Eye Gonorrhea

Gonorrhea is a sexually transmitted disease of a person with a predominant lesion of the mucous membranes of the urogenital organs.

[1], [2], [3], [4]

The causes and epidemiology of eye gonorrhea

The disease is caused by gram-negative diplococcus of Neisser. The source of infection is a person with gonorrhea. The transmission path is mainly contact. Gonorrhea of the eye can develop in adults suffering from gonorrhea of the genitourinary tract, as a result of the introduction of infection into the conjunctival cavity, in persons who are in contact with patients if they fail to comply with hygiene rules. Cases of gonorrhea in the eyes of medical personnel serving these patients are described. Newborns are infected mainly at the time of passage through the birth canal of a mother suffering from gonorrhea. Intrauterine metastatic infection is extremely rare. In children, gonorrhea can also develop as a result of infection from the outside with contaminated hands, undergarments, care items, etc.

Pathogenesis of eye gonorrhea

Gonokoks, getting on the mucous membrane, multiply rapidly and after 3-4 days through the intercellular spaces penetrate into the subepithelial tissue, causing local inflammation, manifested by conjunctivitis. Hematogenous dissemination, accompanied by the proliferation of gonococci in the blood, intoxication and metastases to various organs, is currently extremely rare. A certain part of the hematogenous complications in gonorrhea (arthritis, uveitis) is due to transient bacteremia. With her, gonococci are only mechanically transported by the blood stream, not multiplying in the blood and not staying in it for a long time, but quickly settling in tissues and organs. In the body, especially with chronic gonorrhea, immunobiological changes occur leading to auto-allergy. Autoaggression may play some role in the pathogenesis of post-gonorrheal diseases. Late toxic, toxic-allergic eye injuries are caused not by the action of gonococcal endotoxin, as previously thought, but by the attachment of a secondary infection "{virus, pneumococcus, etc.). So, uveitis, sometimes associated with joint damage, occurs 2-4 weeks or more after the end of treatment, when gonococci have already disappeared. In this regard, they are regarded as allergic reactions of the body with a high degree of sensitization to any of the infectious agents.

Symptoms of eye gonorrhea

The incubation period lasts from several hours to 3 weeks, usually 3-5 days. Clinically, eye lesions with gonorrhea are most often manifested by conjunctivitis. There are gonorrheal conjunctivitis of newborns (gonoblenorea) and adults.

Gonoblennorrhea newborn begins on the 2-3rd day after the birth of the child. The appearance of the first signs of the disease after 4-5 days indicates the introduction of infection from the outside. In most cases, the disease is bilateral from the very beginning; Less often, one eye is involved first, and then the other. In the clinical course of untreated gonoblennorei there are 4 stages. The first stage - the stage of infiltration - is characterized by the appearance of a watery discharge from the conjunctival cavity and rapidly growing hyperemia of the mucosa. From the 2nd day of the disease there is a swelling of the eyelids, their skin becomes tense, it is difficult to open the eye gap, it can not be turned off. The conjunctiva of the eyelid is hyperemic, edematic, its surface glossy, smooth, sometimes covered with fibrin films, easily bleeds. Separated in the heat of the first stage becomes serous-bloody. On the 3-5th day the second stage begins - suppuration. The edema and hyperemia of the eyelids decrease, they become soft. The conjunctiva of the eyeball remains edematous and surrounds the cornea. Detachable copious, thick, purulent, yellow. This stage lasts 1-2 weeks, then goes to the third stage - proliferation. The amount of pus decreases, it becomes liquid, greenish in color. Hyperemia and edema of the conjunctiva are less pronounced, as a result of the growth of the papillae, roughness appears from the surface. The fourth stage - the stage of reverse development - is characterized by the disappearance of the edema and congestion hyperemia. Follicles, papillary growths last much longer, disappear only towards the end of the second month. A common complication of gonoblenaire is the damage to the cornea, which can develop with insufficient treatment. Corneal complications arise as a result of worsening of her trophism due to compression of the vessels of the marginal loopy network with edematous conjunctiva, as well as maceration of the epithelium of the cornea with pus, toxic effects of the gonotoxins and gonococci themselves, attachment of the secondary infection. The defeat of the cornea develops in 2-3 weeks; disease, very rarely at an earlier time. In this case, the cornea becomes diffuse-cloudy. In the lower part of her or in the center appears a gray infiltrate, which quickly turns into a purulent ulcer. The ulcer extends over the surface of the cornea and into the depth, often leading to perforation, with the formation of a simple or fused belly.

Less often the infection penetrates into the eye and causes the development of panophthalmitis.

Gonoblennorrhea of newborns must be differentiated from benign renal conjunctivitis, which is also accompanied by pronounced conjunctival phenomena and profuse suppuration. These conjunctivitis are caused by various pathogens: pneumococcus, Pseudomonas aeruginosa and E. Coli, staphylococcus, streptococcus, large virus, close to the trachoma virus, etc. Diagnosis of gonorrheal conjunctivitis is finally established after bacteriological examination of the conjunctiva smear. In this case, gonococci are located inside and extracellularly. Sometimes in the clinical picture gonoblennorrhea of newborn gonococci do not show, but in cell epithelial cells of the conjunctiva cell inclusions similar to Provacek's bodies in trachoma. Blenorrhea with inclusions, which appears not earlier than a week of a child's life, proceeds much more easily than gonorrhea and does not cause complications from the cornea.

Gonoblennoreya children and adults

The clinical course of the disease goes through the same stages as the gonoblenrhea of newborns, but more violent. Complications of the cornea are frequent.

The prognosis for timely and correct treatment of gonoblenorei is favorable and becomes serious when involved in the cornea process. AI Pokrovsky describes the development of metastatic conjunctivitis in the generalization of gonorrhea infection. Metastatic conjunctivitis occurs extremely rarely and is manifested by a picture of catarrhal conjunctivitis (blurred edema of the mucous membrane of the eyelids and the eyeball, sometimes pinpoint hemorrhages in the conjunctiva and rash of small nodules near the limbus).

Gonorrheal iridocyclitis develops more often months later in the years after treatment and is regarded as an allergic process.

Less often metastatic iridocyclitis with fresh gonorrhea or reinfection. Iridocyclitis is often combined with arthritis, more often with monoarthritis of the knee joint. The process is predominantly one-sided, accompanied by severe pains, marked by an inflammatory reaction. With gonorrheal iridocyclitis, a characteristic serous-fibrinous exudate is found in the anterior chamber of the eye, resembling a transparent oscillating gelatinous mass. Sometimes there is a hyphema and multiple synechia are formed. With appropriate local and general treatment, the exudate quickly resolves, the front synechiae easily burst, visual functions, as a rule, do not suffer.

Diagnosis of eye gonorrhea

The etiological diagnosis is based on an anamnesis, a certain clinical picture. The main method of diagnosis is bacterioscopy. Examine the discharge from the conjunctival cavity, urogenital tract. Staining is carried out according to Gram, and preliminary methylene blue. If there is a suspicion of gonorrhea, when bacterioscopically gonococci are not found, a culture method is used - sowing on medium (meat-peptone agar). By seeding, gonococci are detected 4-6 times more often than in bacterioscopy. Serological studies, in particular the Borde-Gangu reaction, are not diagnostic in acute gonorrhea. Usually during this period it is negative, despite the presence of gonococci, due to the lack of antibodies. This reaction is put for the recognition of complications of gonorrhea (iridocyclitis, arthritis). To identify the infection in hidden foci, various methods of provocation are used: mechanical, chemical or biological. Biological provocation consists in the intramuscular injection of 500 million microorganisms of the gonovaccine or in combination with 200 MT of pyrogenal.

[5], [6]

Treatment of eye gonorrhea

Perform a general (antibiotics mainly penicillin series, sulfonamides, with chronic and latent forms - gonovaccine, pyrogenal) and local therapy. With gonorrheal conjunctivitis, local treatment consists of washing the conjunctival cavity with a solution of potassium permanganate 1: 5000, furacilin, instillation of antibiotic solutions, 30% solution of sulfacyl sodium, 2-3% of collargol solution. At night, it is advisable to lay ointment with an antibiotic or sulfa-sodium. When appearing corneal ulcers additionally apply mydriatica, enzymes (trypsin, chymotrypsin, papaya). Treatment is stopped when the clinical manifestations and sterility of the conjunctival cavity disappear. Obligatory repeated control bacterioscopic examination of smears from the conjunctiva. For the treatment of gonorrheal iridocyclitis, local use is made of mydriatica in drops, by electrophoresis, subconjunctival, antibiotics (often subconjunctivally), enzymes (trypsin, chymothsin, chymotrypsin). Usually, intensive desensitizing therapy (dimedrol, pipolfen, tavegil, diazolip, metaglobulin, etc.) is administered, corticosteroids are prescribed according to indications.

Prevention of eye gonorrhea

Prevention of gonorrhea of the eyes is the timely detection and treatment of patients with gonorrhea, compliance with personal hygiene. In order to prevent gonoblenorrhea of newborns, a mandatory examination of the gonorrhea of pregnant women is carried out and timely and active treatment is found when it is detected. Prevention of gonoblennorrhea of newborns and maternity hospitals is mandatory. In our country, the method of prophylaxis of Matveyev-Kreda was widely used. It consists in the treatment of the eyelids, moistened with a 2% solution of boric acid, and then instilled in each eye 1-2 drops of 2% silver nitrate solution. Currently, and each eye instilled a freshly prepared 30% solution of sulfacyl-sodium. After 2 hours, 30% solution of sulfacyl sodium is once again instilled in the children's room. The drug should be one-day.