The technique of carrying out a combined provocation for gonorrhea. Preparation for tests for latent sexual infections. What is gonorrhea
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 (2 times a year) examination for cytology is indicated for women with HPV, often changing sexual partners, suffering from 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.
The collection of material for the Pap smear is not performed during menstruation, if there is inflammatory diseases vagina and cervix, as this may 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.
A two-handed gynecological examination is 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 the BCC gradually, under the control of HD every 400ml, AB in high initial doses, increase in 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 of the indicated foci is carried out 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
Gonorrhea is an infectious disease of the human body, affecting mainly the mucous membranes of the urogenital tract, caused by gonococcus and transmitted mainly through sexual contact.
What is gonorrhea:
- Pathogen is a gonococcus (discovered in 1879 by Neisser)
- Sources of infection: sick person, his household items.
- How is gonorrhea transmitted? The following are ways you can get gonorrhea:
- Sexual
- Extrasexual- through household items, in newborns - when passing through the birth canal. It is rare, more often from mothers to girls.
- Transplacental- develops gonococcal meningitis, various articular inflammatory processes.
immunity from gonorrhea
There is no innate or acquired immunity from gonorrhea. Although already from 5-7 days antigonococcal antibodies of the Ig G class begin to appear in the body. Their maximum number is by 14 days. But this immune response is not enough.
Gonorrhea classification:
- Forms of gonorrhea:
- Genital
- Extragenital
- metastatic
- By time criterion:
- Fresh
- Acute
- subacute
- Torpidnaya
- Chronic
- Latent
- Fresh
- According to the anatomical features of the organ involved in the process:
- Urethritis (in men)
- front
- rear
- total
- Endocervicitis (in women)
- Urethritis (in men)
Separately allocate gonococcus carriage.
ABOUT fresh gonorrhea say when it has passed since the infection no more than 2 months. chronic gonorrhea More than 2 months have passed since infection. Fresh gonorrhea may be acute, subacute, or torpid.
According to the anatomical features of the organ involved in the process, gonorrhea is divided into urethritis (in men) and endocervicitis (in women). Urethritis, in turn, can be anterior, posterior, total. The transition from the anterior to the posterior part of the urethra can be facilitated by jolting vehicles, alcoholism.
Symptoms and course of gonorrhea
Usually, the first symptoms of gonorrhea are mild itching in the urethra and burning during urination. Then there may be swelling foreskin and head of the penis, copious discharge from the urethral canal in the morning. After some time, the situation worsens, the discharge becomes purulent, there are severe pain during urination, frequent urge to urinate, pain on palpation of the urethra.
incubation period for gonorrhea(from the beginning of infection to the first manifestations). The duration of the incubation period ranges from 1 day to 2-3 weeks, on average 3-5 days.
The infection can penetrate the intercellular spaces subepithelially into the connective tissue and cause inflammation. In addition, the lymphatic system is affected (maybe lymphadenitis). Also, the infection can also spread hematogenously (with blood flow). Such a spread can provoke, for example, gonococcal arthritis.
After 2-3 weeks, the severity of the symptoms of urethritis decreases, which is mistaken for recovery.
Only on clinical grounds gonorrhea diagnosis cannot be set. It is set only when the causative agent of the disease is detected. If the pathogen is not found, then it is better to diagnose acute urethritis.
Diagnosis of gonorrhea
An anamnesis of the disease is collected in order to find out:
- when did the infection occur
- possible source of infection
- whether any measures were taken that could change the course of the disease
- whether treatment was carried out for this or other diseases, whether the fact of this disease in the past
- may have a recurrence
- clarify the possibility of infecting other persons and other issues at the discretion of the doctor.
Clinical picture
Clarification of the etiological factor:
- microscopy method
- bacterioscopy method
- enzyme immunoassay method
- immunofluorescent method
- method of setting allergic tests for gonococcal allergens
- setting a 2 or 3 glass sample
2 glass sample
If the urine is cloudy, but this is a variant of the norm, then it is clarified when concentrated acids are added. In pathological urine there are filaments of mucus, epithelium, floating in a glass and at the bottom of its crumbs of pus. Turbidity is characteristic of urethritis, which does not pass after the action of acids, mucus, crumbs. If the turbidity is only in 1 glass, then this is acute anterior urethritis, if in 1 and 2 glasses, then this is chronic (anterior and posterior) urethritis.
Taking a swab from the urethra
The “Volkmann spoon” is used. It is inserted into the urethra by 1.5 cm, the convex part downwards, rotated 180 degrees and a neat scraping is made along the urethral mucosa. Smears are stained by Gram or methylene blue. It is possible to sow a loop from a scraping of the urethra on a nutrient medium. All laboratory diagnostics is carried out against the background of urinary retention for at least 2 hours.
The Volkmann spoon is designed to take samples of the secretion of the mucous membrane of the vagina, cervix and urethra for the preparation of smears
A special place in the diagnosis is occupied by chronic gonorrhea, because. the diagnosis is made after 2 months from the moment of infection, and in the clinic after 2-3 weeks the signs are minimal. Only the anamnesis remains, the clinic drops out or it is minimal (meager mucous discharge from the urethra in the morning, sticking of the urethra sponges).
Provocation
Gonococcus may be present as L-forms, encapsulated forms. It can hide in the mucosa and with microscopy and bacterioscopy there is a chance not to get the pathogen. For this, there are methods of provocation. Everything is aimed at enhancing the inflammatory response at the expense of the body. Several types of provocations:
- alimentary (alcohol consumption)
- physical methods of stimulation (palpation, physiotherapy)
- mechanical irritation (bougienage)
- chemical irritation (introduction into the urethra of silver, protargol)
- biological irritation (administration of gonovaccine)
Most often in diagnosis of chronic gonorrhea use a combined provocation - biological + chemical.
Gonovaccine- contains 8-12 killed strains of gonococcus. The dosage is measured in specific units - millions of microbial bodies. It is produced in the form of an ampoule preparation, which has its own series and date of manufacture. Introduced as a diagnosticum 60 million microbial bodies intramuscularly.
After the combined provocation, an examination is carried out according to the scheme: taking smears after 24 hours - 48 hours - 72 hours. You can get gonococcus, or you can not detect it. There are cases when only 5-8 provocations can reveal gonococcus.
gonorrhea treatment
Now gonococcal infection is combined with other types of infection - trichomonas and chlamydial. If trichomonas urethritis is added to this, then the gonococci absorb some of the trichomonas - treatment must be carefully selected.
- Treatment of fresh gonorrhea, uncomplicated - the antibiotic of choice are drugs of the penicillin and cephalosporin group. The dose and frequency of administration is determined by the doctor.
- In chronic gonorrhea: immunotherapy, antibiotic therapy is carried out. Pyrogenal, prodigiosan, gonovacine (150-200 million microbial bodies) are used for immunotherapy.
- With a combination of gonococcal and trichomonas infections, they begin with the treatment of trichomoniasis with tenidazole, then gonorrhea is treated with antibiotics for 2-3 days. With a combination of gonococcal with chlamydial infection, treatment with tetracycline antibiotics is carried out.
If left untreated, after some time, the manifestation of painful symptoms may decrease due to the transition of gonorrhea to a particularly dangerous chronic stage. Usually there is a slight burning sensation during urination, as well as erectile dysfunction (insufficient or short-term erection).
The consequences of untreated gonorrhea can be very serious. Acute infectious urethritis often leads to impotence, erectile dysfunction, and infertility. To prevent such troubles, you should worry about possible consequences casual unprotected sexual contact and take appropriate measures.
Two partners need to be treated at once. Left untreated, the infection can lead to more serious and chronic conditions. In addition, gonorrhea can cause tube adhesions in women, which can lead to infertility.
Gonorrhea cure criteria
Gonorrhea cure criteria begin to be determined 7-10 days after the end of treatment. Evaluate the absence of clinical manifestations during examination, palpation and according to the patient. Then a combined provocation is carried out in order to objectively assess the curability. Gonovaccine and protargol are administered intraurethral. A smear is taken after 24 hours - 48 hours - 72 hours. If there is nothing in the smears, then this is an objective curability. Examination is carried out in a month prostate, ureteroscopy, blood for RV (Wassermann reaction). If these indicators are normal, then the patient is removed from the register. The Wasserman reaction (RV) is mandatory. 
Prevention of gonorrhea
The main method of preventing gonorrhea is legibility in sexual relations and the use of barrier contraceptives (condom). In case of accidental unprotected sexual intercourse, prophylaxis is carried out at prophylaxis points at skin and venereal institutions, preferably in the first 2-3 hours.
How to prevent gonorrhea after unprotected sex
- The visitor washes his hands, urinates, washes his genitals with warm water and soap, capturing the skin of the thighs and perineum
- After drying with a napkin, wipe these areas with a napkin soaked in gibitan or miramistin solution or sublimate solution 1:1000.
- From Esmarch's mug, the anterior part of the urethra is washed with 0.5 l of a 0.05% solution of gibitan or a 0.01% solution of miramistin.
- 1-2 ml of 0.05% gibitan or miramistin is injected into the urethra, 6-8 drops of a 2-3% aqueous solution of protargol using an eye dropper. Do not urinate for 2-3 hours.
- A sterile gauze napkin is laid from contaminated linen. All this is carried out in the first hours.
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:
|
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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.
Fallopian tube gonorrhea- 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 condition is 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 take a look at the main types. laboratory diagnostics 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 it will positive result but 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 culture 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 living 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 for the detection of gonococcus, only the complement fixation reaction (RCC) is used, 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 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 the 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. The reproductive organs are usually not affected by the 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 become chronic. 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 its presence creates unfavorable 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 the seminal fluid, for various reasons, may simply not contain spermatozoa, 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 everything 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.
- Lab 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 have relatively large sizes (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 even at the stage of 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 not in any 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 mother's diagnosis, 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. If the cornea is damaged, other drugs must be added. 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.
The diagnosis of the presence of any infectious STDs is always preceded by a series of medical procedures, the most important of which is laboratory tests. They allow not only to identify the pathogen and determine its type, but also to select the optimal course of treatment and drugs to which the pathogen has no resistance.
Types of analyzes
Depending on the data of the initial examination, the dermatovenereologist may prescribe one of several options for laboratory tests:
- Bacteriological culture - is carried out if a number of diseases are suspected, the causative agent of which are bacteria and fungi. It has high accuracy, but requires a lot of time (about 14 days), so it often serves only as a confirmation of the established diagnosis. In venereological practice, sampling for a tank is taken from the vagina, cervical canal, urethra, ejaculate.
- Serological analysis - detection in the blood of specific antibodies for a particular pathogen. Such an analysis for latent infections of the genital organs quite accurately and quickly reveals pathogens, in some cases it determines the degree of development of the disease (chronic or acute).
- PCR - detection of DNA fragments of the pathogen, even if it has not yet had time to lead to the development of severe symptoms.
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Patient preparation
The test results are largely dependent on proper preparation patient before examination. To reduce the likelihood of distortion of the data obtained and increase the accuracy of the study, the specialists of the EUROMEDPRESTIGE clinic recommend adhering to the following rules:
- When analyzing for genital infections with a blood test, you should refrain from eating 8 hours before taking the biomaterial. It is best to undergo the procedure in the morning.
- In serological analysis with suspicion of syphilis, it is not recommended to eat fatty foods 24 hours before sampling. Violation of this recommendation can lead to a false positive result and the appointment of incorrect treatment.
- Urogenital swabs are taken only after 3-4 hours of urination. This will ensure that sufficient biomaterial is present on the tissues of the urethra, which is otherwise washed away in the urine.
- Bacteriological studies exclude the possibility of taking antibiotics in any form. Even taking drugs a week before the analysis will affect the accuracy.
- Rashes in the genitals and adjacent tissues are indications for additional examination of scrapings from the affected parts. In this case, the patient is advised to stop taking local and systemic drugs that reduce itching and inflammation, a few days before the test.
- Taking tests for sexual infections in women is as informative as possible in the first days after menstruation. It is also recommended to refrain from sexual intercourse for a period of at least three days before donating the biomaterial.
Provocation of pathology and its necessity in modern venereology
In some cases, when the disease is on initial stage and the doctor has doubts about the diagnosis, a "provocation" may be required - a temporary decrease in the body's defenses, which increases the activity of the pathogen. Due to the accuracy of modern laboratory tests for genital infections, provocation is rarely resorted to, most often if there is a suspicion of a latent form of the disease.
The simplest option is an alimentary provocation through the use of certain foods and dishes: spicy, salty, smoked, alcohol. For example, in the absence of other contraindications, the doctor may recommend drinking one or two mugs of beer with the usual snacks (smoked or salted fish, bacon, etc.) 1-3 days before taking tests for latent infections. This will help the pathogen to express itself, and it will be detected during laboratory tests. For some STD pathogens, there are specially designed provocateur drugs. They can only be used in a hospital setting, when the doctor can constantly monitor the patient and monitor his condition.
If you suspect any STDs, we recommend that you seek the advice of a dermatovenerologist at the EUROMEDPRESTIGE clinic. Here you will find modern diagnostic methods, precise equipment and highly qualified personnel who can quickly determine the cause of the problem and eliminate it.
The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!
What is gonorrhea?
Gonorrhea is a common infectious venereal disease, which is caused by gonococci and is transmitted mainly through sexual contact. With gonorrhea, the mucous membranes of the genitourinary system are more often affected, much less often - the mucous membranes of the mouth, nose, throat, or rectum. Integuments at this pathology are surprised extremely seldom. To date, gonorrhea is considered a rather serious social problem, as more and more people of working age fall ill with this pathology. Gonorrhea can occur in all age groups however, adolescents and young, able-bodied people between the ages of 18 and 30 are most at risk of infection. It is also worth noting that among adolescents, women are most often ill, while among the adult population - men.
The spread of gonorrhea can contribute to:
- An increase in the population at risk.
- Social cataclysms ( wars, natural disasters and others) associated with the deterioration of sanitary and hygienic living conditions.
- Promiscuous sexual contacts.
- Abuse of alcohol and drugs.
- Prostitution.
The causative agent of gonorrhea
The causative agent of the disease is Neisseria gonorrhea ( gonococcus). The cell wall of this microorganism consists of three layers. On the outer layer there are special filamentous processes ( drank) that promote the spread of infection. When entering the human body, bacteria with the help of pili are firmly attached to epithelial cells ( epithelium is a thin layer of rapidly renewing cells covering mucous membranes and other body surfaces).After fixation on the cells of the epithelium, gonococci pass through the intercellular spaces under the epithelial tissue, which leads to the activation of the body's immune system and the development of the inflammatory process. cells of the immune system neutrophils) are delivered with blood flow to the site of infection and begin to actively absorb pathogens. However, gonococci engulfed by neutrophils usually do not die, and sometimes may even continue to multiply, supporting the inflammatory process. The resulting purulent masses are a lot of dead neutrophils, inside which are active ( contagious) gonococci. The resulting pus accumulates on the surface of the affected mucosa and can be discharged from the urogenital canal.
As the disease progresses, gonococcal infection spreads to new mucosal sites, affecting new organs ( prostate and seminal vesicles in men, uterus, fallopian tubes, or ovaries in women), leading to the development of complications. Also, gonococci can enter the lymphatic vessels and spread to distant organs with the lymph flow. Very rarely, gonococci can enter the bloodstream, leading to the development of severe purulent complications.
It should be noted that gonococci are highly resistant in the human body. Under the influence of unfavorable factors ( including the use of antibiotics) they can turn into the so-called L-forms, which are not able to multiply, but can survive for a long time in adverse conditions, and then reactivate. However, under the conditions environment (outside the host) resistance of gonococci is reduced. They die when the fluid with which they were excreted from the body dries up ( pus, semen and so on). When heated to 41 - 55 degrees, they die almost instantly, as well as when they get into soapy or salt water. Also, gonococci are very sensitive to many antibiotics and antiseptics ( disinfectants).
Ways of getting gonorrhea
The source of infection with gonorrhea can be a sick person who may not even know that he is a carrier of gonococci ( gonorrhea can be latent or chronic).Gonorrhea can be contracted:
- Sexually. The most common ( more than 95% of cases) the route of infection, in which gonococci pass from a sick person to a healthy person during an unprotected ( without using a condom) sexual contact. However, it is worth noting that sexual intimacy with an infected partner does not always lead to the development of the disease. After a single sexual contact with a sick woman, a man can get sick with a probability of 17 - 20%, while a woman who has contact with a sick man will become infected with a probability of 80%. This difference is due to the features anatomical structure male and female urethra urethra). In women, the urethra is shorter and wider, which facilitates the penetration and spread of infection, while the narrower and longer urethra reduces the risk of infection in men.
- Contact household way. Gonococci can pass from a sick person to a healthy person through various household items ( towels, sheets and other bedding, washcloths, underwear and so on). This route of gonorrhea spread occurs in less than 1% of cases, due to the low resistance of infectious agents in environmental conditions ( outside the host).
- vertical way. This route of transmission is characterized by infection of the newborn during passage through the birth canal of an infected mother. In this case, gonococcal infection can affect the mucous membrane of the eyes, mouth or genitals of the baby.
incubation period for gonorrhea
The incubation period is the period of time from the moment of penetration of infectious agents into the body until the first clinical signs of the disease appear. This time is necessary for the body's immune system to recognize the infectious agent and begin to react to it, that is, to produce special anti-infective antibodies, which is the direct cause of the development of an inflammatory reaction.After infection with gonococcus, the incubation period lasts from 12 hours to several weeks ( extremely rare up to 3 months), which is due to the characteristics of the pathogen, the activity of the immune system and the general condition of the patient. On average, the first clinical signs of the disease in men appear after 3-4 days, and in women - 8-10 days after infection. A longer incubation period may occur in the elderly and in patients with AIDS ( acquired immunodeficiency syndrome), as their immune system reacts less actively to the introduction of foreign agents. At the same time, a shorter incubation period may be observed with a high initial dose of the pathogen.
It is worth noting that during the incubation period, no clinical or laboratory signs of gonorrhea are observed, however, an infected person may already be contagious to others. That is why frequent change of sexual partners is one of the most important factors in the spread of gonococcal infections.
Forms of gonorrhea
In clinical practice, it is customary to classify gonorrhea depending on the time elapsed since infection, the rate of development and the severity of clinical manifestations. It is extremely important to timely and accurately determine the form of the disease, on which further diagnostic and therapeutic tactics depend. Depending on the time since infection, there are:
- fresh gonorrhea;
- chronic gonorrhea;
- hidden ( latent, asymptomatic) gonorrhea.
fresh gonorrhea
Fresh gonorrhea is considered if no more than 2 months have passed since the onset of the first clinical signs of the disease. During this period, the body actively fights developing gonococci, which determines the clinical picture of the disease.Fresh gonorrhea can occur:
- in acute form. In this case, the patient has pronounced manifestations of infection, which is due to the increased activity of the immune system against gonococcus. As a result of the progressive development of the inflammatory process, the epithelial cells of the affected mucosal area are destroyed, which can cause the formation of visible defects ( ulceration).
- In substandard form. With this form of gonorrhea, the activity of the infectious-inflammatory process is significantly reduced. As a result, the symptoms of the disease subside somewhat, become less pronounced, but are observed constantly throughout the entire period of the disease and continue to cause inconvenience to the patient.
- In torpid form. The torpid form is characterized by a sluggish, protracted course, in which the symptoms of the disease are extremely weakly expressed or absent altogether.
chronic gonorrhea
When the disease becomes chronic, the infectious agent ( gonococcus) ceases to play a decisive role in the appearance of clinical symptoms. At this stage in the development of pathology, certain changes are noted in the microorganism itself and in the immune system of a sick person, as a result of which it ceases to actively fight the infectious agent. At the same time, gonococci can stay in the affected tissues and cells for a long time, becoming activated when the body's defenses are weakened or when exposed to predisposing stress factors ( hypothermia, other infectious disease, surgery, and so on).The chronic form of the disease is characterized by a sluggish, recurrent or even asymptomatic course ( in 95% of men 3 months after infection, it is difficult to detect any subjective symptoms). Obvious signs of the disease can be determined during an exacerbation of the disease, progress within a few days and disappear on their own, which greatly complicates the diagnostic process. At the same time, proliferative changes occur in the urethra itself, that is, excessive growth is noted. connective tissue, which can block the lumen of the urethra, making it difficult for the outflow of urine.
Hidden ( latent, asymptomatic) gonorrhea
The latent form of the disease is characterized by an almost asymptomatic course and is more common in women. In this case, the patient is infected, that is, he is a carrier and source of infection, however, for one reason or another, his immune system does not respond to a foreign microorganism, as a result of which the inflammatory process does not develop and subjective sensations ( symptoms) are missing.It is worth noting that in men, even with a latent form of gonorrhea, certain non-specific signs can be observed ( adhesion of the lips of the urethra after a night's sleep, the appearance of a small amount of cloudy discharge from the urethra after a long walk, run or sex). However, these manifestations do not cause the patient absolutely no inconvenience and are extremely rarely a reason to see a doctor. The person continues to live a normal life, putting sexual partners or family members at risk of infection.
Symptoms and signs of gonorrhea
Symptoms of gonorrhea are due to the development of an infectious and inflammatory process at the site of infection, as well as the form of the disease and the gender of the patient.
Symptoms of gonorrhea in men
Fresh acute gonorrhea in men usually begins with acute urethritis ( inflammation of the mucous membrane of the urethra). Symptoms of the disease occur abruptly and progress rather quickly, which is usually the reason for going to the doctor.Acute gonorrhea in men is manifested by:
- Inflammation of the urethra urethritis). First of all, the infectious-inflammatory process affects the mucous membrane of the anterior sections of the urethra ( anterior urethritis develops), and then can spread to its entire surface ( in this case we are talking about total urethritis). With the development of the inflammatory process, there is an expansion blood vessels, increased blood flow and swelling of the mucous membrane. Outwardly, this is manifested by hyperemia ( redness) and swelling of the lips of the external opening of the urethra, discomfort during urination and other symptoms.
- Pain and itching. Pain and itching in the urethra are among the first symptoms of gonorrhea. Pain usually occurs in the morning after a night's sleep), at the beginning of urination and is cutting or burning in nature. Patients may also complain of pain during ejaculation ( ejaculation). The occurrence of pain is due to inflammation and swelling of the mucous membrane of the urethra. Also in the inflamed tissue changes ( rises) sensitivity of painful nerve endings, as a result of which a person feels pain when urinating.
- Discharge from the urethra. The second characteristic manifestation of gonorrhea is purulent discharge from the urethra ( thick consistency, yellow, greenish or Brown with an unpleasant odor). They first appear in the morning during urination ( excreted in the first portions of urine). As the disease progresses, pus can be discharged from the urethra and outside of urination, soiling underwear and bedding, thereby causing significant inconvenience to the patient. With total urethritis at the end of urination, a small amount of blood may be released from the urethra, which is associated with the destruction of the mucous membrane of the urethra. There may also be hemospermia ( the appearance of blood in the semen).
- Violation of urination. Violation of urination in gonorrhea is also associated with inflammation of the urethra. As a result of swelling of the mucous membrane, the lumen of the urethra narrows, which can impede the outflow of urine. This can also be facilitated by the accumulation of pus in the lumen of the urethra. With total urethritis, the infectious-inflammatory process can spread to the posterior parts of the urethra, which will manifest itself frequent urges to urinate, during which a small amount of urine and / or pus will be released.
- An increase in temperature. Body temperature in gonorrhea may remain normal, however, in some cases, the development of acute gonorrheal urethritis is accompanied by an increase in temperature up to 37 - 38 degrees, and with the addition of purulent complications - up to 39 - 40 degrees. The reason for the increase in temperature is the release of special substances into the blood - pyrogens. Pyrogens are contained in many cells of the immune system and are released into the surrounding tissues during the development of the inflammatory process, affecting the thermoregulatory center in the brain and thereby increasing body temperature.
Symptoms of gonorrhea in women
In most cases, gonorrhea in women occurs in a latent, asymptomatic form. Only 10 - 15% of women infected with gonococcus go to the doctor on their own because of certain manifestations of the disease. Much more often, women are recommended to undergo a diagnosis for the detection of gonococcus in the event that her husband or sexual partner has developed a clinic of fresh acute gonorrhea.Gonorrhea in women can manifest itself:
- Profuse purulent or mucopurulent discharge from the urethra, worse in the morning after sleep.
- Inflammatory changes in the vestibule of the vagina ( redness, swelling and soreness of the mucous membrane).
- Itching, burning or soreness in the urethra, worse at the beginning of urination or during intercourse.
- An increase in body temperature to 37 - 38 degrees.
Skin lesions in gonorrhea
Damage to the skin as a result of contact with gonococci is extremely rare. This is explained by the fact that for the development of the disease, the infectious agent must get on the skin in a living, active state, and as mentioned earlier, gonococci die quite quickly in environmental conditions. If infection has occurred, gonococci penetrate through damaged skin under the epidermis ( outer protective layer of the skin), causing the development of an inflammatory reaction at the site of implementation. This is manifested by the formation of small ( 0.5 - 2 cm in diameter), slightly painful ulcerations, the edges of which are hyperemic. These defects are located mainly in the region of the frenulum and skin of the penis, in the pubic region, on the inner surface of the thighs.Eye damage in gonorrhea
Gonococcal eye disease usually develops when the pathogen is brought into the eyes with unwashed hands. Also, quite often, gonococcus can infect a newborn baby during its passage through the birth canal of an infected mother.Clinically, eye damage in gonorrhea is manifested by gonococcal conjunctivitis ( inflammation of the conjunctiva, a thin transparent membrane that covers the outside of the eye). The incubation period usually lasts from 3 to 5 days, after which the person has the characteristic manifestations of the disease.
Gonococcal conjunctivitis may present with:
- severe redness of the conjunctiva;
- bleeding of the conjunctiva;
- severe swelling of the eyelids;
- suppuration from the eyes;
- increased lacrimation;
- photophobia.
Throat and mouth lesions in gonorrhea
Gonorrhea is usually asymptomatic. In most cases, on examination it is possible to detect hyperemia ( redness) and swelling of the mucous membrane of the pharynx and palatine tonsils ( tonsils), as well as the presence of a small amount of white or yellowish coating on them. Patients may complain of sore throat, enlargement and mild soreness in the region of regional lymph nodes ( submandibular, cervical).Oral lesions in gonorrhea may present with gingivitis ( inflammation of the gums) or stomatitis ( inflammation of the oral mucosa) with the formation of painful ulcerations in the area of introduction of the pathogen.
Symptoms of anal gonorrhea gonorrhea of the rectum)
They talk about anal gonorrhea when gonococci affect the mucous membrane of the lower third of the rectum ( infection usually does not spread to higher parts of the intestine). Women and girls with acute gonorrhea are at risk of developing rectal gonorrhea. This is explained by the anatomical proximity of the urethra and anus in women, and therefore the pathogen can easily spread, especially if personal hygiene is not followed. Passive homosexuals are also at risk of developing anal gonorrhea, which is due to the peculiarities of sexual contacts among people in this group.Anal gonorrhea can manifest itself:
- Itching and burning in the anus and rectum.
- Tenesmus. Tenesmus is a frequently repeated, severely painful false urge to defecate, during which a small amount of mucopurulent or stool is excreted ( or nothing at all).
- Constipation. Constipation can develop due to damage and destruction of the mucous membrane of the rectum.
- pathological secretions. Mucopurulent or purulent masses may be discharged from the rectum, as well as a small amount of fresh ( bright red or veined) blood ( usually with first stool).
Symptoms of gonorrhea in newborns and children
As mentioned earlier, newborn children become infected with gonococcus when passing through the birth canal of a sick mother. It is important to note that gonococcus can affect not only the eyes, but also other mucous membranes of the baby, which will lead to the development of characteristic clinical manifestations.The incubation period for infection of a newborn lasts from 2 to 5 days, after which signs of damage to various organs begin to appear.
Gonococcal infection in newborns can manifest itself:
- eye injury ( neonatal ophthalmia);
- damage to the nasal mucosa ( rhinitis);
- damage to the urethra urethritis);
- damage to the mucous membrane of the vagina ( vaginitis);
- septic condition ( developing as a result of the penetration of pyogenic microorganisms into the blood).
Methods for diagnosing gonorrhea
Diagnosing the acute form of gonorrhea is quite simple, it is enough to ask the patient in detail about the time of onset of the disease and about the main symptoms. At the same time, not a single dermatovenereologist ( doctor who treats and diagnoses gonorrhea) has no right to make this diagnosis on the basis of symptoms and clinical examination data alone. At the slightest suspicion of gonorrhea, the patient, as well as his sexual partner ( partners) must undergo a comprehensive examination and pass a series of tests in order to confirm the diagnosis.Diagnosis of gonorrhea includes:
- smear for gonorrhea;
- methods of provocation of gonorrhea;
- seeding for gonorrhea;
- laboratory methods for diagnosing gonorrhea;
- instrumental methods.
smear for gonorrhea
smear for gonorrhea bacterioscopic examination) is one of the fastest and most reliable ways to detect gonococcus. The essence of the study is as follows. The patient is given a sampling of biomaterial, which may contain gonococci ( it can be discharge from the urethra or vagina, from the rectum, purulent plaque from the pharyngeal mucosa, and so on). After that, the resulting material is transferred to a special glass and stained with a special dye ( usually methylene blue). The dye penetrates the various structures of the gonococci and stains them, as a result of which they can be easily detected under a microscope.It should be noted that this research method is effective only in the acute form of the disease, when the infectious agent is excreted from the urethra ( or other affected area) along with pus. In chronic gonorrhea, it is not always possible to isolate gonococcus using a conventional smear, and therefore additional studies are often prescribed.
Methods of provocation of gonorrhea
Provocation methods are used in the event that it was not possible to identify gonococcus and bacterioscopic examination failed ( this is usually observed in subacute or torpid form of the disease). The essence of provocative methods is that they stimulate the release of gonococci from the mucous membrane of the affected area. As a result, the probability that during the subsequent sampling of the material the pathogen will enter the smear and be detected by microscopy increases.Provocation in gonorrhea can be:
- Biological. The essence of biological provocation is that the patient is injected intramuscularly with inactivated gonococcal vaccine. This drug contains inactive gonococci, on the surface of which special antibodies have been preserved. These antibodies stimulate the immune system of the body, contributing to a more active absorption of gonococci by neutrophils ( cells of the immune system) and excreting them with pus. Also, biological stimulation can be intramuscular or rectal ( into the rectum) the introduction of the drug pyrogenal, which is an immunostimulant ( activates the body's immune system).
- Chemical. The essence of this method is the introduction into the urethra of various chemical substances (Lugol's solution, 0.5% silver nitrate solution).
- Mechanical. Mechanical provocation is carried out using a metal bougie ( tubes), which is inserted into the patient's urethra.
- Alimentary ( food). Its essence lies in the intake of spicy and / or salty foods, as well as alcohol.
Seeding for gonorrhea
sowing ( bacteriological examination) is also included in the list of mandatory laboratory tests for suspected gonorrhea. The essence of the study is that the biomaterial obtained from the patient is transferred to special nutrient media on which gonococci grow best. If microscopic examination failed to identify the causative agent of the infection, even a small amount of gonococci will begin to actively divide during sowing ( multiply), as a result of which, after a while, several gonococcal colonies form on the nutrient medium. This will confirm the diagnosis and determine the type of pathogen, as well as establish antibiotics to which this pathogen is most sensitive.It is important to remember that the sampling of material for bacteriological examination should be carried out before taking any antibacterial drugs. Otherwise, the antibiotic will begin to have a detrimental effect on gonococci, slowing down the process of their reproduction. As a result, even if the pathogen is present in the test material, colonies may not form during inoculation and the result will be false negative.
Laboratory methods for diagnosing gonorrhea
There are a number of laboratory tests that can detect the presence of gonococci in the test material, as well as assess the general condition of the patient.In the diagnosis of gonorrhea can help:
- General blood analysis. A complete blood count is a routine research method that allows you to identify the presence of an infectious and inflammatory process in the body. The fact is that under normal conditions, the number of cells of the immune system ( leukocytes) is maintained at a constant level ( 4.0 - 9.0 x 10 9 / liter). When foreign agents enter the body, the immune system is activated and begins to synthesize a larger number of leukocytes, as a result of which their concentration in the blood will be higher than normal. Also, the presence of an acute inflammatory process in the body will be indicated by an increase in the erythrocyte sedimentation rate ( ESR), which is normally 10 mm per hour for men and 15 mm per hour for women. This is explained by the fact that with gonorrhea, the so-called proteins of the acute phase of inflammation are released into the bloodstream. They attach to the surface of erythrocytes red blood cells) and contribute to their sticking, as a result of which the latter more quickly settle to the bottom of the test tube during the study.
- General urine analysis. A urinalysis is not a specific test for gonorrhea, but it can detect signs of infection. The presence of a purulent-inflammatory process in the genitourinary tract will be indicated by an increased content of leukocytes and erythrocytes in the urine.
- Three glass Thompson test. This is a special urine test that is prescribed to men in order to determine the localization of the pathological process. For analysis, morning urine is taken ( the day before the examination, the patient should not take red vegetables and fruits, which can change the color of urine). The sampling of material into all three glasses is carried out with a single urination ( the patient urinates first into one, then into the second and then into the third glass, without interrupting the stream of urine), after which each sample is examined separately. If pus is found in the first sample, but is absent in the second and third, the pathological process is localized in the urethra. If there is pus in 2 servings, there is a high probability of damage to the posterior urethra, prostate gland and seminal vesicles.
- Direct immunofluorescence reaction. This study allows you to identify gonococci in the test material in a fairly short period of time. Moreover, the method of direct immunofluorescence is effective if, in addition to gonococci, many other microorganisms are present in the test material. The essence of the method is as follows. A smear is prepared from the obtained material, fixed on glass and stained with special dyes, and then treated with a special fluorescent antiserum. This antiserum contains antibodies that will interact ( unite) only with antigens present on the surface of gonococci. Also, special labels are attached to these antibodies, which glow when examined under a special microscope. If there is a gonococcal flora in the test material, the antibodies will combine with the antigens, causing the gonococci to glow, while other microorganisms remain "invisible".
PCR for gonorrhea
The polymerase chain reaction is modern method research, allowing to bring out gonococci even at their insignificant concentration in the studied material. The principle of the method is based on the fact that every living organism on the planet ( including pathogenic microorganisms, including gonococci) has its own unique genetic information represented by a double strand of DNA ( deoxyribonucleic acid). During PCR, a special chemical process is launched, in which, using a set of enzymes, the desired DNA section is reproduced, and it will be reproduced only if it is present in the material under study.With gonorrhea, a set of enzymes is added to the test material, which must find and "copy" the DNA of gonococci. If there is no gonococcal culture in the material at all, no reaction will occur. If there is one, the reaction will be repeated many times, resulting in the formation of several thousand copies of gonococcal DNA, which will confirm the diagnosis and determine the type of pathogen.
The advantages of PCR over other studies are:
- High accuracy- the method allows to detect gonococci even at their minimum concentration in the biomaterial.
- Specificity is the probability of an erroneous ( false positive) of the result is almost zero ( this is possible if safety rules are not observed in the laboratory, when DNA fragments from the environment can get into the test material).
- Speed of execution- a positive result can be obtained within a few hours after taking the material from the patient.
Instrumental research methods
These methods are used not only for the diagnosis of gonorrhea itself, but also play an important role in identifying various complications of the disease.To identify complications of gonorrhea, you can use:
- Urethroscopy. The essence of this method is to examine the mucous membrane of the genitourinary tract using a ureteroscope - a special device consisting of a long flexible tube with a camera at the end. During ureteroscopy, the doctor can assess the condition of the urethral mucosa, identify erosion, sources of bleeding, or places of pathological narrowing.
- Colposcopy. In this study, the doctor examines the mucous membrane of the entrance to the vagina with the help of special device- a colposcope, the optical system of which allows you to examine various parts of the mucosa under multiple magnification.
- Cervicoscopy. A method for examining the mucous membrane of the cervical canal using a hysteroscope, which is a long rigid tube with a powerful optical magnifying system.
- Diagnostic laparoscopy. The essence of this study is that tubes are inserted into the patient's abdominal cavity through small punctures in the anterior abdominal wall, at the ends of which there are video cameras. This allows you to visually examine the condition of the fallopian tubes and ovaries, assess their patency, and, if necessary, perform some medical manipulations.
