20. Gonorrhea of the lower genital tract. Clinic, diagnostics. Methods of provocation, treatment.
Gonorrhea- an infectious disease caused by gram-negative diplococcus Neisseria gonorrhoeae, located intracellularly in leukocytes and cylindrical epithelial cells. Under the influence of chemotherapy drugs or in chronic course, L-forms of gonococci are formed. Classification. According to ICD X: gonorrhea of the lower urogenital tract without complications; gonorrhea of the lower urogenital tract with complications; gonorrhea of the upper urogenital tract and pelvic organs. Further, a complete topical diagnosis is formulated (cervicitis, urethritis, cystitis, bartholinitis, adnexitis, pelvioperitonitis).
Clinically allocate gonorrhea fresh(up to 2 months old) - acute, subacute, torpid, as well as chronic(more than 2 months old). According to the degree of distribution There are two forms of gonorrhea: 1) lower urinary tract and 2) ascending.
The border between the lower and upper sections is the internal cervical os. to the first form includes gonorrhea of the urethra, paraurethral passages and crypts, vulva, vagina, large vestibular glands and cervix (endocervix). Ascending gonorrhea is considered to have spread to the uterus (mainly the endometrium), fallopian tubes, ovaries and pelvic peritoneum.
gonorrheal urethritis proceeds with mild clinical manifestations even in the acute stage of the disease. The main complaint is frequent urination, Pain and burning at its beginning. On examination, hyperemia and swelling of the mucous membrane of the external opening of the urethra and mucopurulent or purulent discharge, often containing gonococci, are found. The diagnosis of gonorrheal urethritis is made on the basis of the clinic and the detection of gonococci in the discharge of the urethra.
Gonorrheal vulvitis and vestibulitis develop secondarily as a result of prolonged irritating effects of pathological discharge from the vagina, urethra, cervix. These pathological processes occur only occasionally in girls, pregnant women and postmenopausal women. Patients complain of burning, itching, pain when walking in the vulva and copious corrosive discharge. In the acute stage of the disease, tissue hyperemia and edema of the vulva are expressed: the small lips are swollen, painful, covered with purulent plaque and stick together, numerous crypts and glands lined with columnar epithelium. Acute phenomena subside after 5 days.
Gonorrheal bartholinitis usually secondary to gonorrheal infection from urethral and cervical discharge. First, the pathological process affects the excretory ducts (canaliculitis) of the Bartholin glands, which is manifested by hyperemia around their external openings (“gonorrheal spots”) and mucopurulent discharge. When the outlet is blocked, the duct is filled with a pathological secret with the formation of a fluctuating tumor, with suppuration of which a so-called false abscess of the Bartholin gland is formed. In the lower third of the vulva on one or both sides, an extremely painful tumor is determined, which sometimes protrudes the inner surface of the labia majora; the skin above it is edematous, hyperemic, but mobile.
Gonorrheal colpitis is rare due to the presence of stratified squamous epithelium and the acidic reaction of the vaginal contents. The disease is observed in some cases in children, during pregnancy, infantilism and during menopause. More often, secondary colpitis develops under the influence of discharge flowing from the upper parts of the genital tract. Symptoms and clinical course this disease do not differ significantly from nonspecific colpitis.
Gonorrheal endocervicitis is the most common disease of gonorrheal etiology. The cylindrical epithelium of the mucous membrane of the cervical canal, alkaline environment and deeply branching glands create favorable conditions for a long stay and vegetation of gonococci. It is characterized by a pronounced inflammatory reaction, often with multiple periglandular infiltrates and even microabscesses. With a fresh acute process, patients complain of profuse vaginal discharge, sometimes intermittent dull pain in the lower abdomen. When viewed in the mirrors, the vaginal part of the cervix is usually edematous, the mucous membrane of the cervical canal is edematous, hyperemic and bleeds easily when touched. A bright red rim is noted around the external pharynx, mucopurulent discharge flows from it.
Diagnostics based on the data of anamnesis, objective examination and application of laboratory methods. The main methods laboratory diagnostics gonorrhea are bacteriological and bacterioscopic, aimed at identifying the pathogen. use bacterioscopic (basic), cultural and serological research methods. The sampling of material for bacterioscopic examination is carried out from the cervical canal, urethra (paraurethral passages), external openings of the excretory ducts of the Bartholin glands and rectum. With negative results of bacterioscopic examination, but anamnestic and clinical signs of gonorrhea, a cultural method of detection is used. Microscopic studies: detection of gonococci, in the test material stained with eosin and methylene blue or by the Gram method. In acute gonorrhea, pay attention to: The absence or small amount of normal microflora; A large number of polymorphonuclear leukocytes, usually not destroyed; The presence of gram-negative diplococci located inside the cells - phagocytes. Cultural research: isolation and identification of gonococcus in cultures (chocolate agar). Molecular biological: polymerase chain reaction (PCR). It is advisable to take the material (mandatory from the cervical canal, urethra, vagina) immediately after menstruation. In girls, discharge from the urethra, vagina, rectum is examined.
Treatment. Sexual partners are subject to treatment. The main place belongs to antibiotic therapy. The drugs of choice for the treatment of gonorrhea are cephalosporins, aminoglycosides, and fluoroquinolones. Etiotropic treatment fresh gonorrhea of the lower genitourinary system without complications consists in the appointment of one of the following antibiotics: Ceftriaxone 250 mg / m once; Azithromycin 2g orally once; ciprofloxacin 500 mg orally once; cefixime 400 mg orally once; spectinomycin 2g IM once. Alternative schemes: ofloxacin 400 mg orally once; cefozidime 500 mg IM once; kanamycin 2.0 g IM once; amoxicillin 3.0 g orally + clavulanic acid 250 mg + probenicid 1.0 g once orally; trimethoprim 80mg 10 tablets orally once a day for 3 consecutive days. If there are complications: ceftriaxone 1 g IM or IV every 24 hours for 7 days; spectinomycin 2.0 g IM every 12 hours for 7 days. Therapy is carried out for at least 48 hours after the disappearance of clinical symptoms. Post-treatment continued with drugs: ciprofloxacin 500 mg orally every 12 hours; ofloxacin 400 mg orally every 12 hours In order to prevent concomitant chlamydial infection one of the antibiotics should be added to the treatment regimens: azithromycin 1.0 g orally once; doxycycline 100 mg twice a day for 7 days. When associated with trichomoniasis be sure to prescribe antiprotozoal (metronidazole, tinidazole). Pregnant women and children who have been diagnosed with gonorrhea are treated according to the schemes of complicated gonorrhea with cephalosporins.
Cure Criteria used to determine the effectiveness of the therapy: the disappearance of symptoms of the disease and the elimination of gonococci from the urethra, cervical canal and rectum according to bacterioscopy. Due to the difficulty in detecting gonococcus by bacterioscopic method, various methods are used in chronic gonorrhea. methods of provocation.
Provocation in gonorrhea- artificial exacerbation of the inflammatory process in order to detect gonococci. It is advisable to carry out provocation immediately after menstruation. Chemical method: lubrication of the urethra to a depth of 1-2 cm with a 1-2% solution of silver nitrate; mucous membrane of the cervical canal - 2-5% solution of silver nitrate to a depth of 1-1.5 cm.
biological method: intramuscular injection of gonovaccine with 500 million microbial bodies or under the mucous membrane of the cervical canal and urethra - 100 million microbial bodies.
Thermal Method: diathermy or inductothermy is performed daily for 3 days. Physiological method: smears are taken during menstruation (2-3rd day).
Combined provocation: within one day, chemical, biological and thermal provocation is carried out. Smears are taken from all foci after 24, 48 and 72 hours, crops - after 72 hours. Clinical and laboratory control after treatment of gonorrhea is carried out 7-10 days after the end of treatment. Repeated control 1 month after the first, after which the patient is removed from the dispensary.
2305 0
The disease affects the genitourinary system, selectively affects the cylindrical epithelium, respectively, can cause the following diseases: inflammation of the urethra, Bartholin gland, cervical canal, uterus, uterine appendages and pelvic peritoneum.
Mostly transmitted sexually.
But a non-sexual route of infection is possible through linen, sponges, towels. Infection of newborns during passage through the birth canal of a mother with gonorrhea is possible. There is no permanent immunity, so you can get sick many times. Incubation period may last 2-7 days.
Gonorrhea classification
Distinguish gonorrhea:Acute - disease up to 2 months,
- chronic.
Acute gonorrhea is characterized by an acute onset, a clinic of urethritis, endocervicitis, bartholinitis, etc. A woman is worried about itching in the urethra, pain at the beginning of urination and frequent urge to it. Sometimes patients complain of vaginal discharge, rarely - pulling pains in the lower abdomen.
Sometimes there are forms of gonorrhea that are not associated with the genitals: gonorrhea of the rectum, gonococcal lesions of the oral cavity, pharynx, larynx, eyes, kidneys, gonococcal arthritis, endocarditis, etc. Damage to the oral cavity, pharynx, larynx is most often the result of oral sex and usually associated with gonorrhea of the genitourinary system.
With gonococcal stomatitis clinical manifestations occur 2 days after infection. Patients begin to be disturbed by dry mouth, burning of the lips and tongue, in the future - increased separation of saliva containing mucopurulent impurities, sometimes bad breath. The mucous membranes of the oral cavity are painful; if the pharynx is affected, complaints of painful swallowing appear.
For gonorrhea of the rectum, infection of which often occurs during anal sexual intercourse, women experience painful defecation, pain and itching in the anal region, and purulent bloody discharge from the anus.
chronic gonorrhea- This is a sluggish disease lasting more than 2 months. Fresh torpid gonorrhea is an asymptomatic disease, its manifestations are insignificant or absent.
With fresh gonorrhea, it is possible to detect gonococcus in smears.
Fresh gonorrhea, in turn, is divided into:
sharp,
- sharpen
- torpid.
Features of the course of gonorrhea
Currently, there are a number of features of the course of gonorrhea, namely, an increase in the frequency of low-symptomatic or asymptomatic gonorrhea. Women with torpid or asymptomatic gonorrhea usually continue sexual life, unaware of their disease, and spread the infection. In smears, the presence of gonococci is determined.Gonorrhea often occurs as a mixed infection, combined with trichomoniasis, chlamydia, mycoplasmosis, etc.
According to the localization of the process, they distinguish:
Gonorrhea of the lower genitourinary apparatus: include gonorrhea of the urethra, paraurethral passages, large glands of the vestibule of the vagina, cervix;
- gonorrhea of the upper part of the genital apparatus - ascending: gonorrhea of the body of the uterus, tubes, ovaries and peritoneum.
gonorrheal urethritis- this is acute urethritis, one of the frequent manifestations of gonorrhea. However, in women, it manifests itself with few symptoms due to the wide and short urethra: slight pain and burning sensation during urination. With chronic urethritis, there are even fewer complaints, sometimes there is frequent urination.
Gonorrheal endocervicitis- in the acute stage, dull pains in the lower abdomen and mucous or purulent discharge from the vagina are disturbing.
Gonorrheal bartholinitis- less often infected with gonococcus, when the excretory duct is infected, the outflow from the gland can be disturbed and a false or sometimes true abscess is formed. In this case, the gland increases in size, is sharply painful, and the temperature may rise.
Gonorrheal vulvitis It happens in adult women secondary, which is associated with irritation of the mucous membrane of the vestibule with flowing secretions and can be manifested by itching, burning in the vulva.
Gonorrheal proctitis most often develops secondary due to leakage into the rectum of discharge from the vagina or urethra or due to anal sex. Gonococcus affects not only the rectal mucosa, but also the deeper layers of the rectal wall, leading to infiltrates and abscesses. Patients are concerned about pain and burning in the anus, painful urge to defecate.
It is necessary to take smears from the urethra and cervical canal to confirm the diagnosis. The absence of gonococcus in smears does not confirm the absence of the disease; various methods of provocation are used to detect gonorrhea.
ascending gonorrhea It is customary to call inflammation of the internal genital organs located above the internal os of the uterus (the body of the uterus, fallopian tubes, ovaries, pelvic peritoneum). The spread of infection is facilitated by menstruation, especially when hygiene rules are not observed (for example, sexual activity during menstruation), the postpartum and post-abortion periods, intrauterine manipulations with unrecognized gonorrhea of the lower genitourinary system, as well as the weakening of the body's defenses as a result of hypothermia, physical overvoltage and etc.
Gonorrheal endometritis occurs as a result of the entry of gonococci into the uterine cavity; if infection occurs during menstruation, then gonococci immediately enter the basal layer of the mucous membrane. The disease begins with chills, fever, malaise, sharp pains in the lower abdomen and purulent discharge from the uterus. Often there are symptoms of intoxication - dry tongue, frequent pulse.
After 3-4 months, inflammatory changes in the endometrium disappear, and the endometritis becomes chronic with damage to the uterine muscle. This is usually manifested by constant pain in the lower abdomen, profuse watery or mucopurulent discharge, painful periods, various disorders menstrual cycle.
Gonorrheal inflammation of the appendages is obtained as a result of the passage of infection through the tubes to the ovaries. When the tube becomes inflamed, purulent contents appear in its lumen, the tube is sealed, its patency is disturbed, it takes the form of a retort - pyosalpinx, saktosalpinx.
Pathogens, getting into the follicle, contribute to the formation of an abscess, which sometimes extends to the entire ovary. The outcome may be recovery, but more often the tube and ovary turn into saccular formations, which, under adverse conditions, can burst, which will lead to inflammation of the peritoneum.
Gonorrheal pelveoperitonitis occurs as a result of gonococcus entering the peritoneum. It runs very fast: heat body, chills, pain in the lower abdomen, stool retention, flatulence, difficulty urinating.
The acute period lasts about a week, and then turns into a chronic one, which lasts another 3-6 weeks.
Provocation in gonorrhea
There is an artificial exacerbation of the inflammatory process in order to detect gonococci - a provocation in gonorrhea.Physiological provocation is the taking of smears for bacteriological examination on the days of menstruation, after childbirth and after abortion. An increase in secretion during provocation contributes to the "washout" of gonococci from the depth of the glandular passages and increases the frequency of their presence in smears. Artificial provocation of the inflammatory process is achieved by biological, thermal and chemical provocation.
Biological provocation consists in a single intramuscular injection of gonovaccine (500 million microbial bodies).
Thermal provocation is carried out using inductothermy with a vaginal electrode or 4-5 mud vaginal tampons.
Chemical provocation consists in treating the mucous membranes of the urethra, rectum with a 1% solution, and the cervical canal with a 5% solution of silver nitrate or Lugol's solution on glycerin.
After applying these methods, swabs are taken after 24.48 and 72 hours.
S. Trofimov
Read also:
|
1. Gynecological examination.
2. Smears for gonorrhea and trichomoniasis.
3. Oncocytology.
4. Fluorography.
5. Blood on RW.
6. Blood for Rh and group, if 1 pregnancy is interrupted.
7. ultrasound.
8. Analysis of feces for worm eggs.
Direct preparation of a woman:
1. cleanse the intestines and bladder;
2. shave off the hair from the pubis and external genitalia;
3. lay the woman on a gynecological chair covered with a sterile diaper;
4. treat the external genital organs with a solution of 1% iodonate;
5. put sterile shoe covers on the woman, put a sterile diaper on her stomach;
6. put on a clean dressing gown, apron;
7. wash your hands in one of the ways;
8. put on a sterile gown, sterile mask, sterile gloves;
9. cover the sterile table, arrange the instruments in the following order:
Ø metal urethral catheter
Ø injection syringe
Ø vaginal mirrors
Ø straight forceps and curved forceps
Ø bullet tongs
Ø uterine probe
Ø Gegar expanders from #3 to #14
Ø curette for removal of the fetal egg No. 6.4,
Ø abortion collets
Anesthesia: intravenous anesthesia.
Main stage:
After exposing the cervix in the mirrors, the midwife stands to the right of the woman, fixes the lower mirror with her right hand, and holds the upper mirror with her left. After fixing the neck with bullet tongs, the upper mirror is removed
1. after the operation, lubricate the cervix with a solution of iodine 5%,
2. put an ice pack on the lower abdomen.
3. dynamic monitoring of the state of the woman in labor:
Ø complaints,
Ø blood pressure measurement,
Ø pulse characteristic,
Ø coloration of the skin,
Ø discharge from the genital tract.
Taking swabs for gonorrhea using the combined provocation method.
Indications: To detect chronic gonorrhea, various methods of provocation are used in all women with chronic inflammatory diseases and menstrual dysfunction.
provocation methods.
Ø Chemical method: lubrication of the urethra to a depth of 1-2 cm with 1% silver nitrate solution; mucous membrane of the cervical canal with a 3% solution of silver nitrate to a depth of 1-1.5 cm.
Symptoms of gonorrhea in men
| gonorrheal urethritis - | The most common symptom is inflammation of the urethra - Inflammation is accompanied by a number of symptoms: | |
| Prostatitis- inflammation of the prostate gland | As a rule, it occurs a few days after the onset of gonococcal urethritis. Gonococcal infection reaches the tissues of the prostate via an ascending route through the urethra. Prostatitis is characterized by a number of symptoms:
|
Symptoms of gonorrhea in women
| Symptoms of gonorrhea in women usually appear during the next period from the moment of infection. More often this disease is manifested by symptoms of vulvovaginitis and urethritis. | ||
| gonorrheal urethritis | Gonococcal urethritis has a number of symptoms similar to urethritis in men:
|  |
| Vulvovaginitis - inflammation of the mucous membrane of the vulva and vagina | It often manifests itself a few days after infection or during menstruation. Signs characteristic of gonococcal vulvovaginitis:
|
|
Complications of gonorrhea
As a rule, timely and adequately carried out treatment leads to a complete recovery of the patient. However, in some cases, the infectious process can progress, moving upward through the urinary and genital tract. In this case, lesions of the relevant organs occur, which can threaten the life, fertility and health of the patient.Among women, the development of such complications as:
Gonorrheal bartholinitis- inflammation of the Bartholin gland located in the posterior third of the labia majora and having excretory ducts that open into the external environment at the base of the labia majora. Their inflammation is accompanied by a sharp pain, a pronounced inflammatory reaction and swelling of the corresponding area.
Gonococcal endometritis- the promotion of gonococcal infection in an upward direction along the genital tract can lead to infection of the uterine mucosa. This complication may be accompanied by pain in the lower abdomen, profuse bloody and purulent discharge from the genital tract, and a sharp increase in body temperature. This condition requires immediate seeking help from a gynecologist, as it threatens the life of the patient.
Gonorrhea fallopian tubes - when the infection advances from the uterine cavity in the lumen of the fallopian tubes, inflammation of the mucous membrane of the fallopian tubes occurs. This process is accompanied by pain in the lower abdomen, pain during sexual intercourse, infertility and menstrual irregularities.
Gonorrheal peritonitis- inflammation of the pelvic peritoneum is possible with the penetration of gonococci into abdominal cavity. This state accompanied by a rise in body temperature, pain in the lower abdomen. An ultrasound examination reveals the presence of fluid and abscesses in the pelvic cavity can be visualized.
With an inflammatory process in the female genital organs of the small pelvis, infertility may develop. This can be caused by a number of factors: the formation of adhesions in the pelvic peritoneum, tubal obstruction, chronic inflammation of the endometrium of the uterus, menstrual irregularities.
If any of the above complications occur, treatment is possible only in a hospital under the supervision of the attending gynecologist. Unfortunately, with any of the listed complications (the blood of gonococcal bartholinitis), there is a high probability of developing female infertility.
Among the male population infected with gonorrhea, the following complications are possible:
Epididymitis- inflammation of the epididymis. This appendage is an enlarged vas deferens in which semen accumulates before being expelled during ejaculation.
Inflammation of the vas deferens can lead to their subsequent obstruction and the development of male infertility.
Laboratory diagnosis of gonorrhea - rapid test, smear microscopy, immune fluorescence reaction (RIF), enzyme immunoassay (ELISA), complement fixation reaction (Borde-Gangu reaction), polymerase chain reaction (PCR), ligase chain reaction (LHC), culture method, provocative tests.
Features of gonococcus
Gonorrhea or gonorrhea is one of the most common sexually transmitted diseases in the world. Gonorrhea is caused by a specific bacterium gonococcus. Gonococcus is an acid-resistant microorganism, that is, its cell wall is able to protect it from exposure to the normal acidic environment of the female genital tract. The peculiarity of the cell wall of the gonococcus is such that it is able to form antibodies of various classes in the blood (IgG, IgM, IgA). Moreover, gonococcus forms a special state of the human body, in which re-infection occurs more easily than the first. High titers of antibodies against gonococcal infection can remain in the blood for quite a long time. Gonorrhea can be acute or chronic. Chronization of acute gonococcal infection occurs when the immune system is not functioning properly. From the point of view of diagnosis, the identification of chronic gonorrhea is of great difficulty. It should be remembered that in last years gonorrhea often proceeds, hidden, there are many stable forms. In this situation, high-quality and comprehensive laboratory diagnosis of gonorrhea plays an invaluable role. Currently, for the diagnosis of gonorrhea, the most widely used methods are microscopic examination of a smear, culture and immunofluorescence reaction. The polymerase chain reaction method is also being used more and more widely.
So, let's consider the main types of laboratory diagnostics that are currently used to diagnose gonorrhea.
Methods by which it is possible to identify gonococcus:
- rapid tests (immunochemical methods of counter electrophoresis)
- bacteriological (cultural, bacteriological inoculation)
- smear microscopy of urinary tract
- immune fluorescence reaction (RIF)
- linked immunosorbent assay
- serological method (Borde-Gangu reaction or complement fixation reaction)
- methods of molecular genetic diagnostics (ligase chain reaction, polymerase chain reaction)
- provocative tests (to detect chronic infection)
Rapid tests - sensitivity, specificity, advantages and disadvantages of the method
Rapid tests are simple, they can be used at home in an emergency. They look like a pregnancy test. The reading of the results is exactly the same: one strip - the result is negative (no gonorrhea infection), and two strips - the result is positive (presence of gonorrhea infection). Rapid tests for gonorrhea are quite sensitive and specific. In this case, the method of counter electrophoresis is used. When carrying out such a counter electrophoresis, the antigens of the gonococcus and the antibodies contained in the special serum merge. As a result, an antigen + antibody complex is formed, which stains the second strip of the rapid test. However, you should not completely rely on the result of such express tests, since an antigen + antibody complex may form not with a gonococcus, but with another similar microorganism. In this case, a positive result will be obtained, but there is no gonorrhea. Or in the opposite case, when the concentration of antigen + antibody complexes is too low, and the result will be negative, but gonorrhea is present. If you suspect gonorrhea infection, you should be examined using more accurate diagnostic methods.
Microscopy of a smear of the discharge of the genitourinary organs - sensitivity, specificity, advantages and disadvantages of the method
How and when to take a smear? Smear staining methodsFor examination under a microscope, a detachable urethra, vagina, cervical canal, and rectum are taken. At the same time, before taking biological material, it is necessary to stop taking antibiotics at least 4-5 days in advance, and refrain from urinating for 3-4 hours before sampling. Smears are taken in duplicate. The first copies of these smears are stained with methylene blue, brilliant green. The most common staining method is methylene blue. At the same time, gonococci are stained in an intense blue color against the background of a pale blue leukocyte cytoplasm. Gonococci can be inside leukocytes or outside. Brilliant green staining gives a stronger contrast between leukocytes and gonococci, staining gonococci more intensely. Both of these types of coloring serve as indicative, revealing cocci in general. Therefore, after detecting cocci, in a smear stained with methylene blue or brilliant green, the second copy of the smear is stained according to the Gram method. As a result of this method, gonococci turn bright pink. The diagnosis of gonorrhea is made only when gonococci are found in a Gram-stained smear. Methylene blue stain is used to better identify cocci, and Gram stain is used to differentiate gonococci.
Sensitivity, specificity of the method. Advantages and disadvantages
The sensitivity of this method is very variable and ranges from 40-86%. This variation is due to the fact that there are various subspecies of gonococci, some of which are not stained by this method. The specificity of the method is quite high and reaches 92%. Also, when studying stained smears under a microscope, the qualification of a laboratory assistant is of decisive importance. This method is widespread due to its availability, simplicity, speed and low cost.
If gonococci are detected in a Gram-stained smear, other diagnostic methods are not advisable. Bacteriological cultures can be performed to detect sensitivity to antibiotics.
Bacteriological method (cultural) - sensitivity, specificity, advantages and disadvantages of the method
The bacteriological or cultural method is considered to be the "gold standard" in the detection of various infectious diseases, including gonorrhea. The essence of this method is that the discharge of the mucous membranes of the genitourinary tract is sown on special nutrient media and placed in an incubator with conditions suitable for the growth of gonococcus colonies (high carbon dioxide content of 20-23%, temperature 37 ° C). A special medium is used on which gonococcus grows best. After some time (3-7 days), they check whether the colonies of gonococcus have grown. If the colonies have grown, then this is the undoubted result of the presence of gonococcal infection in the body. A huge plus of this method is almost one hundred percent specificity and the absence of false positive results. A false positive result is a result in which microorganisms are detected where they are not present. The sensitivity of the cultural method is also high and varies between 90-98%.
To date, standardized media are used, which give excellent results. A definite disadvantage of the cultural method is its duration. However, the duration pays off with accuracy, which is especially important when detecting a chronic persistent infection.
Immune fluorescence reaction (RIF) - sensitivity, specificity, advantages and disadvantages of the method
The immune fluorescence reaction requires careful training of personnel, the availability of a fluorescent microscope and high-quality reagents. When carrying out this method, a smear is also taken from the mucous membranes of the genitourinary tract and stained with special dyes that fluoresce (glow) under a microscope. The accuracy of staining of gonococci is achieved by an immune reaction of a dye containing antibodies to gonococcus. That is, dye-labeled antibodies bind to antigens on the surface of the gonococcus and form immune complexes. These immune complexes are visible under the microscope as luminous circles. The method of immune fluorescence reaction allows to detect gonorrhea on early stage diseases, as well as to identify gonorrhea if it occurs in conjunction with other urinary tract infections (for example, syphilis or trichomoniasis). The immune fluorescence reaction is sensitive to gonococcus - 75-80% and highly specific. However, the use of this method is limited by a small number of specialists, as well as the high cost of equipment and reagents. At the same time, the method of immune fluorescence allows to conduct a study within 1 hour, which is its undoubted advantage. Enzyme immunoassay (ELISA) - sensitivity, specificity, advantages and disadvantages of the method
ELISA for the detection of gonococcus is not widely used. This method has an advantage and a disadvantage at the same time. During enzyme immunoassay, the presence of antibodies to gonococcus is detected. In this case, it is possible to identify an already dead pathogen that is still in the body, since leukocytes did not have time to eliminate it. In this case, a positive result will be obtained, since the method cannot distinguish between dead gonococci and live ones. This is the minus of enzyme immunoassay for the detection of gonococci. And the advantage is the ability of the method to detect the presence of resistant forms of gonococcus, which are difficult to diagnose. Also, the indisputable advantages of the method include its non-invasiveness, that is, the absence of the need to take smears, since the enzyme immunoassay is carried out in a urine sample. The sensitivity of the enzyme immunoassay for the detection of gonorrhea is 95%, and the specificity is 100%. However, today enzyme immunoassay is used as an auxiliary diagnostic method in most cases.Serological method (complement fixation reaction, Borde-Gangu reaction) - sensitivity, specificity, advantages and disadvantages of the method
Of all the variety of serological methods, only the complement fixation reaction (RCC) is used to detect gonococcus, which, in relation to gonorrhea, bears the name of its developer - the Borde-Gangu reaction. To date, the method is auxiliary, but it is invaluable in identifying chronic gonorrhea, in which the cultural method gives negative results. It is in such rare cases that the Borde-Gangu reaction is used to diagnose gonorrhea.Methods of molecular genetic diagnostics - sensitivity, specificity, advantages and disadvantages of the method
What methods are classified as molecular genetics?
These methods include polymerase chain reaction and ligase chain reaction. The peculiarity of all methods of molecular genetic diagnostics is their exceptionally high sensitivity and specificity. However, the implementation of these diagnostic methods is complex, high-tech, requires specialized laboratories and highly qualified personnel. So, let's look at each method in more detail.
Polymerase chain reaction (PCR)
The sensitivity of the method reaches 99%, and the specificity is 95%. As a biological material for the polymerase chain reaction, the discharge of the mucous membranes of the genitourinary tract, as well as urine samples, can be used. Polymerase chain reaction is a highly accurate diagnostic method that can compete even with the "gold standard" - the cultural method. The advantage of the polymerase chain reaction is also the possibility of simultaneous determination of the presence of gonococci and chlamydia in the same biological sample. The polymerase chain reaction method is faster than the culture method. However, PCR diagnostics is quite expensive due to expensive reagents required for the reaction and complex expensive equipment.ligase chain reaction
The sensitivity of the ligase chain reaction exceeds that of the polymerase chain reaction, and the specificity reaches 99%. The ligase chain reaction is superior in its characteristics to the cultural method, but is not so widespread. This is due to the fact that specially equipped laboratories, highly qualified personnel and reagents are required. To date, ligase chain reaction is not even carried out in all major centers. However, its value is very high. The ligation chain reaction also allows detection of both gonococcus and chlamydia in the same biological sample. The duration of the ligase chain reaction is the same as that of the polymerase chain reaction, that is, a minimum of 3-4 hours, a maximum of 7-8 hours (depending on the equipment). As a biological sample, it is also possible to use urine or a smear from the mucous membranes of the genitourinary tract.
Provocation of gonorrhea - tests for the detection of chronic gonococcal infection
In what cases is it necessary to conduct provocative tests?In cases where the gonorrhea infection is neglected, has been subjected to inadequate treatment or repeated treatment with antibiotics, in a word, when the process is chronic, difficulties arise in the diagnosis of gonorrhea. In such cases, the gonococcus acquires a dense cell wall, which is called cyst, and goes into the deep layers of the genitourinary tract (up to the muscle layer). Inside the cells of the deep layers of the genitourinary tract in this state of the cyst, the gonococcus is able to live for a long time, and under favorable conditions for it, it will again enter the mucous membranes and cause a recurrence of gonorrhea. The course of such chronic gonorrhea is very long and persistent, and a smear or scraping does not reveal the presence of a microorganism, since the gonococcus is hidden deep in the tissues of the urinary tract.
To cause the appearance of gonococcus on the mucous membranes of the genitourinary tract, if it is present in the body in the form of a cyst, provocative tests are used. Provocation promotes the release of gonococcus on the mucous membranes of the genitourinary tract, and then it can be detected in a smear or bacteriological culture.
| Types of provocative tests | Methods of carrying out |
| chemical provocation | At the same time, the urethra is lubricated with 1-2% solution of silver nitrate, the rectum with 1% Lugol's solution in glycerin and the cervical canal (cervical canal) with 2-5% solution of silver nitrate. After one day (24 hours) from the moment of the provocation, a scraping-smear of the separated mucous membranes of the urethra, cervical canal and rectum is taken. Such scrapings-smears from the mucous membranes are taken 48 and 72 hours after the provocation. Three days after the provocation (72 hours), a bacteriological culture of the detachable mucous membranes of the genitourinary tract is also performed. In all scrapings-smears, the presence or absence of gonococcus is microscopically detected. Bacteriological culture allows you to identify the presence of a microorganism, and its sensitivity to antibiotics. |
| biological provocation | The essence of this type of provocation is the introduction of a gonococcal vaccine intramuscularly or at the same time a gonococcal vaccine is administered in combination with an immune system stimulant - pyrogenal. After such a provocation, scraping swabs are also taken after 24, 48 and 72 hours from the moment of the test. 72 hours after the introduction of biological provocateurs, a bacteriological culture is taken. In smears-scrapings and bacteriological culture, the presence or absence of gonococci is detected. |
| thermal provocation | During thermal provocation, a physiological procedure of diathermy or inductothermy is performed. In this case, diathermy is carried out for three consecutive days according to the following scheme - 30 minutes on the 1st day, 40 minutes on the 2nd day, 50 minutes on the 3rd day. Inductothermia is also carried out for three consecutive days for 15-20 minutes daily. Scrapings-smears of the separated mucous membranes of the genitourinary tract for bacteriological examination under a microscope are taken daily 1 hour after the physiotherapeutic procedure of diathermy or inductothermy. |
| physiological provocation | It does not require any special preparation and uses swabs on the days of menstruation. This provocation is natural, because during the period of menstruation there is a decrease in the immune defense of the woman's body. |
| alimentary provocation | This type of provocation is based on the use of salty, spicy food together with alcohol. Acceptance of incompatible products (for example, pickles with milk and beer, etc.) is welcome for maximum information content of the provocation. At the same time, after the provocation, scrapings-smears are taken after 24.48 and 72 hours and bacteriological culture after 72 hours, counting from the moment of the test - provocation. |
| combined provocation | Includes two or more provocative tests within one day. Scrapings-smears and bacteriological culture are carried out in the same way as when conducting each sample separately. That is, the discharge of the mucous membranes of the genitourinary tract is taken after 24, 48 and 72 hours, and bacteriological culture of the discharge is carried out 72 hours after the combined test. |
gonorrhea treatment
Gonorrhea is an infectious disease, and therefore the treatment is based on the use of antibacterial drugs. Basic principles of gonorrhea treatment:
- Adequate treatment is possible only under the supervision of the attending gynecologist, urologist or venereologist.
- Treatment should be preceded by a full-fledged diagnosis, including laboratory tests (microscopic, bacteriological smear examinations), instrumental studies (ultrasound of the pelvic organs to exclude possible complications).
- Before prescribing treatment for gonorrhea, it is necessary to conduct laboratory tests for other sexually transmitted diseases - chlamydia, syphilis, mycoplasma, ureaplasma. As a rule, in our time, infection with only one venereal disease is rare - more often a bouquet of several infections is diagnosed. Only by identifying all concomitant infections, the attending physician will be able to prescribe adequate treatment.
- Independently start treatment, make your own changes to the treatment regimen and its duration, as well as interrupt it. This can lead to the development of chronic gonorrhea resistant to certain types of antibiotics.
- Treatment should be accompanied by a diagnosis of gonorrhea in all sexual partners.
- During the period of treatment, any sexual contact should be excluded.
- After the treatment, laboratory control of cure is mandatory. Only this study can confirm or refute the fact of recovery. The absence of purulent discharge or signs of inflammation does not mean the patient is cured.
We provide standard regimens used in the treatment of fresh gonorrhea:
- Ceftriaxone 0.25 g
- Ciprofloxacin 0.5 g. Inside once
- Ofloxacin 0.4 g. Inside once
- Lomefloxacin 0.6 g. Inside once
Treatment of chronic and latent forms of gonorrhea:
The use of antibiotics should be preceded by the use of a special vaccine, which is administered intramuscularly. This vaccine contains fragments of gonococci and contributes to the formation of specific immunity to gonococcal infection. The vaccine is administered in courses of 6-8-10 injections with a single dose of 300-400 million microbial bodies and a total course dosage of 2 billion microbial bodies.
Along with vaccination, non-specific simulation of immunity is performed using medications: pyrogenal, streptokinase, ribonuclease.
After stimulation of the immune system and provocation, it is possible to prescribe antibacterial drugs according to standard treatment regimens.
Treatment of gonorrhea during pregnancy
The state of pregnancy imposes a number of restrictions on the use of immunostimulating and antibacterial drugs. However, the preference in treatment in this case is given to the following antibiotics: ceftriaxone, erythromycin, spectrinomycin, chloramphenicol.
Treatment of pregnant women is possible only under the strict supervision of the attending gynecologist.
Prevention of gonorrhea
The only reliable means of preventing gonorrhea is sexual contact with partners who have been diagnosed without this disease or who have used a condom. In the event that these conditions are not met, then the likelihood of infection with gonorrhea with each new sexual contact remains.Among pregnant women, preparation for childbirth includes testing for the presence of sexually transmitted diseases.
Also, all newborns after birth are instilled with antiseptic drugs that destroy gonococcus. These measures help to minimize infection of the newborn.
The use of individual hygiene products, underwear and towels will eliminate the household route of infection.
How long does gonorrhea treatment take?
Gonococcal infection, or gonorrhea, is a disease that has various clinical forms. Therefore, it is rather difficult to unambiguously answer how long the treatment of the patient will last. It depends on a number of different factors. Depending on the characteristics of the course of the disease in a particular patient, treatment can be reduced to a single injection of an antibiotic or drag on for several months. The main factors affecting the duration of treatment are:
- Features of the pathogen. Each microorganism, like each person, has its own unique characteristics. In particular, strains with different sensitivity to antibiotics are distinguished among microorganisms. If a microbe has come into contact with a particular drug but has not been destroyed, then there is a high probability that it will no longer be susceptible to the same treatment in the future. Such strains are called antibiotic resistant. Currently, among gonococci, they make up from 5 to 30% of all cases, depending on the locality ( countries, cities). Thus, the treatment of a susceptible strain will last less than a resistant one. Doctors do not always prescribe an analysis for sensitivity to certain drugs ( antibiogram). Because of this, the first course of antibiotic treatment may not be effective, and treatment will be delayed.
- Localization of infection. In most cases, gonorrhea occurs in the form of gonococcal urethritis ( inflammation of the urethra). In this case, her treatment will consist of a single injection of ceftriaxone or cefotaxime ( less than other drugs). In more than 95% of patients, this is enough for a complete cure. If the gonococcal infection is localized in atypical places ( mucous membrane of the anus, pharynx, conjunctiva of the eyes), then along with the systemic use of an antibiotic, a local one will also be required. Then the treatment may be delayed. The most difficult to treat is disseminated gonococcal infection, when the pathogen enters the bloodstream and spreads to various organs.
- Compliance with doctor's orders. With gonorrhea, this factor is of great importance. The fact is that interrupting treatment without laboratory confirmation of a cure can lead to serious consequences. First, the infection can acquire a chronic course. After that, it will be necessary to artificially cause an exacerbation in order to cure it. Secondly, the microbial strain of a given patient may develop resistance to the drug with which treatment was started. Then in the future, for a second course, you will have to select a new antibiotic. Finally, thirdly, the patient, who believes that he has recovered, begins to lead an active sexual life. This leads to infection of his sexual partners. As a result, the infection circulates in a vicious circle, and it becomes even more difficult to get rid of it.
- Presence of other infections. Often gonorrhea is combined with urogenital chlamydia or trichomoniasis. This is due to the fact that the first infection weakens the protective resources of the mucous membrane and, as it were, "opens the gate" for the second. For a complete cure, accordingly, a longer course of antibiotics is required.
- Presence of complications. Sometimes gonorrhea does not show acute symptoms, but over time leads to a number of unpleasant complications. In men, this is balanoposthitis, acute and chronic prostatitis, and in women, gonococcal bartholinitis and salpingitis. These complications, as a rule, complicate the treatment process and the patient has to spend more time and effort on it.
- Body condition. In immunocompromised patients, as well as in women during pregnancy, gonococcal infection may be more aggressive. It spreads faster and easier, often accompanied by complications. Because of this, the treatment of such patients, as a rule, lasts longer.
To minimize the duration of treatment for gonorrhea, regardless of its form, you need to follow a few simple rules:
- compliance with the doctor's instructions regarding the use of antibiotics ( terms, doses, frequency of use);
- simultaneous examination and treatment of all sexual partners of the patient;
- abstinence from sexual intercourse until a control bacteriological analysis;
- testing for other infections.
Can I make love while I'm being treated for gonorrhea?
As you know, gonococcal infection, or gonorrhea, most often affects the genitourinary system. In men, it usually causes anterior or posterior urethritis ( inflammation of the urethra), and in women also vulvovaginitis. In addition, gonorrhea is a highly contagious infection that is easily transmitted through sexual contact. It does not leave immunity after curing, so a person can easily get sick again. Based on this, during the treatment of gonorrhea, the patient should refrain from any sexual contact, as this can lead to serious consequences. Sexual contact during treatment is dangerous for the following reasons:
- Spread of infection. Until the end of the course of treatment and the conduct of control tests, the patient poses a threat in terms of the spread of infection. Despite the fact that 1 injection of an antibiotic is often enough for recovery, no doctor can say for sure whether gonorrhea is cured after this. Thus, there is a chance that the patient will simply infect his sexual partner. This is also dangerous because after the end of treatment ( obtaining a negative result of the control analysis) he may come into contact with that partner again and become infected again. Thus, the infection will, as it were, circulate between two people. If they have more than one sexual partner, gonorrhea will begin to spread in society.
- Re-infection. Reinfection is dangerous through sexual contact with a partner who also has gonorrhea. In this case, the patient under treatment receives a new portion of bacteria. Unlike their own, dying under the influence of an antibiotic, these gonococci are stronger. When the course of treatment is over, they will be able to multiply again, and recovery will not occur, although the patient has completed the full course of treatment. In addition, it is possible to become infected with another strain of gonococci. If he is not receptive to the started treatment, then you will have to repeat all the tests and change the drug.
- Chronic infection. Re-infection contributes to chronic infection. If gonococci survive after a course of antibiotics, they will not make themselves felt for a long time. Many patients consider this a sufficient confirmation of recovery and do not conduct a control analysis. Then, after some time, gonorrhea will worsen again, its treatment will be much longer and more difficult, and the risk of complications will also increase.
- The development of antibiotic resistance. antibiotic resistance ( resistance to certain antibacterial drugs) is one of the major problems in modern medicine. Among gonococci, it is recorded in approximately 5 - 15% of cases. If a patient during the treatment period infected a sexual partner with gonorrhea, then it is highly likely that in the future his partner will develop a disease that is resistant to the drug that was used in the treatment. After all, the microorganism has already been in contact with this antibiotic, and genetic rearrangements in gonococci occur quite quickly. As a result, after some time, such patients have to spend money on stronger antibiotics in order to still defeat the resistant strain and be cured.
- Development of complications. During sexual intercourse, the spread of gonococcal infection is possible not only to the mucous membrane of the genitourinary tract, but also to other anatomical areas. Both the partner of the patient and the patient himself may in the future give a number of complications or atypical forms of gonorrhea. We are talking about anorectal and pharyngeal gonorrhea. In addition, during unprotected intercourse, microtrauma of the mucous membrane often appears. Through such defects, the infection can enter the bloodstream and spread throughout the body.
- Infection with other infections. In medical practice, patients with several concomitant genitourinary infections are often encountered. Their treatment requires more careful selection of drugs, takes more time and is much more expensive. Sexual contact during treatment for gonorrhea can not only negate the treatment itself, but also lead to an “exchange” of infections. As a result, the patient may become infected with chlamydia, trichomoniasis, or other common diseases.
If sexual contact did take place during the treatment period, this must be reported to the attending physician. In this case, the course of antibiotic treatment may be extended. Additional tests for other urinary tract infections may also be needed. At the same time, a sexual partner is found, examined and preventive treatment is started.
Safe sex becomes only after a special control analysis. It is carried out on the 7th - 10th day after the end of treatment. If bacteriological culture does not give growth of gonococci, and the patient does not have any symptoms of the disease, he is considered healthy.
Is it possible to get pregnant after gonorrhea?
Gonococcal infection in women most often occurs without severe symptoms and is localized in the urethra. Therefore, neither during the illness, nor after the end of treatment, nothing usually prevents the onset of pregnancy. reproductive organs are generally unaffected by infection. However, in rare cases, a number of serious complications may develop that may affect the reproductive function of a woman. First of all, we are talking about a long-term chronic infection, the treatment of which was not given enough time. Problems with conceiving a child after gonorrhea can occur in the following cases:
- incomplete recovery. Gonococcal infection with improper treatment or premature termination can turn into chronic form. In this case, there are no symptoms of the disease, but the pathogen still remains on the mucous membrane of the urinary tract. The problem is that his presence creates unfavourable conditions inside the vagina and uterus. The chance of getting pregnant is reduced partly due to insufficient lubrication, partly due to low mobility and too rapid death of spermatozoa after ejaculation ( ejaculation). In addition, the chance of attaching chlamydia or trichomoniasis increases, which also reduce the likelihood of successful fertilization. In this case, no structural changes in the genitourinary system may be observed. The detection of such a latent infection and proper treatment usually return reproductive function.
- Gonococcal salpingitis. Salpingitis is called inflammation of the fallopian tubes. It can occur in the acute course of infection with pronounced symptoms. During the period of illness, changes may appear in the mucous membrane lining the fallopian tubes. As a result, after a course of treatment, there is no more gonococcal infection, but the patency of the fallopian tubes for the egg is reduced. The stronger the inflammatory process was, and the longer the disease was ignored, the greater the chance of losing reproductive function. In severe cases, changes at the level of the fallopian tubes are irreversible. In addition to sterility, the risk of ectopic pregnancy increases.
- Gonococcal pelvioperitonitis. It is the most severe local complication of gonococcal infection, in which the inflammatory process spreads to the pelvic peritoneum. Then the treatment can take quite a long time. During this period, the sensitive peritoneum forms adhesions. These are connective tissue bridges that do not disappear after the inflammatory process subsides. They deform the organs to which they are attached, and disrupt their normal operation. Thus, after this complication, a woman will have adhesive disease of the small pelvis, which in some cases can manifest itself as infertility. However, here the problem can usually be solved by surgical dissection of the adhesions.
- Complications of gonorrhea in a sexual partner. Even if a woman is completely cured of gonorrhea, this does not mean that her partner does not have the disease either. Genitourinary infections usually circulate between sexual partners unless treated concomitantly. In men, the disease is usually more severe. Without adequate treatment, it is possible to develop prostatitis, purulent urethritis, lesions of the glands and even testicles ( orchitis). Then seminal fluid for various reasons, it may simply not contain sperm, or they will be unable to fertilize the egg.
What are the discharges for gonorrhea?
Discharge from the urethra is a kind of "calling card" of acute gonorrhea. This symptom distinguishes it from most other genitourinary infections and is of great diagnostic value. In the acute course of the disease, it is the characteristic discharge that helps to suspect the correct diagnosis. Allocations with gonorrhea have the following characteristic features:
- In men, they usually appear 1 to 5 days after unprotected sexual contact with an infected person. Sometimes this period is extended up to 30 days ( depending on the state of immunity and the characteristics of the pathogen). In the chronic course of the discharge may not be for months.
- In women, the discharge is usually more meager even in the acute course of the disease.
- Outwardly, the discharge has a white-yellow color. Without appropriate treatment, after a few days they become white-green, which indicates impurities of pus.
- Most often, in men, the discharge appears in the form of a “morning drop”. This is a symptom in which a large drop of a mucopurulent mixture is released from the opening on the glans penis in the morning. In women, this symptom is absent due to a different anatomical location of the urethra.
- In an acute course, a lot of pus is formed in the urethra. Therefore, it can be mixed with the morning portion of urine in the form of flakes.
- In a chronic open course, discharge can be observed continuously for several months. At the same time, the daily volume is small - only 1 - 2 small drops.
- Discharge from gonorrhea has an unpleasant pungent odor that appears 2 to 3 days after the onset of the symptom itself. In women, the discharge may not be visible ( e.g. during menstruation). But the menstrual flow itself against the background of gonorrhea becomes more abundant and also acquires an unpleasant odor.
- In the acute course of the disease, discharge can be observed at night. This can be detected by small yellowish spots on the underwear.
- Discharge from the urethra urethra) are enhanced under certain conditions. Alcohol, spicy food, excess caffeine, sex, drug provocation can become such a provoking factor ( may be necessary to start treatment in a chronic course of the disease).
- Allocations in men are almost always accompanied by a burning sensation and moderate soreness.
- If left untreated, the discharge may decrease after 12 to 15 days. However, this sometimes only indicates the spread of infection up the urethra. Then in patients at the end of the act of urination, 1 - 2 drops of blood can be released, sometimes with impurities of mucus and pus. This indicates an unfavorable course of the disease, the risk of complications and the need for an urgent start of treatment.
- In rare advanced cases, as a variant of discharge, hemospermia is possible - streaks of blood in the seminal fluid during ejaculation.
With extragenital forms of gonococcal infection ( conjunctivitis, pharyngitis) are not so typical. They may appear as a whitish coating on the tonsils or accumulate around the edges of the eyelids in young children with blenorrhea.
In chronic latent course of the disease ( more characteristic of women) there may be no discharge at all. However, this does not mean that the disease has disappeared or the patient is on the mend. Under the influence of the provoking factors listed above, an exacerbation occurs, and discharge appears ( sometimes for the first time months after the infection itself).
Microscopic examination of secretions in gonorrhea shows the presence of the following components:
- epithelial cells;
- pathogen cells ( Neisseria gonorrhoeae) - diplococci located inside epithelial cells;
- slime;
- erythrocytes ( rarely, outwardly look like streaks of blood).
Can gonorrhea be cured at home?
In principle, the most common form of gonorrhea is gonococcal urethritis ( inflammation of the urethra) may well be cured at home. However, home treatment does not mean self-treatment. In any case, the patient must definitely visit a doctor and pass all the necessary tests. At home, he can directly undergo a course of treatment prescribed by a specialist. To treat gonorrhea at home, you must go through the following steps:
- Consultation of a dermatovenereologist. A symptom specialist may suspect gonorrhea and order appropriate laboratory tests. The patient himself, based only on his own complaints, may confuse gonorrhea with another genitourinary infection.
- Laboratory tests. As a rule, the doctor takes a swab from the mucous membrane of the urethra. Subsequently, the obtained material is inoculated on nutrient media in a microbiological laboratory. Obtaining a culture of gonococcus confirms the diagnosis. If necessary, the doctor also takes a smear from the mucous membrane of the rectum, conjunctiva or pharynx. With severe general symptoms ( temperature, general weakness, etc. The patient's blood is also taken for analysis. This is how the clinical form of the disease is determined.
- Home treatment. If the gonococcal infection is localized only in the urethra, the doctor prescribes the necessary antibiotic. Most often, only one dose is needed ( injection or tablet). Less commonly, the course lasts 1 - 2 weeks. The patient independently treats the mucous membrane and skin with disinfectant solutions ( installations in the urethra in men, in the vaginal cavity in women). In this case, hospitalization is not required.
- Control analysis. 7 to 10 days after the end of antibiotic treatment, the patient takes a smear again. If the result is negative, he is considered healthy. Women may need another follow-up smear after their second menstrual cycle.
blindness, and sometimes even a threat to life. In this regard, proper care can only be provided by doctors in a hospital setting.
Self-treatment of gonorrhea at home without contacting a specialist most often ends with a chronic infection. Neither means traditional medicine, nor self-selection of an antibiotic usually does not completely eradicate the infection. They can only remove the symptoms of the disease. Then the patient believes that he is cured, and no longer goes to the doctor. The problem is that in the future such neglected gonorrhea will worsen again and again, its treatment will require more time and effort, and the risk of complications will greatly increase.
Is gonorrhea transmitted through a condom?
Currently, condoms are the easiest and most affordable way to protect against sexually transmitted diseases. There are many studies proving that this remedy is effective against all bacterial and most viral infections. The gonococci that cause gonorrhea are bacteria. They are relatively large ( compared to viruses) and are unable to penetrate the microscopic pores of the latex from which the condom is made. Thus, it can be argued that gonorrhea is not transmitted through a condom. However, there are two important exceptions that the patient needs to be aware of. First, condoms are highly effective in protecting against gonorrhea only when used correctly. In most cases, people who claim to have been infected through a condom simply did not know how to use it correctly.
To achieve maximum protection against infection, the following rules must be observed:
- Compliance with the expiration date. Each condom package has an expiration date. If it is exceeded, then the lubricant inside begins to dry out, and the latex loses its elasticity. Because of this, when used, the risk of rupture increases. Even if the condom does not break, microcracks will appear in it, which are larger than normal pores. Through them, gonococci can already penetrate.
- Use with any sexual contact. Gonococci can affect not only the mucous membrane of the urinary tract, but also other tissues ( though less likely). Therefore, a condom should also be used for orogenital and anogenital contact. However, in these cases, the risk of its rupture rises to 3-7%.
- Proper opening of the package. The dense-looking condom packaging is actually easy to open with your hands. To do this, it is necessary to tear it from the side of the ribbed surface or in a specially indicated place. Opening with sharp objects ( knives, scissors) or teeth can cause accidental damage to the latex itself.
- Proper donning. When putting on a condom, the penis must be in a state of erection. Otherwise, it will subsequently slip and form folds, and during intercourse the risk of rupture will increase.
- Air release. When putting on a condom, you need to pinch a special cavity at its top with your fingers so that air comes out of it. This cavity is designed to collect semen after ejaculation ( ejaculation). If you do not release air from it in advance, there is a high risk of rupture.
- Use throughout the act. The condom should be put on at the stage foreplay, before the first contact of the partner with the infected mucous membrane occurs. After the end of intercourse, the condom is thrown away, and the penis is washed with warm water to remove the remnants of semen.
A condom does not protect against the following forms of gonococcal infections:
- gonococcal conjunctivitis ( inflammation of the mucous membrane of the eye);
- pharyngitis ( damage to the mucous membrane of the pharynx);
- skin lesion.
In general, the correct use of a condom gives almost one hundred percent guarantee of protection against gonorrhea. Nevertheless, doctors recommend that patients with this disease refrain from sexual intercourse until complete recovery.
Is gonorrhea transmitted by kissing?
Gonococcal infection is most often localized in the urethra ( urethra) and on the mucous membrane of the genital organs. In this case, the transmission of the disease through a kiss is impossible, since the pathogen is neither in the oral cavity nor in saliva. However, there are also atypical forms of this disease, in which other organs and systems are also affected. One of these forms is pharyngeal gonorrhea or gonococcal pharyngitis. With this disease, gonococci colonize the mucous membrane of the pharynx and, less often, the oral cavity. Then, with a kiss, it is theoretically possible to transfer the pathogen to a partner. However, the chance of such infection in practice is extremely small.
Transmission of pharyngeal gonorrhea through kissing is unlikely for the following reasons:
- Gonococci in the pharynx are in unusual conditions. The mucous membrane of the urethra, which differs in structure from the mucous membrane of the mouth and pharynx, is best suited for their reproduction. Because of this, the number of gonococci is smaller, they weaken, and the likelihood of infection is reduced.
- Human immunity also plays a significant role in this form of gonorrhea. The likelihood of infection is somewhat higher if the patient's immune system is weakened. In this case, the body does not fight well with the microbe, and the gonococci are activated. But for infection, immunity must be weakened in the second person who kisses the patient. Otherwise, the gonococcus simply will not take root on its mucous membrane.
- For gonococci, the mucous membrane of the pharynx is better suited than the oral cavity. With a kiss, infections localized above are more often transmitted.
How to treat gonococcal conjunctivitis?
Gonococcal conjunctivitis ( gonoblenorrhea) is a specific inflammation of the mucous membrane of the eyes caused by the microbe Neisseria Gonorrhoeae. In adults, gonorrhea is most often localized within the genitourinary system. But in newborns, eye damage is more common. Infection occurs when a child passes through the birth canal if the mother has a gonococcal infection. Treatment of such conjunctivitis should begin even before the first symptoms appear. If doctors know the diagnosis of the mother, but it was not possible to completely eradicate the infection before childbirth, it is necessary to carry out special prophylaxis. To do this, immediately after the birth of a child, drugs are dripped into the eyes that destroy the causative agent of the disease.
For the prevention of gonorrhea, the following means are used:
- silver nitrate 1% ( drops);
- tetracycline ointment 1%;
- erythromycin ointment 1%;
- sulfacetamide 20% ( solution).
Antibiotics to treat gonococcal conjunctivitis
| Name of the drug | Recommended dose | special instructions |
| Cefazolin | Solution 133 mg/ml 1 drop every 2-3 hours. | Treatment lasts 3 - 4 weeks. After the symptoms decrease and until the end of the course, the drug is dripped 3-4 times a day. |
| Ceftazidime | Solution 50 mg/ml 1 drop every 2 to 4 hours. | |
| Ofloxacin | Ointment 0.3% is applied every 2 to 4 hours. | |
| Ciprofloxacin | Ointment or solution of 0.3%, applied every 2 to 3 hours. | |
| Ceftriaxone | Intramuscular injection, done once. Adults - 1 year Children weighing up to 45 kg the dose is reduced to 125 mg. newborn - 25 - 50 mg per 1 kg of body weight ( but not more than 125 mg per day), within 2-3 days. | The exact dose for children is determined only by the attending physician. |
In addition to antibiotics, it is necessary to use means for local disinfection. They will reduce the likelihood of other infections and speed up recovery. In case of damage to the cornea, it is necessary to add other medicines. The most effective - Retinol acetate ( solution 3.44% 3 times a day) or Dexpanthenol ( ointment 5% 3 times a day).
With intense leakage of pus, it must be washed off. To do this, you can use potassium permanganate ( potassium permanganate) 0.2% or nitrofural ( furatsilin) in the form of a 0.02% solution.
In general, the treatment of gonococcal conjunctivitis in both children and adults should be handled by an ophthalmologist. With concomitant other localization of infection ( usually urethritis) consultation of a dermatovenereologist is necessary. Self-treatment can lead to further spread of the process to other structures of the eye, which is fraught with irreversible loss of vision.
Rp.: “Citoflavinum” 5 ml (pentoxifylline 2%-5ml)
D.t.d. N.10 in amp
S.: 5% glucose solution 200ml
51. 1. The technique of taking a surface scraping from the cervix for oncocytological examination.
A cervical scraping test, also known as a cytology test (Pap test or Pap smear), is performed to detect precancerous and cancerous conditions of the cervix. The material for cytological examination is the cells of the cervical canal (ectocervix and endocervix), which are examined for signs of atypia, dysplasia and malignancy.
Annual cytological examination of cervical scrapings is indicated for all women over the age of 20 years (or since the onset of sexual activity). More frequent (twice a year) cytology screening is indicated for women with HPV, frequently changing sexual partners, menstrual irregularities, obesity, infertility, genital herpes, taking hormonal contraceptives. A cytological examination of scrapings of the cervix is performed for women before setting up an intrauterine device.
Material sampling for a Pap smear is not performed during menstruation, in the presence of inflammatory diseases of the vagina and cervix, as this can lead to a false result. The day before the smear, you should not have sex, use tampons or vaginal suppositories.
Smear for cytological examination taken during the examination in the gynecological chair using vaginal mirrors. The material is taken from 3 sections: the vaginal vaults, the vaginal part of the cervix (ectocervix) around the external os and the cervical canal. If changes are visually detected on the cervix (erosion, leukoplakia, etc.), a smear for cytological examination is taken from these areas.
Taking material from the mucous membrane is carried out by surface scraping. Before taking a scraping, the cervix should not be wiped. If there is an accumulation of secretions in the region of the posterior fornix of the vagina, they are carefully removed with a swab. Scraping is taken with a cyto-brush (cervix-brush), or with an Eyre spatula. After taking samples of the material, they are applied to glass slides and sent to the cytology laboratory.
two-handed gynecological examination performed after taking the material for cytological examination.
In a cytological examination of scrapings of the cervix, an assessment of the size, shape, number and nature of the location of the cells is carried out. To do this, the method of staining the smear according to the Papanicolaou method is used, it is dried and examined under a microscope. The result of the Pap test is considered negative (normal) if all cells have an unchanged structure.
To interpret the results of a cytological examination of a smear, a classification is used according to the degrees (stages) of assessing anomalies.
Stage I corresponds to the normal cytological picture observed in healthy women. Stage II is characterized by some morphological changes in cells due to the presence of inflammation of the internal genital organs. This stage is also considered the norm, but requires a thorough additional examination to identify the pathogen. At stage III, individual cells with an abnormal structure of nuclei are determined. In this case, it is recommended to retake and examine the smear, as well as a histological examination of the material. Stage IV is characterized by altered cells (with changes in the cytoplasm, chromosomes and nuclei), which gives reason to suspect a malignant process and also requires a thorough follow-up examination. The cytological picture of stage V shows a large number of atypical malignant cells.
2. Emergency care for toxic-infectious shock in obstetric and gynecological practice.
In case of hypovolemia, crystalloids and colloids, replenish BCC gradually, under the control of HD every 400ml, AB in high initial doses, increased nonspecific resistance - albumin, plasma, retabolil 50mg, methyluracil 0.8% -200ml, desensitization, with Tr-singing Tr-mass , electrolytes, GK 0.7-1.0, vasoactive - NA, mezaton.
Write out a prescription: a remedy for the treatment of vomiting of pregnant women.
Combination of drugs:
Rp.: Sol. Atropini sulfatis 0.1% - 1ml
D.t.d. N.10 in amp
S.: 1 ml i/m
Rp.: Sol. Droperidoli 0.25%-10ml
D.t.d. N.6 in amp
S.: 1-2 ml / m
52. 1. The technique of taking a smear from the cervical canal for bacteriological examination.
On the armchair. CMM is exposed with a folding mirror, mucus is removed, a loop is taken and, without touching the walls of the vagina, they enter the cervical canal by 1.5 cm; rotate the loop clockwise for 15 min. Then remove the loop, without hitting anything, place it in a test tube and within an hour for analysis
Emergency care for threatening uterine rupture.
Transportation p / is indicated, anesthesia to relax the uterus, in childbirth - to remove labor, CS, with a dead fetus, craniotomy. P / shock and p / anemic therapy. If there is a subperitoneal hematoma, cut the peritoneum, remove blood, ligate the vessels.
Write a prescription: a means for medical abortion.
Rep: Tab. Mefipristoni 0.2 D.t.d. N 3 S. inside 3 tabs at the same time. h/h 48-72h on ultrasound
53. 1. Technique for conducting a combined provocation for gonorrhea.
Alimentary (drinking alcohol)
Physical methods of irritation (palpation, physiotherapy)
Mechanical irritation (bougienage)
Chemical irritation (introduction into the urethra of silver, protargol)
Biological irritation (administration of gonovaccine)
7-10 days after the end of treatment: examination of the patient, bacterioscopic examination of discharge from the urethra, cervix and lower rectum, combined provocation (intramuscular injection of 500 million microbial bodies of gonovaccine or 25 μg of pyrogenal, lubrication of the urethra with 1-2% silver nitrate solution, cervical canal with 2-5% silver nitrate solution or Lugol's solution on glycerin).
After a combined provocation, a bacterioscopic examination is carried out from the indicated foci after 1-2-3 days and a bacteriological examination after 2 or 3 days.
II control examination is carried out during the next menstruation: three times (with an interval of 24 hours) sampling of discharge from the urethra, cervix and lower rectum for bacterioscopic examination.
III control examination is carried out at the end of menstruation, the combined provocation is repeated, followed by a bacterioscopic examination after 1-3 days and a bacteriological examination 2 or 3 days after the provocation.
With favorable results of clinical and laboratory examination, patients are removed from the register. With positive results, further treatment is planned.
Emergency care for amniotic fluid embolism.
Amniotic fluid (possess thromboplastin activity) enters the bloodstream with intrauterine pressure (with violent labor activity) and prematurely. opening of the fetal bladder (transplacental, transcervical, through the intervillous space during detachment). In the clinic, shock, SSN, ↓ BP, CVP, cyanosis, dyspnea, agitation. Immediate abdominal or vaginal delivery, resuscitation and IT. Urgent ventilator-assisted intubation. Reopoliglyukin, glucose with insulin, novocaine, hydrocortisone, strophanthin. With persistent cardiogenic shock, intravenous blood transfusion or polyglucin. Heparin 500 U/h.
3.
Rp.: Ceftriaxoni 1.0 N. 10
D.S. intramuscular injection diluted in 3.5 ml of 1% lidocaine solution and injected deep into the gluteal muscle.
Rp: Cefotaximi 1.0
D.t.d. N 10
S. In / in 2 times a day, pre-dissolve in 2 ml of water for injection.
Rep: Sol. Metrogyli 0.5% - 100 ml
D.t.d. N 10
S. Intravenous drip 2-3 times a day.
54 1. The technique of taking a smear for colpocytological examination.
On the armchair, a folding mirror is inserted. The smear is taken from the anterolateral fornix. If there is colpitis with a spatula, then on the glass