Gonorrhea in women

Gonorrhea in women is an infectious disease that is transmitted mainly by sexual intercourse (both natural and unnatural). By domestic means this disease is transmitted very rarely. The causative agent of gonorrhea is the gonococcus, which is almost immune to immunity. The main blow gonorrhea puts on the human urinary system - the tube of the uterus, the mucous membranes of the vagina. Anal type of contact - there is a lesion of the rectum, or rather of its mucous membrane. Oral type of contact - the larynx and throat suffers.

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

Epidemiology

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

[5], [6], [7], [8], [9],

Causes of the gonorrhea in women

Causes of gonorrhea in women - Neisseria gonorrhoeae - gram-negative diplococcus, having the form of coffee beans, facing their concave surface to each other. Gonococci are located intracellularly in the protoplasm of leukocytes, usually in groups, but sometimes it is possible to see extracellular gonococci.

Gonorrhea is considered a sexually transmitted infection, and in case of detection of the subject to mandatory registration. The causative agent of gonorrhea is the gram-negative diplococcus Neisseria gonorrhoeae, which is a member of the Neisseriaceae family of the genus Neisseria. This is a bean-shaped coccus with cells arranged in pairs, concave sides to each other. The size of the cocci is 1.25-1.60 microns in length and 0.7-0.8 microns in diameter.

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

• the sensitivity of gonococcus to traditional antibacterial agents decreases;
• uncontrolled use of antibiotics promotes the emergence of resistant microorganisms;
• the frequency of isolation of penicillinase-producing strains of the gonococcus increases;
• cases of detection of mixed infections have increased, which leads to an increase in the severity of the course of the disease.

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

Gonorrhea in women is manifested most often in the form of urethritis, cervicitis, less often proctitis. Often there is a prolonged recurrent course of gonococcal infection. Asymptomatic infection is often met - in men up to 10% of cases, and in women up to 50%. In recent years, there have been an increase in cases of asymptomatic infection. Asymptomatic carriage is most often associated with extragenital localization of the process, for example in the rectum or pharynx.

[10],

Risk factors

• prostitution;
• numerous and occasional sexual intercourse;
• homosexuality;
• rare use of barrier methods of contraception and spermicides.

[11], [12]

Symptoms of the gonorrhea in women

As a rule, gonorrhea in women is manifested by a painful burning sensation in the genital area over time. The cause is purulent inflammation. After a certain time interval, pus begins to come out. The further, the stronger the painful sensations are accompanied by this process. Eventually, the pus thickens and turns from a yellow slurry into a thick enough brownish mass, which in its consistency resembles a jelly.

Also, if the upper part is affected, gonorrhea in women can be accompanied by uncomfortable sensations in the lower abdomen, as well as nausea. Consequences are: diarrhea, vomiting, a significant increase in body temperature (up to 39 degrees).

Gonorrhea in women has an incubation period that ranges from a few days to a week. However, medicine knows cases when an infected person did not feel any symptoms of the disease for a longer period. Such examples, in general, refer to the weaker sex, in men this is almost not found. Because of this prolonged incubation period, the subsequent treatment of the disease is greatly complicated.

In the case of oral sex, gonorrhea in women can lead to inflammatory processes in the oral cavity, as well as in the larynx. The itching pain is felt in the throat, which is accompanied by an increased level of salivation. In the case of anal intercourse, the infection manifests itself in the form of an uncomfortable sensation in the region of the anal opening caused by inflammation of the rectum. Bringing the gonorrhea to a neglected state in women is fraught with loss of reproductive function.

[13], [14]

Flow features

• Sluggish, asymptomatic course (associated with a decreased function of summer residents, an inadequate dose of sulfonamides that reduce the virulence of gonococci, the formation of L-forms of gonococcus);
• the infection often proceeds as a mixed-mixed infection: gonorrhea-trichomonas, gonorrhea-chlamydia, gonorrhea-mycoplasmic, gonorrhea-candidiasis);
• several organs are infected (multifocal lesion).

[15], [16], [17]

Forms

• The 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 infection, fresh gonorrhea gonorrhea in women is divided into acute, subacute and torpid.
  • Chronic gonorrhea in women, as a rule, has a torpid current with periodic exacerbations.
• Also, latent gonorrhea (gonokokonositelstvo), characterized by the absence of an inflammatory reaction in the presence of an agent on the mucosa, is isolated.
• Gonorrhea in women can be complicated and uncomplicated.
• Depending on the location of the pathological process, gonorrhea is divided into genital and extragenital.
• If an infection gets into the bloodstream, disseminated gonococcal infection may develop.

Gonorrhea of the lower part of the genital organs (urethritis, paraurethritis, bartholinitis, vestibulitis, cervicitis, endocervicitis) and gonorrhea of the upper genital organs, or ascending gonorrhea (endometritis, salpingitis, salpingoophoritis, pelvioperitonitis). Salpingitis is the most frequent manifestation of an ascending gonococcal infection. Gonococcal salpingitis is subacute, sluggish, with minor symptoms. Patients complain of the following symptoms of gonorrhea: aching pains in the lower abdomen, sometimes cramping, intensifying with physical exertion, during menstruation, with defecation. Gonorrhea in women symptoms are periodically exacerbated by alcohol and after sexual intercourse.

With gonococcal salpingo-oophoritis, patients complain of aching pain in the lower abdomen and in the region of the sacrum, which is strengthened with the tension of the abdominal wall. Sometimes the body temperature rises to 38-39 ° C, there is a chill. Violated rhythm, intensity and duration of menstruation. As a result of gonococcal salpito-oophoritis, tubal obstruction can develop.

Gonorrheal pelvioperitonitis occurs due to infection of the peritoneum with gonococci from the abdominal opening of the fallopian tube, from the opened pyosalpinx, pyovarium, and also penetration of them from the subserous base of the fallopian tube into lymphatic vessels.

[18], [19], [20]

Complications and consequences

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

Women:

• PID;
• ectopic pregnancy;
• abscess of Bartholin glands;
• pelvioperitonitis;
• infertility.

Men:

• orcoepididymitis;
• balanoposthitis;
• phimosis;
• paraphimosis;
• prostatitis;
• vesiculitis;
• stricture of the urethra;
• lymphadenitis;
• infertility.

Men and women:

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

[21], [22], [23], [24],

Diagnostics of the gonorrhea in women

Indications for examination for gonorrhea

Men:

• the presence of complaints of purulent or mucopurulent discharge from the urethra, itching of the urethra, symptoms of dysuria;
• the presence of pain in the epididymis;
• the presence of pain and discharge from the rectum, signs of proctitis;
• presence of inflammatory changes in the area of the external opening of the urethra, paraurethral cords, skin of the glans penis;
• presence of signs of inflammation of the prostate. Women:
• presence of inflammatory diseases of the genitourinary sphere, mucopurulent discharge from the cervical canal, symptoms of urethritis, adnexitis, proctitis, vulvovaginitis, cervicitis, PID;
• the presence of complaints about emerging subjective disorders in the genital area (itching, burning with urination, abdominal pain, bleeding, spotting, etc.);
• presence of cervical erosions;
• suffering from infertility, habitual miscarriages, with premature births in the anamnesis;
• directed to the interruption of pregnancy.
• Pregnant women are examined three times:
  • the first survey is conducted during registration;
  • the second - at the time of 27-30 weeks;
  • the third - in 36-40 weeks.
• After delivery on the 4-5th day.

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

• in gynecological hospitals all women who were not examined prior to admission, before prescribing antibacterial treatment;
• in the maternity homes, all the women in childbirth without exchange cards;
• puerperas with a complicated course of the postpartum period, better on the 5th-6th day after birth.

Newborns with purulent conjunctivitis and (or) vulvovaginitis. When confirming the gonococcal etiology of conjunctivitis and (or) vulvovaginitis, parents are examined.

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

Persons:

• Having sex with a sick gonorrhea;
• undergoing examination for other STIs;
• with diagnosed trichomoniasis, before and after treatment of the latter;
• decreed occupations in the course of compulsory pre-employment admission and periodic medical examinations in accordance with approved regulatory documents;
• victims of sexual violence.

[25], [26], [27], [28], [29], [30]

Laboratory diagnosis of gonorrhea in women

Methods of laboratory diagnostics are aimed at:

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

Methods for laboratory diagnosis of gonorrhea

• The microscopic method is aimed at microscopy of smears stained with methylene blue and by Gram - the main method of diagnosing gonorrhea. Sensitivity and specificity in men with symptoms of 95-99% and 97-98%, respectively, in those without symptoms 69% and 86%, respectively. The method is considered the main and referent in the diagnosis of gonorrhea in men. When diagnosing gonorrhea in women, the sensitivity of the method is 45-64% for endocervical tests and 16% for urethral tests.
• The bacteriological method is used to isolate and identify Neisseria. In men - to confirm the diagnosis. Sensitivity in men with symptoms is 94-98%, and in asymptomatic patients - 84%; specificity up to 100%, depending on the confirmatory methods. In women, this method is considered the main method of diagnosis. Sensitivity of the method for endocervical tests is 86-96%, for urethral - 60-86%; specificity up to 100%, depending on the confirmatory methods. Be sure to use for examining children and women in menopause. The main method of diagnosis in the study of extragenital materials, with sensitivity for samples from the pharynx 50-70%, conjunctiva 70-80%, rectum 70-85%; specificity up to 100%. Used to determine the sensitivity to antibiotics.
• Molecular-biological method (polymerase chain reaction - PCR), NASAVA in real time) involves the detection of DNA or RNA of the pathogen. Applied only as screening with subsequent confirmation by culture method.
• Immunological method (direct immunofluorescence - PIF) involves the detection of antigens of the pathogen. Applied only as screening with subsequent confirmation by culture method. Can be used to identify Neisseria in culture.
• Serological methods (complement fixation, latexagglutination, immunofluorescence, immunoblotting, and others) do not distinguish the current infection from the past. Therefore, in order to diagnose gonorrhea, serological reactions are not used.

Areas for taking the main material:

• urethra in young men and adult men with or without secretions;
• cervical canal of the cervix and urethra in women;
• rectum in women and male homosexuals;
• oropharynx, if there was an orogenital contact.
• Other areas:
  • rectum and urethra in women, if the cervix is removed;
  • material from the pelvic organs when performing laparoscopy in women with PID;
  • blood and other fluids in the dissemination of infection (eg, pus);
  • synovial fluid;
  • Aspirate from epididymis in epididymitis;
  • conjunctiva;
  • the first portion of freely released urine (10-15 ml) in men for the PCR method.

Screening of gonorrhea in women

Survey on gonorrhea is subject to:

• 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 sick gonorrhea;
• persons undergoing testing for other STIs;
• newborns with purulent conjunctivitis, in the detection of gonorrhea etiology of conjunctivitis, the parents are examined.

Indications for counseling specialist for gonorrhea - diagnosis and treatment of gonorrhea in women, gonorrhea in pregnant women, children and adolescents are conducted in specialized institutions of the dermatovenereological profile.

The procedure of the doctor with the established diagnosis of gonorrhea

1. Tell the patient about the diagnosis.
2. Presentation of information on behavior during treatment.
3. Gathering of a sexual anamnesis.
4. Identification and examination of sexual contacts are carried out depending on the clinical manifestations of the disease and the estimated duration of infection:
   • for acute manifestations of the disease - from 3 days to 3 months;
   • at torpid and malosymptomnom process - 6 months.
5. Detection of household contacts of the patient is carried out:
   • among girls living together on the same living space;
   • In the case of detection of gonorrhea in children (girls) attending a preschool, children (girls) and workers of the group are examined.
6. In the case of detection of gonorrhea in a woman in labor or a woman in a hospital, a newborn is examined, taking material for microscopy and culture from the vulva and conjunctiva of both eyes. When revealing gonorrhea, the newborn is examined by his parents.
7. In the presence of gonococcal genital, rectal and pharyngeal infections in children in the postnatal period, it is necessary to suspect sexual violence. Native brothers and sisters of an infected child should also be examined. The fact of sexual violence must be reported to law enforcement agencies.
8. Conduction of epidemiological measures among the contact persons (sanation of the epidemic focus) is carried out jointly with the regional epidemiologist:
   • inspection and examination of contact persons;
   • ascertaining laboratory data;
   • the decision on the need for treatment, its scope and timing of follow-up.
9. In case of residence of contact persons in other territories, a dress-card is sent to the territorial HLC.
10. In the absence of results from treatment, the following possible causes are recommended:
    • false positive result of the study;
    • non-compliance with treatment regimen, inadequate therapy;
    • repeated contact with an untreated partner;
    • infection from a new partner;
    • infection with other microorganisms.

Treatment of the gonorrhea in women

Gonorrhea in women, pregnant women, children and adolescents is treated in specialized institutions of the dermatovenerologic profile.

The patient should be constantly monitored and monitored. It is treated gonorrhea in women should be systematically, and also in combination with the strictest bed rest. And antibiotic therapy should be prescribed in accordance with the stage and complexity of the course of the disease.

In the absence of the above-mentioned antibiotics, gonorrhea in women is treated using alternative schemes: spectinomycin, 2 g once / once, or a single-time regimen for cephalosporins (ceftizoxime 500 mg IM once, or cefoxitine 2 g once with probenecid 1 g orally) .

Patient education

In a conversation with patients, the doctor needs to show patience, respect, compassion and not to condemn. An effective method of communicating with a patient includes using terms that are understandable to him, as well as assuring the patient that the treatment of gonorrhea in women will be provided regardless of his ability to pay, citizenship, immigration status, the language he speaks or lifestyle. Training of patients should be aimed at implementing measures to prevent infection of sexual partners.

Prevention

The only true means of preventing gonorrhea is the use of a condom partner. The most suitable is the latex safety product, however, in case of latex intolerance, a polyurethane membrane can be used.

Especially not recommended antibiotic prophylaxis after sexual contact, since a similar 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 infection of the partner is quite high. Also, doctors do not recommend taking a large number of antibiotics after each questionable sexual contact, since such a method is fraught with serious violations 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 the pill that is used to treat gonorrhea is Cefixime.

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

Modern preventive measures include both training and changing motivations and behaviors. In general, preventive work is divided into primary and secondary.

• Primary prevention of gonorrhea involves the implementation of theoretically valid interventions aimed at changing patterns of behavior in high-risk populations to prevent infection. Currently, preventive activities in the community include mainly health promotion of sexual health and information to the public on the pages of the periodical press, in the media, schools and other educational institutions, as well as in medical institutions. The population should be aware of the features of early and late clinical manifestations of infections, ways of infection, ways of preventing them. It is also important to inform about the places of purchase of individual prevention products. In addition, preventive programs should provide for the refusal of self-treatment and unprofessional treatment in cases of suspected infection.
• Secondary prevention of gonorrhea is aimed at individuals with diagnosed sexually transmitted infections to reduce the likelihood of transmission of infection to partners during the "infectious" period during sexual intercourse. Secondary prevention should be aimed at reducing the risk of re-infection among patients and already ill persons.

Individual prevention of gonorrhea can be carried out independently by a person who has been exposed to the risk of contracting a sexually transmitted disease as a result of accidental sexual intercourse. It is carried out with the help of individual portable (pocket) preventive devices, 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.

[31], [32], [33]

Forecast

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

[34], [35], [36]