- Gonorrhea and its prevalence
- Dates of occurrence of symptoms after infection
- Symptoms in women
- Chronic gonorrhea
- Complications of gonorrhea
- How to avoid infection after unprotected intercourse
- Treatment of gonorrhea
Despite the fact that medicine is now at the highest level, leaped forward, still gonorrhea does not lose its relevance.Unfortunately, when the symptoms of gonorrhea in women can be acute, it occurs mostly erased therefore often complicated and women become the main source of infection.Gonorrhea Treatment is necessary for both women and men, mainly because it is a consequence of infertility.
Gonorrhea and its prevalence
Gonorrhea is an infectious disease that is transmitted mainly through sexual contact.That is, gonorrhea - is one of venereal infections.The causative agent is the gonococcus (Neisseria gonorrhoeae), named after the scientist Neisseria.Translated from the Greek for "gonorrhea" means the expiration of the seed.Each year, the WHO registers about 62 million people infected with gonorrhea.In Russia, 170 thousand patients recorded for 2000.
main route of transmission of gonorrhea - sexual, with all possible variants of sexual contacts (traditional, oral-genital, anal-genital, and even petting).
Household path of infection is allowed, but rare, non-compliance with the rules of hygiene and the use of personal items toilets (wearing someone else's clothes, shared towels, bed general parents and the child, etc.).
possible gonorrhea infection of the newborn during childbirth when passing through the natural genital tract.Gonokokki unstable in the environment, so die quickly when temp.above 55 degrees, and when exposed to ultraviolet light.
Pathogen vysokokontagiozen (contagious), so the chances of "catching" gonorrhea even if a single sexual contact is 70%.Gonorrhea is rarely "travels" on their own, in 70 - 80% of cases detected has Trichomonas and / or chlamydia.
risk for gonorrhea among women:
- women younger than 25 years;
- gonorrhea history;
- presence of infections, sexually transmitted infections;
- neglect of condoms;
- woman leading an antisocial way of life (alcoholics, drug addicts).
Classification of gonorrhea:
- fresh gonorrhea - disease duration 2 months or less (acute, subacute);
- chronic gonorrhea - after the infection has been more than 2 months (asymptomatic, latent or concealed and subacute).
Gonokokki prone to "conquer" free territories, therefore emit fresh and rising chronic gonorrhea (inflammation of the endometrium of the uterus, ovaries, fallopian tubes, pelvic peritoneum).
Dates of occurrence of symptoms after infection
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infection incubation period lasts from 3 - 7 days to 2 - 3 weeks.Accordingly, the first signs of the disease usually appear 5 days after shortening or lengthening of the incubation period depends on the body's defenses.
If immunity is very weak, then the first symptoms appear within 24-48 hours (seriously infectious diseases recently, treatment with steroids, chemotherapy, etc.).
later manifestation of gonorrhea due either to good immunity, or with the reception after infection antibiotics for other infections or attempt self-treatment.With this, not only related that the first symptoms of gonorrhea are practically invisible.
Symptoms in women
In gonorrhea, disease manifestations associated with those bodies that affects the pathogen.Thus during coitus urethral gonococcal fall into female genital tract, primarily attack the cervix.Further ascent of infection in the inflammatory process involves the epididymis (ovaries, tubes), lining of the uterus, and in some cases the peritoneum.In addition, in the process of gonococci involve mucous rectum and urethra (at the anal-genital intercourse or contact with infected secretions from the vagina and urethra in the rectal mucosa).Quite common, and gonorrheal pharyngitis (oral - genital contact).
Once infected with gonorrhea symptoms appear secretions - this is the first, a classic sign of the disease.This is usually thick, yellow or white whites with an unpleasant odor.Women often take this for a sign of the manifestation of yeast or nonspecific vaginitis, and begin to be treated independently, erasing the clinical picture.
Tsirvitsit - Also secretions are concerned itching, burning or tickling feeling in the perineum and vagina.During a pelvic examination with the naked eye you can see that the cervix is bright scarlet color, somewhat swollen, and from the cervical canal by a yellow ribbon whites - a characteristic symptom of gonorrhea.All of these phenomena suggest gonorrheal cervicitis.
Inflammation of the appendages and uterus - With the penetration of infection is higher, affected endometrium and appendages.There are pain or acute abdomen pulling character, purulent discharge, mixed with blood (affected mucosa of the uterus), the temperature rises to 38 - 39 degrees, and there are signs of intoxication (weakness, malaise, nausea and vomiting, loss of appetite).In this case, there is gonorrheal endometritis and salpingo.
And Endocervicitis, and with involvement of pelvic process, the woman feels pain during sexual intercourse (dyspareunia).
urethritis, cystitis, pyelonephritis - gonococcus infection of the urethra leads to gonorrheal urethritis in which patients complain of frequent and painful urination (see the causes of frequent urination in women, pain and burning sensation when urinating.).The urethra is swollen, hyperemic, painful palpation it appear false urge to urinate.Climbing infection involves in the process of the bladder and kidneys (see cystitis in women: a. The symptoms, treatment, pyelonephritis).
Proctitis - Gonorrheal proctitis manifested by itching and burning in the anus, and painful defecation tenesmus (false desires).There have been discharge from the rectum yellow, usually with bloody streaks.On examination revealed redness of the anus, anal folds filled with pus.Learn more about the symptoms and treatment of proctitis.
Pharyngitis - Gonorrheal pharyngitis occurs under the guise of an ordinary sore throat.It appears sore throat, pain when swallowing, increased submandibular lymph nodes, fever.But most often it occurs with pharyngitis Just noticeable symptoms (sore throat, hoarseness) or asymptomatic.Objectively: revealed edematous, erythematous palatine tonsils with yellowish-gray patina.
Chronic gonorrhea occurs with erased clinic symptoms malovyrazheny or invisible altogether.Among the symptoms characteristic of chronic gonorrhea, can be identified only vaginal discharge, recurrent pain, smack in the leg and aching pain in the lower abdomen.
gonorrhoeal In chronic inflammation of the uterus is a violation of the menstrual cycle.There are intermenstrual bleeding (see. Vaginal bleeding between periods), while they themselves are periods longer and more abundant.Menstruation can cause exacerbation of infection (cervicitis, endometritis, adnexitis, urethritis).
Since gonokokki prefer columnar epithelium, the vaginal mucosa, which is represented by squamous epithelium, almost staggering.The only exceptions are the girls and pregnant women who developed vulvovaginitis.
Complications of gonorrhea Gonorrhea
unpleasant not only its manifestations, but also a high% of complications th:
- Bartolini (infection of Bartholin's glands - the glands large vestibule);
- female infertility (obstruction of pipes, defective endometrium);
- decreased sexual desire (libido);
- complication of pregnancy and the postpartum period (spontaneous abortion, intrauterine growth retardation, birth before term, premature rupture of membranes, increased risk of ectopic pregnancy, postnatal purulent-septic diseases, the death of a child in the first days after birth, fetal death, horionamnionit);
- birth of an infected child (ophthalmia - gonorrheal conjunctivitis, otitis media - inflammation of the middle ear, genital tract infection in girls, gonococcal sepsis);
- disseminated gonorrhea - the penetration of the pathogen in the blood and its distribution throughout the body (haemorrhages on the skin, joint disease, liver, kidney, heart, brain);
- gonorrheal conjunctivitis (non-compliance with the rules of hygiene).
Case study: Gonorrhea in women without treatment can lead to the formation of tubo-ovarian.One night with me in the hospital admitted a young woman with symptoms of intoxication, intense pain in the abdomen, with signs pelvioperitonita (irritation of the peritoneum).This running event I have never been.The operation lasted for more than 2 watches - adhesions were round, with one side of the uterine appendages not visualized (only some of konglomrat intestinal gland, ovary and fallopian tube), was massive purulent exudate in the abdominal cavity.After the operation it became clear that it was gonorrhea.I operated a lot of tubo-ovarian abscesses, but such a heavy case is not seen anymore.
gonorrhea diagnosis is confirmed by laboratory tests:
- smear microscopy of the cervix, vagina, urethra and rectum (Gram stain and painting strokes with methylene blue or brilliant green);
- rapid tests (for home diagnostics);
- culture method (crop discharge from the urethra and cervix in the culture medium);
- response of the immune fluorescence - RIF (painting smear fluorescent dyes);
- immunosorbent assay - ELISA (the study of urine);
- compliment fixation - RAC (serological method, is studied venous blood, is invaluable in the diagnosis of chronic gonorrhea);
- polymerase chain reaction - PCR (studied swabs and urine).
methods of provocation used when the disease is suspected, chronic and latent gonorrhea, when the conventional assays pathogen is not identified:
- chemical (lubrication urethra 1 - 2% solution of silver nitrate, and the cervical canal 2 - 5% solution);
- biological (introducing the vaccine into the muscle of gonococcal and / or pyrogenal);
- alimentary (alcohol, salty, spicy food);
- heat (diathermy holding for 3 days in a row - three times swabs taken one hour after physiotherapy);
- physiological (smears during menstruation analysis).
As a rule, combine 2 or more methods of provocation.Swabs taken three times at 24, 48, 72 hours.
Case study: history right Bulgakov.At the reception I came well-groomed, well-dressed and confident woman.But once the fear in his eyes.After some questioning, it turned out that her husband admitted that he was in Moscow, he decided to "try a prostitute", so even without a condom.The result is disappointing: gonorrhea.That woman came running up to me, get tested and learn their fate.Inspection and conventional smear Gram revealed nothing.I decided to take swabs from provocation.Results fortunately for women, were negative.I, as a doctor, it is very pleasant to work with such conscious patients, since in many cases confronted with gonorrhea chance, after the development of septic complications (very much like we women deal with self-diagnosis and self-treatment).
How to avoid infection after unprotected intercourse
If there was unprotected sexual intercourse with a partner, in which there is no confidence, or in the case of rape, it is necessary to take urgent measures to prevent the infection of urogenital infections.The earlier measures are taken, the lower the chance of infection:
- Immediately after intercourse should urinate, possibly several times (urine wash pathogenic bacteria from the urethra).
- inner thighs and external genitalia to wash with soap and water.
- in the urethra enter the 1 to 2 mL, and not more than 5 ml Miramistin solution in the vagina or Betadine from the vial with urological attachment, but no later than 2 hours after unprotected n / act.
- skin of the perineum and inner thighs to handle antiseptic - a solution of potassium permanganate (weak), Chlorhexidine or Miramistin.If not Miramistin or Betadine can prosprintsevatsya slightly diluted potassium permanganate.
Miramistin reduces the risk of contracting gonorrhea, trichomoniasis, syphilis, genital herpes by 10 times.
not later than 48 hours after unprotected intercourse, seek medical advice (he will appoint medical prophylaxis).After two weeks, it is recommended to hand over smears for analysis of urogenital infections by PCR.
Treatment of gonorrhea
gonorrhea treatment in women is to conduct antibiotic therapy.Therapeutics are subject to both the sexual partner at the time of treatment prohibited alcohol consumption and sexual rest appointed.From antibiotics preference is given to preparations of penicillin, cephalosporin, ftorhnilonovogo series.
Therapy fresh gonorrhea lower divisions sexual sphere is limited to a single dose or administration of antibiotics:
- Ceftriaxone 0.25 g or gentamicin 2.0 g / m 2
- Sumamed g (Z-factor analogues, Azitroks, Hemomitsin, Azitsid,Ecomed)
- Cefixime ciprofloxacin 0.4 g or 0.5 g orally
Acute ascending gonorrhea treated following preparatami6
- ceftriaxone 1 g / m 1 every day for a week, ciprofloxacin 500 mg / 2 timesdaily for 7 days, ofloxacin 0.4 g of 2 times a day for a week.
- The use of other antibiotics (tetracycline, clindamycin, rifampicin, bitsillin, josamycin, ofloxacin and so on. D.)
- chronic gonorrhea treatment complement immune stimulant and gonococcal vaccine (pirogenal, Methyluracilum, levamisole, prodigiozan).
- effectively activates the body's defenses autohaemotherapy.
Since gonorrhea often combined with trichomoniasis and / or chlamydia, Doxycycline is connected to therapy for 10 days and preparations metronidazole for 5 - 7 days.Local treatment consists of washing the urethra 0.5% silver nitrate solution, vaginal douching with solutions of manganese protargola, chlorhexidine, miramistinom and decoction of chamomile.
In the last decade, the WHO is concerned about the increasing incidence of gonorrhea resistance to some antibiotics, for example, the chief expert of the UK Health, Sally Davies, said that in 2013, 80% of clinical cases determined resistance to tetracyclines causative agent of gonorrhea.In this connection, experts in such cases offer use of new treatment regimens, drug using 2 - Azithromycin (oral) + gentamicin (injection) or another combination - gemifloxacin + Azithromycin orally.
In case of complications, surgical intervention.In acute pelvioperitonit and absence of positive dynamics of treatment for 24 hours, laparotomy was performed to remove appendages and washing the abdominal cavity.Acute Bartolini opened, the wound was washed and drained.
Obstetrician-gynecologist Anna Sozinova