Gonorrhea is a sexually transmitted disease caused by gonococcus (an intracellular parasite).

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 sexually transmitted.

But a non-sexual route of infection is possible through linen, sponges, towels.. Possible infection of newborns during passage through the birth canal of a mother with gonorrhea. There is no permanent immunity, so you can get sick many times. The incubation period can 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 concerned 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 \u200b\u200bthe rectum, gonococcal lesions of the oral cavity, pharynx, larynx, eyes, kidneys, gonococcal arthritis, endocarditis, etc.. The defeat of the oral cavity, pharynx, larynx is most often the result of oral sex and is usually combined with gonorrhea of \u200b\u200bthe genitourinary system.

With gonococcal stomatitis, clinical manifestations occur 2 days after infection.. Patients begin to worry about 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..

With gonorrhea of \u200b\u200bthe rectum, the infection of which often occurs during anal sexual intercourse, women experience painful defecation, pain and itching in the anal area, purulent bloody discharge from the anus.

Chronic gonorrhea is an indolent 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:.

- acute, - subacute, - 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-symptom or asymptomatic gonorrhea.. Women with torpid or asymptomatic gonorrhea usually become sexually active without knowing they have the 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 \u200b\u200bthe lower genitourinary apparatus: include gonorrhea of \u200b\u200bthe urethra, paraurethral passages, large glands of the vestibule of the vagina, cervix;

- gonorrhea of \u200b\u200bthe upper genital apparatus - ascending: gonorrhea of \u200b\u200bthe body of the uterus, tubes, ovaries and peritoneum.

Gonorrheal urethritis is an acute urethritis, one of the frequent manifestations of gonorrhea.. However, in women, it manifests itself oligosymptomatically 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, outflow from the gland may be disturbed and a false or sometimes true abscess is formed. In this case, the gland increases in size, is sharply painful, the temperature may rise..

Gonorrheal vulvitis is secondary in adult women, 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 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 swabs 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 is commonly called inflammation of the internal genital organs located above the internal os of the uterus (uterine body, 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 \u200b\u200bthe lower genitourinary system, as well as the weakening of the body's defenses as a result of hypothermia, physical overstrain, 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, rapid 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 menstrual irregularities..

Gonorrheal inflammation of the appendages is obtained as a result of infection passing 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 proceeds very rapidly: high body temperature, 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.. Increased secretion during provocation contributes to the " 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, smears are taken after 24.48 and 72 hours.

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