

Women do not seek help, become carriers of gonorrheal infection and a source of infection of sexual partners. Exacerbation of the process with the development of clinical symptoms occurs with hypothermia, during menstruation, when the top of the genital system opens and the infection passes behind the internal cervical pharynx. And clinical symptoms appear: lower abdominal pain, fever, changes in the blood — high sed rate, small leukocytosis. In women, several organs become infected at the time of infection, and a multifocal lesion develops. A modern feature of STDs is the so-called mixt-infection (mixed infection). Gonorrhea patients are diagnosed in 70-80% of cases.

There are associations

• Gonococcus with trichomonas,
• With candida fungi, with staphylococcus aureus,
• Chlamydia,
• and combinations with viruses, including HIV.

Routes of infection

• Mostly gonorrhea is sexually transmitted,
• The domestic route of infection through bed linen, towels, sponges, because the wet sponge gonococci remain viable for 24 hours.
• Newborns become infected when passing through the birth canal of a mother with gonorrhea.

Incubation period The duration of gonorrhoea is from 3 to 5 days, but now it can last up to 14-15 days, which depends on the resistance of the macroorganism.

Examination methods

The anamnesis is used to determine the timing of the onset of the disease, its relation to the beginning of sexual activity or unprotected intercourse. The nature of the complaints depends on the form of the gonorrheal process and its localization. Examination and palpation of the abdomen, inguinal lymph nodes. Examine the external genitalia for swelling and hyperemia of the urethra. Palpation of the urethra, note infiltration, pastosity of the urethral walls, an increase in the bartholin glands, and their painfulness. When examining the cervix in mirrors, assess the nature of the discharge, the presence of inflammation in the cervical canal. Two-handed examination is carried out by the usual method.

Laboratory diagnosis

Microscopic and culture tests are used to detect gonococcus (in girls and women over 60 years of age &#Cultures only -samples- with determination of gonococcal enzymatic properties). Microscopic smears from the urethra, cervical canal, rectum, stained by Gram stain. Because it is difficult to detect gonococci by bacterioscopy, culture and provocation are used.

The following types are currently used

• Chemical – Coating the urethra at a depth of 2 cm 1-2% silver nitrate solution, the rectum &#Lugol 1% solution at a depth of 4 cm, cervical canal at a depth of 1-1.5 cm 2-5% silver nitrate solution.
• Biological – Intramuscular injection of gonovaccine with 500 million microbial bodies or gonovaccine with pyrogenal.
• Thermal – Diathermy or inductothermy is performed for 3 days, one hour after heating take a secretion for analysis.
• Physiological – Menstruation. The combined provocation is the best.

Smears are taken 24-48-72 hours later. Visages are taken 72 hours after provocation.
Gonorrhea is diagnosed only after laboratory detection of gonococcus.

The basic principles of treating gonorrhea — targeting the pathogen and increasing the body’s resistance.

When treating acute cases of ascending gonorrhea

• Hospitalization,
• bed rest,
• Light diet, plenty of fluids,
• antibiotic therapy,
• detoxification,
• desensitization.

As the acuteness of the process subsides, physical therapy, exercise therapy, immunotherapy are added.
When treating subacute ascending gonorrhea, do not detoxify and begin physical therapy earlier.

In chronic gonorrhea Provoke (aggravate) a focal reaction before starting antibiotic therapy.
Current antibiotics for the treatment of gonorrhea: ofloxacin, sumamed, ciprofloxacin, norfloxacin.

Treatment of pregnant women Conducted in a hospital at any stage of pregnancy. Antibiotics are used that have no effect on the baby.
Cephalosporins, macrolides, benzylpenicillin are used.

Tetracyclines, fluoroquinolones, aminoglycosides are contraindicated

Gonovaccine should not be used – risk of miscarriage.
Streptomycin, tetracycline, levomycetin, monomycin, kanamycin should not be used in parturients.

Treatment of gonorrhea in children is carried out in a hospital. Penicillin is indicated in all stages of the disease. In girls over 3 years of age with chronic gonorrhea, gonovaccine is used, followed by antibiotics, local treatment, and general strengthening therapy. Treat gonorrhea in children with ceftriaxone 125 mg vm once.

Routes of infection in children

Genital route of infection, as a result of sexual abuse, newborns are infected when passing through the birth canal of a mother with gonorrhea. Children should be examined if their parents or caregivers have gonorrhea.

SELF-TREATMENT OF GONORRHEA IS INADMISSIBLE!

If there is a suspicion of inflammation or infection you should immediately consult a doctor – A venereologist, a gynecologist, a urologist.

Keep in mind that having a gonorrheal infection in your body makes you a MARRIAGE to the people around you. You can infect your loved ones even through your bedding, soap, washcloths, and towels.

Cure criteria

The criterion of cure is set 7-10 days after the completion of treatment. The criteria of cure are the absence of subjective and objective symptoms of the disease, negative results of microscopic and cultural studies. Before antibiotic therapy for gonorrhea is prescribed, serologic testing is done syphilis.

Repeated serological examination of the patient for syphilis is carried out after 3 months.

Gonorrhea prophylaxis

Public prevention – Health education, medical examinations of the decreed group of people, treatment of STDs, observing the criteria of curability.

Personal prevention – Personal hygiene, personal toiletries, safe sex practices, healthy lifestyle.

Prophylaxis for girls is done at maternity hospitals with Albucid solution (eye and vulva drops).

In the family Children should sleep separately from adults. It is useful not only for preventing diseases transmitted through bedding. But also for the correct formation of the child’s geographical map of the family. The child must have personal hygiene items — soap, washcloth, towel, potty.

In child care facilities – Staff examined by a venereologist, individual potties, standing-type latrines, staff having a separate toilet. Employees of children’s institutions are hospitalized for 1 month after treatment in acute and 1.5 months. In chronic gonorrhea.