Gonorrhea is a sexually transmitted disease that is quite common in modern society. According to statistics, about 200 million people in the world are sick with it.
Pathology has a progressive course, which in advanced cases can lead to serious complications. Therefore, it is important, when the first symptoms of the disease appear, to sign up for an examination and find out how to get tested for gonorrhea.
Indications for examination
It is possible to suspect the presence of gonorrhea when a patient has symptoms characteristic of it. A triad of symptoms is distinguished, which is the reason for an urgent analysis for gonorrhea.
It includes:
- pain when urinating;
- itching and burning in the genital area;
- the occurrence of purulent discharge.
In addition, indications for the analysis of gonorrhea are:
- the presence of frequent changes of sexual partners;
- practicing unsafe sex;
- early pregnancy (mandatory to prevent infection of the child);
- infertility for unknown reasons.
In gonorrhea, analysis is also necessary during treatment to monitor its effectiveness.
Diagnostic search
When contacting a doctor, the examination begins with the collection of an anamnesis. The doctor asks the patient about when the symptoms of the disease began, how they progressed over time. An important part of the history is information about the patient's sexual life. After questioning, an examination is carried out, in which characteristic changes in the area of the external genital organs are revealed.
The data obtained enable the doctor to suspect gonorrhea and prescribe a set of laboratory tests. It includes:
- taking a smear and examining it;
- additional methods (blood test, enzyme immunoassay, biochemical analysis of serum).
Which tests are given in each case is determined by the attending physician.
Smear analysis
The main diagnostic method most widely used in hospitals is the smear. It is taken from the genitals: in women - from the vagina or from the cervical canal, in men - from the urethra.
In some cases, an atypical course of the disease is possible, when the infectious process also spreads to the pharynx, eyeballs, and rectum. With this course of the disease, it is necessary to take several smears from all damaged organs at once.
The resulting material is examined using a number of laboratory techniques.
Bacterioscopy
Initially, the so-called bacterioscopy is carried out - a study that does not require a lot of time and resources. Secretions from the genital organs are applied to the surface of a glass slide, which is examined under a microscope.
When studying a micropreparation, the laboratory assistant notices a large number of bean-shaped bacterial organisms that are linked in a pair of 2 cells. This is the gonorrhea diplococcus.
After that, additional staining of the smear is carried out. Gram stain is usually used. It makes it possible to determine the morphological features characteristic of the microorganism found in smears.
According to the classification, all bacteria are divided into gram-positive and gram-negative. Gonorrhea diplococci belong to the group of gram-negative organisms, therefore, when examining preparations, they are stained blue.
With microscopy, one can clearly see the boundaries of the cells separated by the membrane, and the internal environment of the body - the cytoplasm. It has a dark blue core.
Gonococci are microorganisms that do not survive well in the environment. Therefore, it is important to send the material for bacterioscopy immediately after taking a smear. The waiting period should not exceed 15 minutes.
In general, bacterioscopy of secretions from the genital organs is effective method detection of gonorrhea pathogens. The study is highly accurate, very easy to conduct and cheap. This makes it possible to use it as a routine method for confirming the diagnosis.
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Cultural research method
Cultural analysis also involves the detection of microorganisms in a swab taken from the genitals. The study begins in parallel with bacterioscopy. It has great accuracy, but it takes quite a long time.
The resulting biological material is placed on a nutrient medium - a special agar-agar, which is poured into Petri dishes. It contains all the trace elements, organic substances and vitamins that are needed for the rapid reproduction of bacteria.
The Petri dish is placed in a thermostat in which microorganisms are kept for a day. After that, reseeding of the grown colonies and repeated daily incubation is carried out. When bacteria grow, their species is determined by the following features:
- microscopic picture;
- color features;
- types of colonies grown on agar;
- biochemical features.
Thus, sowing on gonorrhea makes it possible to identify microorganisms even if they are not detected in the smear. An obvious disadvantage of the method is the duration of the preparation of the analysis. On average, the results come at least 4-5 days later.
Culture analysis has another advantage that makes it an indispensable component in the diagnosis of gonorrhea. The grown colonies of the microorganism can be tested for antibiotic sensitivity using special techniques. This makes it possible to choose exactly the drug that will affect the strain of bacteria that multiply in the patient's body.
Gonococci may be resistant to certain groups of drugs, therefore, in order to prescribe the correct treatment, antibiotic typing of the obtained bacterial cultures is mandatory.
polymerase chain reaction
The polymerase chain reaction, or PCR, is the most accurate method for diagnosing gonorrhea. Its name means that the research is carried out using the possibilities of molecular biology.
The technique is based on the detection of DNA, which is contained in bacterial cells, and its multiple copying - replication. Thanks to this, even minimal amounts of microorganisms can be detected in a smear.
Diagnosis using PCR is used in cases where there is a clinical picture of the disease, and bacterioscopy and cultural examination of the causative agent of the pathology could not be determined. Polymerase reaction is the only effective method for diagnosing latent forms of gonorrhea. This avoids the progression of the disease and the development of complications.
The analysis is given in specially equipped laboratory complexes, which are not available in all settlements. This can be considered a disadvantage of PCR diagnostics. Another disadvantage of the method is the high cost of resources, and hence the high cost of the procedure.
Sometimes a polymerase chain reaction can lead to a false positive result. This error occurs in the following cases:
- When a sample of biological material has been contaminated with third-party microorganisms.
- When the rules for transporting smears are violated.
- When the immunity of the human body has already coped with the infection, and in fact the patient is healthy, but dead gonorrhea bacteria continue to be released from his body.
The likelihood of these errors occurring is minimal. But still, in order to avoid misdiagnosis, it is recommended to conduct a PCR test for gonorrhea several times.
Despite the disadvantages, a study using a polymerase reaction is considered the most accurate way to detect gonococci. Its efficiency is 95-98%, which is a very good result.
Serological research methods
For the diagnosis of gonorrhea, tests do not necessarily have to be aimed at detecting a gonorrheal pathogen. Upon contact with a microorganism, the patient's body begins to produce specific immune complexes - antibodies that bind to gonorrhea pathogens.
Developed immune complexes can be detected in the serum. For this, serological tests are given - blood for gonorrhea. These include.
Diagnosis of gonorrhea is based on the results of a laboratory test. Gonococcus is identified by several indicators: gram-negative microorganism, diplococcus, location inside the cell. Not all methods make it possible to identify gonorrhea, since it has an increased ability to change.
Several methods are used for the laboratory diagnosis of gonorrhea.
We list the main ones:
- Microscopic, in which the study of the material is carried out using a microscope. In the presence of an acute disease, gonococci are located inside the leukocyte. The chronic type of gonorrhea is characterized by an extracellular location of the pathogen.
- Bacteriological (cultural), carried out by sowing microorganisms on a nutrient medium. This method is indicated for repeated negative microscopy results.
- Serological, based on the results of the Borde-Gangu reaction. This method is currently the auxiliary one.
- Immunoenzymatic. The technique allows to detect antibodies to gonococcus, but most often experts use it as an additional one.
How is microscopic analysis for gonorrhea done?
The bacterioscopic type of research is the main method used to diagnose genital infections.
In men, the material is obtained from the urethral canal, intestines, tonsils and throat. Before the examination, the patient must refrain from emptying the bladder for four hours. The area of the urethral opening is wiped with a sterile tampon with saline, in case of insufficient release of fluid, the canal is massaged. The material is taken by inserting an instrument into the depth of the urethra.
In women, a smear is taken not only from the urethral canal and cervix, but also from the zone of the Bartholin gland, throat, tonsils and intestines. Previously, the opening of the urethra is wiped with a swab. If the received liquid is not enough, massaging this area is carried out. Scraping is performed by inserting an instrument into the canal and cervix to a depth of about two centimeters.
The sampling of material from the intestine is carried out by scraping from the mucous membranes with a Volkmann spoon. In some cases, enemas are used, after which purulent discharges are collected and sent for microbiological analysis.
The principle of the method is based on the staining of the material, while the gonorrheal pathogen becomes blue. The combined staining technique (according to Gram) is based on the use of several types of solutions:
- lugol;
- crystal violet;
- red;
- alcohol-acetone.
How is bacteriological culture for gonococci performed?
Material for bacteriological examination is taken in the same way as for microscopic analysis. Sowing is carried out using artificial nutrient media.
Since the pathogens of gonorrhea are very selective, it is necessary to observe a certain condition for their growth. Currently, special test systems have been developed, which are tubes made of plastic plates, which are coated with nutrient media.
A large role in obtaining the correct result is played by the observance of a number of rules:
- The plates must be removed with the utmost care. Do not touch the surface of the agar.
- It is necessary to lower a couple of tablets that generate carbon dioxide into the cavity of the tube.
- The plug must be screwed on quickly.
- The material may be stored at room temperature no more than two hours.
Microbiology identifies the pathogen by using an oxidase test and Gram staining of smears.
In what cases is serodiagnosis of the disease performed?
In laboratory practice, there are several types of serological analysis, but in order to make a diagnosis of gonorrhea, only the Borde-Gangu reaction is used, which helps to identify the chronic form of the disease. Most often, with this form of infection, the bacteriological method does not give a positive result.
Blood (serum) is heated for half an hour at a temperature of 56 degrees. This is necessary to dissolve the protein part. After warming up, gonococcal antigens are added. In the case when antibodies to infection are present in the material, their adsorption occurs on the surface of the antigen.
How to detect gonorrhea using enzyme immunoassay
ELISA, like serodiagnosis, is not common. This technique has both advantages and disadvantages. During the analysis, antibodies to the gonorrhea pathogen are detected. During the procedure, the following problem may arise: the analysis sometimes reveals already dead gonococci that are still in the body. As a result, the diagnosis shows positive results.
The advantage of enzyme immunoassay is the ability to identify resistant types of gonococci, which are often difficult to diagnose.
In addition, this method is non-invasive: the patient must pass a urine test.
Gonorrhea analysis by PCR
Polymerase chain reaction (PCR) is carried out using the discharge of the mucous membranes of the urinary tract and urine. The technique is considered to be highly accurate and competes in sensitivity with the cultural one. The advantage of the polymerase chain reaction is the ability to determine both gonococci and chlamydia in the same material. Such diagnostics is carried out in a faster time than bacteriological. The disadvantage of the method is the high cost of reagents and laboratory instruments required for the implementation of the polymerase chain reaction.
The basis of diagnosis is amplification, in which a large number of copies are created from a short section of DNA. Thanks to this, laboratory assistants receive the amount of material necessary for the study. The sample is taken by scraping from the oral cavity, tonsils, urinary tract. Three days before the study, the patient must refrain from sexual intercourse.
Differential diagnosis of gonorrhea
To make a correct diagnosis, medical workers use additional research methods. They can be based on the results of bacteriological seeding, polymerase chain reaction, the study of general smears. The regulatory document speaks of the need to use various provocations if there is a suspicion of a chronic form of gonorrhea. Throat, mouth, tonsils also require examination.
Express tests for gonorrhea at home
A home test allows you to determine the presence of a gonorrheal pathogen yourself. This technique is not highly accurate, however, in most cases it is possible to detect an infection. Express diagnostics is carried out as follows: the test is lowered into the morning portion of urine. After 15 minutes, in the absence of disease, he will show one strip. In the presence of antibodies to the pathogen, two stripes will appear.
If a sexually transmitted infection is detected using a test, you should consult a doctor. You should not resort to self-medication! Only a qualified specialist can determine the type of disease. The acute type of gonorrhea requires immediate treatment with antibacterial drugs.
Instrumental research methods
Instrumental techniques are used not only to detect gonorrhea, but also to determine the complications that have arisen after past illness. Research is carried out using:
- ureteroscopy;
- colposcopy;
- cervicoscopy;
- diagnostic laparoscopy.
All of these methods are carried out using special equipment. During the procedures, the doctor determines the condition of the mucous membranes of the urethral canal, cervix, ovaries and appendages.
If a specialist suspects the presence of gonorrhea in a newborn, a number of studies are carried out, including biomicroscopy of the eye, diaphanoscopy. A child suffering from the disease is prone to the development of purulent conjunctivitis. In order to determine the route of infection, it is important to examine the parents. Blennorrhea requires differentiation from other types of conjunctivitis.
Quite often there are cases of atypical localization and clinical symptoms of the course of gonorrhea (colloquially, this disease is called gonorrhea). Therefore, for a reliable diagnosis of infection with the establishment of the type of pathogen, laboratory diagnostics is mandatory. For this, an analysis is made for gonorrhea.
In men, the study is carried out using several methods, and the material is taken not only from the structures of the urogenital tract. Smears are also taken for gonorrhea from the mouth, anus, and even the discharge of the eye.
What methods are used to diagnose gonorrhea
If gonorrhea was suspected during a clinical examination by a doctor, the smear analysis is examined by several methods:
- Microscopy. In the classic course of gonorrhea, a significant number of gonococci accumulate on the mucous membrane, which are detected by microscopic examination.
- Tank sowing. The technique is a bacteriological study in which the material is applied to special nutrient media. Provided that bacteria are present in the test material, colonies grow on the media. Bacteria are identified by morphological, biochemical and antigenic properties,.
- Polymerase chain reaction (PCR). The study includes the identification and identification of the genetic material of the pathogen through the reaction of multiple doubling (amplification) of nucleotide bases.
How to establish a diagnosis of gonorrhea, what tests to pass , and also with the help of what methods to investigate them, the attending venereologist determines.
The choice is made depending on the course of the infectious process, its localization, as well as the capabilities of the laboratory.
Smear on flora for gonorrhea
Microscopic examination is one of the methods by which a smear is analyzed. Gonococci are detected during the determination of the microflora of the mucous membrane of the urethra or vagina. The determination of the microflora of the mucous membrane of the structures of the urogenital tract is more often carried out in women. In men, this study is performed to detect gonococci.
If there is inflammatory process, deciphering the analysis for gonococci, after microscopy includes several indicators:
- The appearance of bean-shaped microorganisms. They are located in pairs under one capsule, as well as inside leukocytes. When stained by Gram, these bacteria have a pink coloration (gram-negative bacteria). In a smear with an acute course of gonorrhea, the number of gonococci is very significant. Often they occupy the entire field of view.
- A significant number of leukocytes. Normally, the mucous membrane contains a small number of leukocytes (1-2 in the field of view of the microscope). With the development of gonorrhea, which is an infectious purulent process, the number of leukocytes increases dramatically. They can cover the entire field of view of the microscope and cannot be counted.
- Increase in mucus. Indicates the development of an inflammatory process, because cells respond to inflammation by increasing functional activity and increasing mucus production.
In the chronic or atypical course of the infectious process, such changes in the smear may not be. Therefore, other laboratory diagnostic methods can be used to reliably diagnose gonorrhea.
Culture test for gonorrhea
An analysis for gonorrhea using bacteriological culture of a smear for gonorrhea is a very informative research method. It detects the pathogen in the material in 95% of cases. After identification of gonococci, their sensitivity to the main groups of modern antibiotics is determined, which makes it possible to choose the most effective medicine for etiotropic therapy of gonorrhea.
The main disadvantage of bacteriological research is the long period required to obtain results. It can be several days, since it takes time for the accumulation of microorganisms on a nutrient medium and the growth of colonies. The test result can be positive or negative.
During diagnostics, the amount of pathogen per unit volume of biological material is counted, followed by indication of this value in the analysis results.
PCR analysis for gonorrhea
PCR is a specific and reliable diagnostic method. Thanks to the enzymatic amplification reaction (multiple doubling), the genetic material (DNA) of gonococcal microorganisms is accumulated and identified. To obtain the result of the study by PCR, a short period of time is sufficient.
The result can be positive or negative. Despite the high specificity of this technique, in some cases it is possible to obtain a false negative result of the study. With gonorrhea, the material contains a high number of leukocytes. Enzymatic systems of immunocompetent cells break down the genetic material of gonococci. This leads to a false negative result. Its probability increases with the wrong taking of the material and its long-term storage.
Express analysis for gonorrhea
To date, methods have been developed for the rapid detection of gonococcus in the test material.
For this it is used:
- Smear microscopy (results can usually be obtained within half an hour), .
- Special test strips in which gonococcus is detected using an immunochromatographic reaction (the result can be obtained within 5 minutes).
Express diagnostics has a low specificity, therefore, a subsequent full-fledged examination of a smear for gonorrhea is required.
How to get tested for gonorrhea
A swab is taken to test for gonorrhea. It is a scraping from the mucous membrane, taken from the area of \u200b\u200btypical or atypical localization of the pathogen. A typical localization of gonorrhea in men is the mucous membrane of the urethra. A urologist or andrologist takes a scraping from it using a sterile probe.
In case of suspicion of an atypical localization of infection in gonorrhea, scrapings can be taken from the mucous membrane of the rectum, pharynx and tonsils, conjunctiva of the eyes. In the chronic course of the infectious process, urine and sperm from men can be taken for microscopy and PCR.
The analysis for gonococci in gonorrhea is false negative. To minimize the risk of obtaining false test data, a provocation is carried out. It is necessary for the development of inflammation to increase the number of microbial cells per unit volume of biological material. The provocation is performed with the help of a local increase in body temperature, the use of special chemical compounds or intramuscular administration of gonovaccine.
Preparing for a smear test for gonorrhea
To obtain reliable results of the analysis, it is important for a man to follow a few simple recommendations before taking a smear.
They include:
To control the effectiveness of ongoing etiotropic therapy, the doctor prescribes control tests, the negative results of which are the basis for stopping treatment.
If you need to test for gonorrhea in men and women, contact competent venereologists.
Gonorrhea is a sexually transmitted infection of the urinary tract.
The causative agent of gonorrhea is gonococcus, a bacterium from the genus Neisseria. This group also includes meningococcus, the causative agent of meningitis.
Gonococcus is poorly preserved in environment outside human body. The temperature range in which it can exist: 18-56 degrees. The sun's rays, drying act on the bacterium is detrimental.
Gonococcal infection affects the mucous membranes. It can develop in the urogenital tract, rectum, palatine tonsils, nasopharynx, conjunctiva of the eye.
Gonorrhea is transmitted primarily through sexual contact. It is also possible to infect a child in childbirth from a sick mother. Occasionally, girls have cases of household transmission of the disease through toilet items.
The incubation period is usually 2 to 14 days.
Symptoms of the disease in men
The main symptom of acute gonorrhea in men is purulent discharge from the urethra (urethra). The discharge is accompanied by burning and pain when urinating. Sick men note adhesion of the external opening of the urethra in the morning.
Sometimes a drop of blood appears at the very end of urination (when the infection spreads to the posterior urethra and bladder). If the inflammation passes to the epididymis, there is pain in the scrotum and swelling.
In chronic sluggish gonorrhea, men may have almost no complaints. Discharge from the urethra in the chronic form is meager (single drop). Disorders of sexual function (erection dysfunction, premature ejaculation) gradually appear.
Symptomatic manifestations in women
The main manifestations of the acute form of the disease in women include vaginal discharge, pain during intercourse, painful urination, pain of varying intensity in the lower abdomen.
Gonococcal infection in women, in addition to the urinary tract, almost always captures the cervix.
The disease in women often occurs in an erased form. About 50% of patients do not present active complaints.
What tests should be done when screening for gonorrhea?
Diagnosis of this infection is based on laboratory tests. This is mainly due to the fact that the clinical picture of gonococcal infection is nonspecific. Pain and discharge from the urinary tract in both men and women can be in large numbers a wide variety of diseases.
The key methods of laboratory diagnosis of gonorrhea, i.e. direct tests for gonorrhea are microbiological studies.
Microbiological methods
Microbiological methods are aimed at identifying and determining the type of infectious agent. There are bacterioscopic and cultural methods.
Bacterioscopy is the study of a specially stained smear under a microscope for the presence of bacteria. For bacterioscopy, a scraping swab is taken from the urethra or other organ affected by inflammation.
Bacterioscopic examination is widely used throughout the world. Its advantages are speed, low cost and high reliability. If gonococcus is detected during bacterioscopy, further diagnostic measures are usually not needed.
Unfortunately, it is not always possible to identify gonococci in a smear. The absence of gonococci in the studied smear does not exclude the diagnosis of gonorrhea.
The second method used to detect gonococci is culture. Its meaning is that the biological material collected in the focus of the disease (discharge from the urethra or vagina) is placed on special media for growing bacterial colonies. By the appearance of the formed colonies (cultures), one can say exactly which microorganisms created them.
The cultural method is accurate, relatively cheap, but it takes time to grow a gonococcus culture (up to 7 days) and special laboratory conditions. Another advantage of the method is the ability to determine the sensitivity of gonococcus to various antibiotics.
In some cases, microbiological studies do not sufficiently clarify the situation. Then you have to resort to molecular genetic methods for determining the causative agent of gonococcal infection. These include PCR and LCR.
The role of PCR and LCR in the laboratory diagnosis of gonorrhea
PCR is a polymerase chain reaction. LCR is short for ligase chain reaction. Both methods are aimed at identifying the genetic material of gonococci in secretions from the urethra or other biological media.
PCR and LCR are highly sensitive and fast. The problem is the high cost of research. LCR is also difficult to obtain due to the fact that it is done in a small number of laboratories. PCR is more widely used.
Bordet-Gangu reaction - blood test
The Borde-Jangu reaction refers to serological research methods. The word "serological" comes from the word "serum" - serum.
For analysis, the patient's blood serum is taken. The study determines the presence in the human bloodstream of antibodies to the causative agent of gonorrhea.
The method has a number of disadvantages, it is used to a limited extent, mainly in chronic gonococcal infections.
What is gonorrhea provocation and how is it performed?
Provocation in gonorrhea is carried out with latent inflammation, when there is a suspicion of a gonococcal infection, but the gonococcus was not isolated during a routine examination. A provocation is an action aimed at the exit of gonococci from the walls of the genitourinary tract into the lumen of organs, where the pathogen can be detected bacterioscopically or culturally.
It is possible to provoke the "exit" of gonococci by chemical, thermal, biological means. So, when using chemical method the mucous membrane of the urethra is lubricated with silver nitrate. A day after the provocation, as well as on the second and third days, a smear is taken from the urethra for examination for the presence of the infectious agent.
It must be said that the provocation of gonorrhea is considered a method with unproven diagnostic efficiency and is not used in the United States and Western Europe. In the Russian National Guide to Dermatovenereology, this diagnostic method is also skeptical.
Other tests
With gonorrhea, you need to pass general clinical tests of urine and blood. They will not reveal the pathogen, but will show the severity of the inflammatory reaction.
Yes, in general analysis blood in acute gonococcal infection is usually elevated ESR and increased the number of leukocytes. Urinalysis shows an increase in the number of leukocytes, protein levels, and some other inflammatory changes.
To determine the level of damage to the urinary tract, a two-glass test is performed. If the infectious process covers only the anterior urethra, the first urine sample will be cloudy and the second transparent. If the gonococcal inflammation has spread to the posterior urethra and bladder, both urine samples will be cloudy.
How to identify gonococcal infection at home
There are rapid tests for self-diagnosis of gonorrhea. By appearance they are like a pregnancy test strip. These tests can serve as a guide, but a visit to the doctor is necessary to establish an accurate diagnosis.
Laboratory diagnosis of gonorrhea is carried out to identify it from others. possible diseases sexually transmitted. Gonorrhea belongs to the group of sexually transmitted diseases, it occurs equally often in men and women. There are cases of infection of young children from a sick mother during delivery. Gonorrhea affects the mucous tissues of the genitourinary system, it is possible to generalize the pathological process in the pharynx, rectum and conjunctiva of the eye.
Even in ancient times of healing, the diagnosis of gonorrhea was given great importance in various sources. A little later, in the 2nd century AD. Gonorrhea was described by Galen as an ejaculation that is different from the usual ejaculation during an erection. Pathogen infectious disease first discovered by Albert Neyser by separating the purulent exudate of the conjunctiva and urethral lumen. It is in honor of this doctor that the causative agent of the pathology is named - Neyser's infection (or Neyser's gonococcus). The classification of gonorrhea is of key importance in the diagnosis and determination of treatment tactics.
The nature of the pathology
Gonorrhea (another name - gonorrhea) is an infectious process with the formation of purulent inflammatory foci on the mucous membrane of the urinary tract. The only causative agent of venereal disease is gonococcal infection (Neisseria gonorrhoeae). Gonorrhea, the diagnosis of which is carried out in the laboratory, requires timely identification. Gonococcal agents die in the external environment under the influence of negative factors: drying, antiseptic and thermal effects. The defeat of the mucous membranes is especially noted where the glandular or cylindrical epithelial layer is concentrated. Because of this characteristic feature pathology in clinical practice, gonococcal urethritis is common, and almost never inflammation extends to the vaginal wall.
The main feature of gonococci is the ability to take different shape and localized in different parts of the cells. So, their intracellular location or localization on the surface of the cytoplasmic membrane is possible. In some cases, L-types are formed that are resistant to the effects of antibacterial drugs, antibodies of immunity. According to the localization of the pathological process, the following types of infectious lesions are distinguished:
- anorectal (gonococcal proctitis);
- genitourinary (damage to the pelvic organs);
- musculoskeletal (formation of gonarthritis);
- conjunctive (blennorrhea);
- gonococcal larynopharyngitis.
Gonococcal infection tends to spread in an ascending line. Affecting the urethral or cervical canals, the pathogen easily spreads to the higher organs.
Gonorrhea is also classified according to the form of the course of the pathological process. Allocate fresh form with acute, subacute and torpid course of the disease, and chronic. The fresh form is characterized by the relative recentness of the disease, but not more than 2 months from the moment of the first manifestations of the pathology. Chronization of gonorrhea is possible in the absence of adequate treatment of the fresh form or in the course of the pathology for more than 2 months.
Important! Chronic gonorrhea in men and women is most dangerous for the development of serious complications from the genitourinary system and general health due to the latent course of periods of exacerbation. The symptoms of chronic gonorrhea are blurred, which is perceived by patients as the norm or temporary disturbances for a variety of reasons.
Mechanisms of infection and development of infection
The causative agent of venereal disease is gonorrheal gonococcus Neisser. It is this pathogenic agent that determines the etiology of the disease. The bacterium is bean-shaped with concave sides. It has a high instability to external influences, but the opposite effect is created when it hits favorable environment. The body of the bacterium has a protective capsular shell that is resistant to the effects of immune antibodies.
The result of the pathogenic activity of the bacterium is the production of beta-lactomase, a substance that neutralizes the action of certain antibiotics. Beta-lactam strains are most often found in the chronic course of pathology, in the event of complications of gonorrhea. You can get an infection in several ways:
- sexual way (unprotected sexual contact in history is noted in almost 90% of cases);
- contact-household (less common due to the rapid death of bacteria in the external environment);
- transplant (from mother to fetus through the placenta, during the passage of the child through the birth canal).
Gonorrhea in men and women occurs mainly with a frequent change of sexual partners. You can get infected during anal or oral sex, with external contact of the penis with the mucous tissues of the partner. During sexual intercourse with a sick man, a woman becomes infected in all cases. Therefore, condoms are one of the reliable methods of protection against the disease.
Gonococci are localized in men on the glans penis, enter the genital organs through the urethral canal. Gonococcal infection contributes to the development of impotence, infertility, bacterial prostatitis and other complications. In women, the bacterium first comes across the mucous membranes of the vagina, after which it penetrates into the cavity structures of the organs. reproductive system. Especially dangerous is extragenital gonorrhea, affecting other organs of the human body and metastatic, when there is an exacerbation of all types of gonorrhea.
Important! The disease is highly contagious, which is why the risks of infection are so high even with a single sexual intercourse with a carrier of gonococcus. Gonorrhea is almost always associated with trichomonas and chlamydial infection.
Diagnostic measures
Gonorrhea treatment begins with laboratory tests. Diagnosis of infection is a whole range of measures, mainly laboratory, to confirm or refute the final diagnosis. Treatment of men is carried out by an andrologist, urologist-venereologist or infectious disease specialist. Treatment of gonorrhea in women is carried out by a gynecologist-dermatovenereologist. Often gonorrhea occurs simultaneously with other diseases of the urethal-genital localization, has similar symptoms and forms. In addition to the physical examination of patients, conducting ultrasound of the pelvic organs and studying the clinical history of patients, along with their complaints, a large-scale laboratory study is carried out to create a complete clinical picture of the disease.
Laboratory diagnostics
Laboratory research methods are a detailed study of the patient's biological material (mucus samples from the cervical or urethral canal, urine, blood) to establish the true cause pathological changes and unpleasant clinical picture. Considering that for last years the course of gonorrhea is practically not accompanied by vivid symptoms, many resistant gonococcal strains have formed. Laboratory diagnostics allows you to quickly identify gonorrheal gonococcus from other bacteria of various biological groups, prescribe adequate treatment and prevention of subsequent exacerbations, especially when the process is chronic. The main methods of laboratory diagnostics include:
- bacteriological analysis (cultural inoculation);
- carrying out rapid tests (counter electrophoresis reaction);
- study of the reaction of immune fluorescence (in the abbreviation RIF);
- analysis for enzyme immunoassay;
- serological research method (according to the Borde-Gangu reaction):
- conducting molecular genetic research (basic chain reactions);
- carrying out provocative tests (effective in identifying the chronic form of gonorrhea).
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gonococcal conjunctivitis
The effectiveness of methods in diagnostics has been achieved through centuries of knowledge and research activities of many medical scientists. Only one analysis to clarify gonorrhea is not enough to identify the manifestation of the disease. Treatment of gonorrhea should begin only after a reliable diagnosis.
Types of laboratory tests
- Test strips (express method). Rapid tests are widely distributed in pharmacy chains, they can be used independently in case of suspicion of infection with gonorrhea or after questionable sexual intercourse. The principle of action is identical to a pregnancy test: one strip is a negative result, two strips indicate the development of a gonorrhea infection. The method is based on the counter electrophoresis reaction - this is how the reaction of the gonococcal agent and the antibody in the serum is ensured. If it is successful, an antibody + antigen complex is formed, which is responsible for the appearance of the second strip. Such express tests have low sensitivity, so it is impossible to unambiguously rely only on the result of the tests. In some cases, the method of counter electrophoresis is possible, which is characterized by the fusion of the antigen not with the gonococcus, but with a similar pathogenic microorganism. If a positive result appears, you should consult a doctor to accurately identify the disease.
- Microscopic examination of the smear. For analysis, a detachable exudate is taken from the vaginal cavity, cervix, urethral lumen and rectum. The sampling is carried out in two test tubes: the first option is stained with a brilliant green solution or methylene blue (the more commonly used method). Given the presence of gonococci inside or outside of leukocytes, contrast staining allows the identification of cocci in the cytoplasm of leukocytes. The second version of the smear is studied according to the Gram method, which involves staining with a rich pink tint. The final diagnosis is established only after studying the second version of the Gram smear. While the first smear will simply identify coccal infections, Gram staining will accurately identify gonococci. The sensitivity of the method is variable, ranging from 40-85%. The scatter is due to the presence of many subspecies of gonococci, which are not stained at all in such ways. The specificity of the method is very high, reaching 95%, but the experience of the laboratory assistant plays an important role in obtaining reliable results.
- Cultural method of detection.
Bacterial examination of pathogenic discharge for the presence of gonococci is considered one of the best ways to identify gonorrhea. The method is based on the principle of sowing the patient's biological material in special nutrient media. After some time, the Petri dish, placed in a thermostat, is examined for the growth of colonies of gonococci. A feature of the method is high accuracy and the absence of false positive results. The sensitivity of the method is equal to 95-98%. - Study of immune fluorescence. A reliable reaction is based on the high qualification of the laboratory staff, the presence of a fluorescent microscope and reagents. For the study, it is necessary to make a sampling from the mucous structures of the patient's urogenital canal. Then the sample is stained. The dye includes antibodies to gonococcal microorganisms, and glowing circles indicate the development of gonorrhea. The advantage of the method is the ability to detect the disease at the initial stages of its development. At the same time, it is possible to determine concomitant pathologies of the genitourinary organs of a fungal or bacterial nature. The speed of the method is also an undoubted advantage of the method.
- Analysis for enzyme immunoassay. Enzyme immunoassay to determine gonococcal infection is not a very common diagnostic method. An important plus is the ability of the test to identify antibodies to gonococcus. The downside is the definition of a dead pathogenic agent, which also leads to positive result analysis. The method does not require taking a smear from the patient's cervical or urethral canal; for the diagnosis of gonorrhea, you will need to pass an average portion of urine. The specificity of the technique is almost 99%, and the sensitivity of the analysis reaches 93-94%.
- Bordet-Gangu reaction. The method according to Borde-Zhang is called the serological method of research. It is based on the complement fixation reaction for the diagnosis of gonorrhea. It plays a key role in the detection of gonorrhea at the stage of chronic pathology. Refers to secondary research methods in clinical practice.
- Genetic molecular reactions. Two main methods are of particular value to clinicians: the polymerase chain reaction and the ligase chain reaction. Both methods have the highest diagnostic sensitivity and specificity. Carrying out this kind of research is not available for all laboratories, because high-tech reagents and equipment are required for reliability. Polymerase chain reaction (abbreviated as PCR). The method is a high-precision method for detecting gonococcal infection, exceeds in accuracy the cultural bacteriological method. In one biological sample, it is possible to detect not only the pathogens of gonorrhea, but also chlamydia. As a material for the study, a smear from the patient's urethral canal and a urine sample are used. Ligas chain reaction. The specificity of the method tends to 98-99%, surpasses the cultural method of research, allows you to identify several groups of pathogenic bacteria and fungi in one sample at once. For the study, an average portion of the patient's urine or a sample of mucus from the cervical canal is suitable. Both methods are expensive procedures, carried out at the expense of the patient due to the high cost of reagents and equipment. Despite the high accuracy, for the reliability of the diagnosis, it is necessary to conduct a cultural analysis.