Gonorrhea - an infectious disease caused by gonococci and sexually transmitted diseases.
Pathogens - Neisseria gonorrhoeae.
Risk factors
- Sexually promiscuous
- Rare use of barrier methods of contraception (condoms)
- Newborn - infection ancestral ways of mother
- Children - attempted sexual assault by the infected person
- The presence in the body hearth gonococcal infections - for example, introduction of infection into the hands of the eye
- For inflammatory diseases of the pelvic organs - the use of an intrauterine device
Risk groups: prostitutes and their clients, businessmen, tourists, drug addicts and others.
Ways of gonorrhea infection: most sex, at least for home (through personal hygiene items). Newborns infected during passage through the birth canal ailing mother.
manifestations of gonorrhea
Symptoms in women
The incubation period - from 1 day to 1 month (on average - 2-5 days). Gonorrhea affects the genito-urinary organs, urethra, cervix, rectum, eyes. Vagina, pharynx involved in the process only under special conditions (trauma, hormonal alteration, immune disorders). Gonococci are able to penetrate into the blood, but only in exceptional cases can spread through the body to form a gonococcal metastases in different organs, or to the development of
sepsis.Gonococcal infection does not have the characteristic manifestations that distinguish it from other infections and is often combined with Chlamydia (In 30-60% cases), trichomonas, Ureaplasma and other infections.
Gonorrhea in women is characterized by multifocal and in 75-85% of cases asymptomatic. In the acute stage, patients complain of sharp pain during urination, chronic - no complaints, can be confusing pain in the lower abdomen, menstrual irregularities. In the acute stage - fever.
Symptoms in men
Gonorrhea in men occurs in the form urethritis.
Front acute (fresh) urethritis: pain during urination, copious purulent discharge, redness and swelling of the urethra sponges.
Subacute urethritis: painful urination decreased, there was a slight serous-mucous discharge mostly morning, redness urethral sponge.
Torpid urethritis occurs malosimptomno; note scant secretions or urethral sponge bonding in the morning, often not noticed by patients; With the spread of the posterior urethra join a frequent urge to urinate and increased morbidity
gonorrheal prostatitis more often chronic, less acute. Noted a feeling of heaviness in the perineum, the weakening of erection, premature ejaculation. In the acute stage - fever, urinary disorders.
Gonorrhea in children
Blennophthalmia - gonococci enter the conjunctiva of the eye as it passes through the birth canal ailing mother. gonorrheal vulvovaginitises girls there when passing through the birth canal sick mother or sharing hygiene items. At older ages, the infection often occurs as a result of depraved actions of adults.
Gonorrheal proctitis - the defeat of the lower third of the rectum; observed in women and girls with gonorrhea, as well as in male homosexuals. Subjective feelings are often absent, sometimes only notice itching, burning, slight pain during defecation.
Gonorrhea manifests oropharyngeal lesions of the tonsils and pharynx: redness and swelling, sometimes the tonsils appears purulent plaque
Gonorrhea eye in adults is recorded at non-observance of personal hygiene: swelling of the eyelids, redness of the conjunctiva, suppuration, photophobia
Diagnostics
- Men take swabs from the urethra and rectum, women - from the urethra, vagina and rectum
- Seeding is required in women because of the low detection rate of gonococcal when stained smears and in children with suspected sexual abuse
- At negative results of bacteriological tests in case of suspicion of gonorrhea requires provocative tests (lead to temporary weakening of the immune defense and active proliferation gonococci). The chemical method provocation - lubrication endocervical mucosa 2-5% sodium or urethra 1-2% silver nitrate solution. Biological method provocation - intramuscular administration of 500 million microbial bodies or 20 ug gonovaktsiny pyrogenal. The thermal method - daily diathermy or inductothermy genitals for 3 days. Physiological method - swabs are taken during menstruation. Food processing method - receiving acute and salty food. Physical methods - massage of the urethra
- IFA
- PCR
- Antibiotics, even in small doses, affect the findings.
gonorrhea treatment
necessarily
- study of all patients for the presence of syphilis and HIV infection.
- assessment and treatment of sexual partners.
When uncomplicated gonococcal infections of the lower genital tract, throat and rectum:
- Ceftriaxone - 250 mg intramuscularly once
- 3 g of amoxicillin or inwardly once,
- benzylpenicillin or intramuscularly susceptibility.
Alternative drugs for gonorrhea:
- 1 g azithromycin once inside,
- spectinomycin 2 g intramuscularly,
- norfloxacin 800 mg by mouth,
- ciprofloxacin 500 mg
- combination of cefuroxime 1 g, 1 g of cefotaxime intramuscularly.
Due to the fact that gonococcal infection is often associated with chlamydia, One of the drugs listed above administered simultaneously with doxycycline 100 mg orally 2 times per day for 7 days (pregnant - erythromycin 500 mg orally 4 times a day for 7 days).
When complicated by gonorrhea of the lower genital tract, gonorrhea of the upper genital tract and pelvic organs, with gonococcal proctitis, pharyngitis and disseminated gonococcal infections:
- 1 g of ceftriaxone intramuscularly or vnutrivennr 1 time per day.
- pregnant - erythromycin, penicillin G (sodium salt) or some cephalosporins
Chemotherapy gonorrhea cease no earlier than 24-48 hours after the disappearance of symptoms of the disease.
When gonorrheal conjunctivitis:
- 125-250 mg of ceftriaxone intramuscularly once,
- or topically every 2 hours - gentamicin
Local treatment of gonorrhea
Men - washing urethra potassium permanganate solution (1: 10,000), nitrofural (1: 5000), instillation 0.25-0.5% silver nitrate solution, by tamponade Vashkevich, bougienage
Women: at urethritis - instillation 0.25-0.5% silver nitrate solution; at cervicitis - vaginal baths, smearing cervical canal 1% Lugol solution with glycerol, 2% silver nitrate solution; at vulvitis - hip baths with potassium permanganate solution (1: 8000), chamomile extract.
7-10 days after the last treatment is carried out through a combined provocation and 24-48-72 hour charge material for research. Provocation and clinical examination was repeated after 1 month.
