Gonorrhea in women

Gonorrhea in women is an infectious disease that is transmitted mainly through sexual intercourse (both natural and unnatural). This disease is rarely transmitted through everyday life. The causative agent of gonorrhea is gonococcus, immunity to which is practically not developed. Gonorrhea strikes the main blow to the human urinary system - the fallopian tube, the mucous vaginal membranes. Anal contact - the rectum is affected, or rather its mucous membrane. Oral contact - the larynx and throat suffer.

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Epidemiology

According to WHO, the incidence of gonorrhea is about 200 million cases per year.

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Causes gonorrhea in women

Causes of gonorrhea in women - Neisseria gonorrhoeae - a gram-negative diplococcus, shaped like coffee beans, with their concave surface facing each other. Gonococci are located intracellularly in the protoplasm of leukocytes, usually in groups, but sometimes extracellular gonococci can be seen.

Gonorrhea is classified as a sexually transmitted infection and is subject to mandatory registration if detected. The causative agent of gonorrhea is the gram-negative diplococcus Neisseria gonorrhoeae, which is part of the Neisseriaceae family of the genus Neisseria. It is a bean-shaped coccus with cells arranged in pairs, with their concave sides facing each other. The cocci are 1.25–1.60 µm long and 0.7–0.8 µm across.

Currently, the course of gonorrheal infection has acquired a number of features:

• the sensitivity of gonococcus to traditional antibacterial agents decreases;
• uncontrolled use of antibiotics contributes to the emergence of resistant microorganisms;
• the frequency of isolation of penicillinase-producing gonococcal strains increases;
• There has been an increase in the incidence of mixed infections, which leads to an increase in the severity of the disease.

The social significance of gonorrhea is due to the high level of morbidity and the rapid development of complications, leading to an increase in the incidence of male and female infertility.

Gonorrhea in women most often manifests itself as urethritis, cervicitis, and less often proctitis. Often, a long-term recurrent course of gonococcal infection is noted. Asymptomatic infection is common - up to 10% of cases in men and up to 50% in women. In recent years, an increase in cases of asymptomatic infection has been observed. Asymptomatic carriage is most often associated with extragenital localization of the process, for example, in the rectum or pharynx.

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Risk factors

• prostitution;
• multiple and casual sexual relationships;
• homosexuality;
• rare use of barrier methods of contraception and spermicides.

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Symptoms gonorrhea in women

As a rule, gonorrhea in women manifests itself as a painful burning sensation in the genital area that increases over time. The cause is purulent inflammation. After a certain period of time, the pus begins to come out. The further, the more intense the pain sensations accompany this process. Eventually, the pus thickens and turns from a yellow liquid into a fairly thick brownish mass, which in its consistency resembles jelly.

Also, in case of damage to the upper part, gonorrhea in women can be accompanied by discomfort in the lower abdomen, as well as nausea. The consequences are: diarrhea, vomiting, a significant increase in body temperature (up to 39 degrees).

Gonorrhea in women has an incubation period that ranges from several days to a week. However, medicine knows of cases where an infected person did not feel any symptoms of the disease for a longer period. Such examples mainly relate to the weaker sex; in men, this is almost never the case. Due to such an extended incubation period, subsequent treatment of the disease is significantly more complicated.

In case of oral sexual contacts, gonorrhea in women can lead to inflammatory processes in the oral cavity, as well as in the larynx. An itching pain is felt in the throat, which is accompanied by increased salivation. In case of anal sexual contacts, the infection manifests itself as a discomfort in the anal area, caused by inflammation of the rectum. If gonorrhea in women reaches an advanced stage, it is fraught with loss of reproductive function.

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Features of the flow

• sluggish, asymptomatic course (associated with reduced function of summer residents; inadequate dose of sulfonamides, which reduce the virulence of gonococci; formation of L-forms of gonococci);
• the infection often occurs as a mixed infection: gonorrhea-trichomoniasis, gonorrhea-chlamydia, gonorrhea-mycoplasma, gonorrhea-candidiasis);
• several organs are infected (multifocal lesion).

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Forms

• By duration of the disease - fresh (up to 2 months) and chronic gonorrhea in women (over 2 months).
  • Depending on the severity of clinical manifestations of the infection, fresh gonorrhea in women is divided into acute, subacute and torpid.
  • Chronic gonorrhea gonorrhea in women, as a rule, has a sluggish course with periodic exacerbations.
• Latent gonorrhea (gonococcal carriage) is also distinguished, characterized by the absence of an inflammatory reaction in the presence of the pathogen on the mucous membrane.
• Gonorrhea in women can be complicated and uncomplicated.
• Depending on the localization of the pathological process, gonorrhea is divided into genital and extragenital.
• If the infection enters the bloodstream, disseminated gonococcal infection may develop.

There is gonorrhea of the lower genitals (urethritis, paraurethritis, bartholinitis, vestibulitis, cervicitis, endocervicitis) and gonorrhea of the upper genitals, or ascending gonorrhea (endometritis, salpingitis, salpingo-oophoritis, pelvioperitonitis). Salpingitis is the most common manifestation of ascending gonococcal infection. Gonococcal salpingitis is subacute, sluggish, with minor symptoms. Patients complain of the following symptoms of gonorrhea: aching pain in the lower abdomen, sometimes cramping, increasing with physical exertion, during menstruation, and during defecation. Gonorrhea in women symptoms periodically worsen due to alcohol consumption and after sexual intercourse.

With gonococcal salpingo-oophoritis, patients complain of aching pain in the lower abdomen and in the sacral region, which intensifies with tension of the abdominal wall. Sometimes the body temperature rises to 38-39°C, chills are observed. The rhythm, intensity and duration of menstruation are disrupted. As a result of gonococcal salpingo-oophoritis, obstruction of the fallopian tubes may develop.

Gonorrheal pelvioperitonitis occurs as a result of infection of the peritoneum with gonococci from the abdominal opening of the fallopian tube, from the opened pyosalpinx, pyovarium, as well as their penetration from the subserous base of the fallopian tube through the lymphatic vessels.

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Complications and consequences

One of the consequences of gonococcal infection is primary or secondary infertility.

Women:

• VZOMT;
• ectopic pregnancy;
• Bartholin's gland abscess;
• pelvioperitonitis;
• infertility.

Men:

• orchyoepididymitis;
• balanoposthitis;
• phimosis;
• paraphimosis;
• prostatitis;
• vesiculitis;
• urethral stricture;
• lymphadenitis;
• infertility.

Men and women:

• disseminated gonococcal infection: arthritis, endocarditis, myocarditis, pericarditis, meningitis, Reiter's syndrome.

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Diagnostics gonorrhea in women

Indications for testing for gonorrhea

Men:

• the presence of complaints of purulent or mucopurulent discharge from the urethra, itching of the urethra, symptoms of dysuria;
• presence of pain in the epididymis;
• presence of pain and discharge from the rectum, signs of proctitis;
• the presence of inflammatory changes in the area of the external opening of the urethra, paraurethral passages, and skin of the glans penis;
• presence of signs of inflammation of the prostate gland. Women:
• the presence of inflammatory diseases of the genitourinary system, mucopurulent discharge from the cervical canal, symptoms of urethritis, adnexitis, proctitis, vulvovaginitis, cervicitis, PID;
• the presence of complaints about the appearance of subjective disorders in the genital area (itching, burning during urination, pain in the lower abdomen, leucorrhoea, bloody discharge, etc.);
• presence of cervical erosions;
• suffering from infertility, habitual miscarriages, with a history of premature birth;
• directed towards termination of pregnancy.
• Pregnant women are examined three times:
  • the first examination is carried out upon registration;
  • the second - at 27–30 weeks;
  • the third - at 36–40 weeks.
• After birth, on the 4th–5th day.

Outside the specified periods, examination of pregnant women is carried out according to indications (appearance of discharge, subjective complaints, etc.):

• in gynecological hospitals, all women who were not examined prior to hospitalization, before prescribing antibacterial treatment;
• in maternity hospitals all women in labor without exchange cards;
• women in labor with complicated postpartum period, preferably on the 5th-6th day after birth.

Newborns - with purulent conjunctivitis and (or) vulvovaginitis. If the gonococcal etiology of conjunctivitis and (or) vulvovaginitis is confirmed, the parents are examined.

Children (girls) - with symptoms of vulvovaginitis, vaginitis.

Persons:

• those who have had sexual contact with a person with gonorrhea;
• undergoing testing for other STIs;
• with diagnosed trichomoniasis, before and after treatment of the latter;
• decreed professions during mandatory preliminary medical examinations upon admission to work and periodic medical examinations in accordance with approved regulatory documents;
• sexually abused.

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Laboratory diagnostics of gonorrhea in women

Laboratory diagnostic methods are aimed at:

• isolation of Neisseria gonorrhoeae from clinical material;
• detection of antigens or nucleic acid of the pathogen;
• detection of gram-negative intracellular diplococcus in a smear from the male urethra.

Methods of laboratory diagnostics of gonorrhea

• The microscopic method is aimed at microscopy of smears stained with methylene blue and Gram stain - the main method for diagnosing gonorrhea. Sensitivity and specificity in symptomatic men are 95-99% and 97-98%, respectively, in asymptomatic individuals 69% and 86%, respectively. The method is considered the main and reference method for diagnosing gonorrhea in men. When diagnosing gonorrhea in women, the sensitivity of the method is 45-64% for endocervical samples and 16% for urethral ones.
• The bacteriological method is used to isolate and identify Neisseria. In men - to confirm the diagnosis. Sensitivity in symptomatic men is 94-98%, and in asymptomatic men - 84%; specificity is up to 100% depending on confirmatory methods. In women, this method is considered the main diagnostic method. The sensitivity of the method for endocervical samples is 86-96%, for urethral ones - 60-86%; specificity is up to 100% depending on confirmatory methods. It is always used to examine children and menopausal women. The main diagnostic method in the study of extragenital materials, while the sensitivity for samples from the throat is 50-70%, conjunctiva - 70-80%, rectum - 70-85%; specificity is up to 100%. It is used to determine sensitivity to antibiotics.
• The molecular biological method (polymerase chain reaction - PCR), NASBA in real time) involves the detection of DNA or RNA of the pathogen. It is used only as a screening with subsequent confirmation by the culture method.
• The immunological method (direct immunofluorescence - DIF) involves the detection of pathogen antigens. It is used only as a screening method with subsequent confirmation by the culture method. It can be used to identify Neisseria in culture.
• Serological methods (complement fixation reaction, latex agglutination, immunofluorescence, immunoblotting and others) do not allow to distinguish the current infection from the one suffered in the past. Therefore, serological reactions are not used for the purpose of diagnosing gonorrhea.

Areas for taking the main material:

• urethra in adolescents and adult men with or without discharge;
• cervical canal of the cervix and urethra in women;
• rectum in women and homosexual men;
• oropharynx, if orogenital contact occurred.
• Other areas:
  • rectum and urethra in women if the cervix has been removed;
  • material from pelvic organs during laparoscopy in women with PID;
  • blood and other fluids during dissemination of infection (eg, pus);
  • synovial fluid;
  • epididymal aspirate in epididymitis;
  • conjunctiva;
  • the first portion of freely released urine (10–15 ml) in men for the PCR method.

Screening for gonorrhea in women

The following are subject to examination for gonorrhea:

• men with purulent or mucopurulent discharge from the urethra, symptoms of dysuria, signs of inflammation of the epididymis, prostate gland;
• women with mucopurulent discharge from the cervical canal, symptoms of adnexitis;
• persons who have had sexual contact with a person with gonorrhea;
• persons undergoing testing for other STIs;
• newborns with purulent conjunctivitis, if gonorrheal etiology of conjunctivitis is detected, parents are examined.

Indications for consultation with a specialist regarding gonorrhea - diagnosis and treatment of gonorrhea in women, gonorrhea in pregnant women, children and adolescents are carried out in specialized dermatovenereological institutions.

The doctor's procedure when diagnosed with gonorrhea

1. Informing the patient about the diagnosis.
2. Providing information on behavior during treatment.
3. Collection of sexual anamnesis.
4. Detection and examination of sexual contacts is carried out depending on the clinical manifestations of the disease and the expected period of infection:
   • in acute manifestations of the disease - from 3 days to 3 months;
   • in case of a torpid and low-symptom process - 6 months.
5. Identification of household contacts of the patient is carried out:
   • among girls living together in the same living space;
   • If gonorrhea is detected in a child (girl) attending a preschool institution, the children (girls) and the group workers are examined.
6. If gonorrhea is detected in a mother or child, the newborn is examined, with material taken for microscopy and culture from the vulva and conjunctiva of both eyes. If gonorrhea is detected in a newborn, its parents are examined.
7. In the presence of gonococcal infection of the genitals, rectum and pharynx in children in the postnatal period, sexual abuse must be suspected. Siblings of the infected child must also be examined. The fact of sexual abuse must be reported to law enforcement agencies.
8. Epidemiological measures among contact persons (sanitation of the epidemic focus) are carried out jointly with the district epidemiologist:
   • examination and screening of contact persons;
   • laboratory data statement;
   • deciding on the need for treatment, its scope and observation period.
9. If the contact persons live in other territories, a work order is sent to the territorial KVU.
10. If there are no results from treatment, it is recommended to consider the following possible reasons:
    • false positive test result;
    • non-compliance with treatment regimen, inadequate therapy;
    • repeated contact with an untreated partner;
    • infection from a new partner;
    • infection with other microorganisms.

Treatment gonorrhea in women

Gonorrhea in women, pregnant women, children and adolescents is treated in specialized dermatovenereological institutions.

The patient must be under constant observation and control. Gonorrhea in women must be treated systematically, as well as in combination with the strictest bed rest. And antibacterial therapy must be prescribed in accordance with the stage and complexity of the disease.

In the absence of the above antibiotics, gonorrhea in women is treated using alternative regimens: spectinomycin 2 g intramuscularly once or single treatment regimens with cephalosporins (ceftizoxime 500 mg intramuscularly once, or cefoxitin 2 g intramuscularly once with probenecid 1 g orally).

Patient education

When communicating with patients, physicians should be patient, respectful, compassionate, and nonjudgmental. Effective communication techniques include using terms that the patient understands and reassuring the patient that treatment for gonorrhea in women will be provided regardless of the patient's ability to pay, citizenship, immigration status, language spoken, or lifestyle. Patient education should focus on implementing measures to prevent infection of sexual partners.

Prevention

The only sure way to prevent gonorrhea is for the partner to use a condom. The most suitable is a latex condom, however, in case of latex intolerance, a polyurethane membrane can be used.

Antibacterial prophylaxis after sexual intercourse is especially not recommended, as such a method can cause significant harm to the body. Such a preventive method should be used only in the most extreme cases, when the probability of the partner being infected is quite high. Also, doctors do not recommend taking a large number of antibiotics after each questionable sexual intercourse, as such a method is fraught with serious disturbances of the internal microflora and subsequent severe complications.

Gonorrhea in women is a very complex type of disease. At the moment, the only drug in tablets that is used to treat gonorrhea is Cefixime.

Prevention of gonorrhea includes a number of measures common to all sexually transmitted infections.

Modern preventive measures include both education and changes in motivations and behavior. In general, preventive work is divided into primary and secondary.

• Primary prevention of gonorrhea involves the implementation of theoretically sound interventions aimed at changing behavior patterns in high-risk populations to prevent infection. Currently, preventive measures carried out in society mainly include medical and sanitary propaganda of sexual health and informing the population in the pages of periodicals, in the media, in schools and other educational institutions, as well as in medical institutions. The population should know the characteristics of early and late clinical manifestations of infections, routes of infection, and methods of their prevention. It is also important to inform about places to purchase personal preventive measures. In addition, preventive programs should provide for the rejection of self-medication and unprofessional treatment in cases of suspected infection.
• Secondary prophylaxis of gonorrhea is aimed at individuals diagnosed with sexually transmitted infections to reduce the likelihood of transmitting the infection to partners during the "infectious" period during sexual contact. Secondary prophylaxis should be aimed at reducing the risk of reinfection among patients and those who have already recovered.

Individual prevention of gonorrhea can be carried out independently by a person who has been exposed to the risk of contracting a venereal disease as a result of casual sexual intercourse. It is carried out using individual portable (pocket) preventive means, in accordance with the instructions attached to them. Such means include chlorhexidine bigluconate, cidipol, benzyldimethyl-myristoylamino-propylammonium, etc. The most important means of individual prevention include the use of condoms.

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Forecast

If the treatment of gonorrhea in women is inadequate, complications may develop.

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