Indications and methods of provocation for STIs. Preparing for tests for hidden sexually transmitted infections

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The disease affects the genitourinary system, selectively affects the cylindrical epithelium, and can therefore cause the following diseases: inflammation of the urethra, Bartholin's gland, cervical canal, uterus, uterine appendages and pelvic peritoneum.

Infection mainly occurs through sexual contact.

But a non-sexual route of infection through linen, sponges, and towels is possible. Newborns may become infected during passage through the birth canal of a mother with gonorrhea. There is no strong immunity, so you can get sick many times. The incubation period can last 2-7 days.

Classification of gonorrhea

Acute - illness up to 2 months,
- chronic.

Acute gonorrhea is characterized by an acute onset, symptoms of urethritis, endocervicitis, bartholinitis, etc. A woman is worried about itching in the urethra, pain at the beginning of urination and an increased urge to urinate. Sometimes patients complain of vaginal discharge, rarely - of nagging pain in the lower abdomen.

Sometimes there are forms of gonorrhea that are not associated with the genital organs: gonorrhea of ​​the rectum, gonococcal lesions of the oral cavity, pharynx, larynx, eyes, kidneys, gonococcal arthritis, endocarditis, etc. Damage to the oral cavity, pharynx, larynx is most often the result of oral sex and usually combined with gonorrhea of ​​the genitourinary system.

For gonococcal stomatitis clinical manifestations occur 2 days after infection. Patients begin to be bothered by dry mouth, burning of the lips and tongue, and subsequently increased secretion of saliva containing mucopurulent impurities, and sometimes bad breath. The oral mucosa is painful, and if the pharynx is affected, complaints of painful swallowing appear.

For rectal gonorrhea, infection of which most often occurs during anal sexual intercourse, women experience painful defecation, pain and itching in the anal area, and purulent-bloody discharge from the anus.

Chronic gonorrhea- This is a sluggish disease lasting more than 2 months. Fresh torpid gonorrhea is an asymptomatic disease, its manifestations are insignificant or absent.

With fresh gonorrhea, gonococcus can be detected in smears.

Fresh gonorrhea, in turn, is divided into:

Spicy,
- I’ll sharpen it up,
- torpid.

Features of the course of gonorrhea

Gonorrhea often occurs as a mixed infection, combined with trichomoniasis, chlamydia, mycoplasmosis, etc.

According to the localization of the process, they are distinguished:

Gonorrhea of ​​the lower part of the genitourinary apparatus: includes gonorrhea of ​​the urethra, paraurethral passages, large glands of the vestibule of the vagina, cervix;
- gonorrhea of ​​the upper genital apparatus - ascending: gonorrhea of ​​the uterine body, tubes, ovaries and peritoneum.

Gonorrheal urethritis- This is acute urethritis, one of the common manifestations of gonorrhea. However, in women it manifests itself with few symptoms due to the wide and short urethra: minor pain and burning when urinating. With chronic urethritis there are even fewer complaints, sometimes frequent urination occurs.

Gonorrheal endocervicitis- in the acute stage, dull pain in the lower abdomen and mucous or purulent discharge from the vagina are disturbing.

Gonorrheal bartholinitis- less commonly infected with gonococcus; when the excretory duct becomes infected, the outflow from the gland may be disrupted and a false or sometimes true abscess may form. In this case, the gland increases in size, is sharply painful, and the temperature may rise.

Gonorrheal vulvitis It happens secondary in adult women, which is associated with irritation of the mucous membrane of the vestibule by leaking secretions and can manifest itself as itching and burning in the vulva area.

Gonorrheal proctitis most often develops secondary to the flow of vaginal or urethral discharge into the rectum or due to anal sex. Gonococcus affects not only the mucous membrane of the rectum, but also the deeper layers of the rectal wall, leading to infiltrates and abscesses. Patients are concerned about pain and burning in the anus, painful urge to defecate.

To confirm the diagnosis, it is necessary to take smears from the urethra and cervical canal. The absence of gonococcus in smears does not confirm the absence of the disease; various methods of provocation are used to detect gonorrhea.

Ascending gonorrhea It is customary to call inflammation of the internal genital organs located above the internal os of the uterus (body of the uterus, fallopian tubes, ovaries, pelvic peritoneum). The spread of infection is facilitated by menstruation, especially if hygiene rules are not observed (for example, sexual activity during menstruation), the postpartum and post-abortion periods, intrauterine manipulations with unrecognized gonorrhea of ​​the lower genitourinary system, as well as the weakening of the body's defenses as a result of hypothermia, physical stress, etc.

Gonorrheal endometritis occurs as a result of gonococci entering the uterine cavity; if infection occurs during menstruation, the gonococci immediately enter the basal layer of the mucous membrane. The disease begins with chills, fever, malaise, sharp pain in the lower abdomen and purulent discharge from the uterus. There are often symptoms of intoxication - dry tongue, rapid pulse.

After 3-4 months, inflammatory changes in the endometrium disappear, and endometritis becomes chronic with damage to the uterine muscle. This is usually manifested by constant pain in the lower abdomen, profuse watery or mucopurulent discharge, painful periods, and various menstrual irregularities.

Gonorrheal inflammation of the appendages results from the passage of infection through the tubes to the ovaries. When the tube becomes inflamed, purulent contents appear in its lumen, the tube becomes sealed, its patency is impaired, and it takes the form of a retort - pyosalpinx, sactosalpinx.

Pathogens entering the follicle contribute to the formation of an abscess, which sometimes spreads to the entire ovary. The outcome may be recovery, but more often the tube and ovary turn into saccular formations, which under unfavorable conditions can burst, leading to inflammation of the peritoneum.

Gonorrheal pelvic peritonitis occurs as a result of gonococcus entering the peritoneum. It proceeds very violently: high body temperature, chills, pain in the lower abdomen, stool retention, flatulence, difficulty urinating.

The acute period lasts about a week, and then becomes chronic, which lasts another 3-6 weeks.

Provocation for gonorrhea

Physiological provocation is taking smears for bacteriological examination on the days of menstruation, after childbirth and after abortion. An increase in secretion during provocation helps to “wash out” gonococci from the depths of the glandular ducts and increases the frequency of their presence in smears. Artificial provocation of the inflammatory process is achieved through biological, thermal and chemical provocation.

Biological provocation consists of a single intramuscular injection of gonovaccine (500 million microbial bodies).

Thermal provocation is carried out using inductothermy with a vaginal electrode or 4-5 vaginal mud tampons.

Chemical provocation consists of treating the mucous membranes of the urethra, rectum with a 1% solution, and the cervical canal with a 5% solution of silver nitrate or Lugol's solution on glycerin.

After applying these methods, smears are taken after 24,48 and 72 hours.

S. Trofimov

Making a diagnosis of the presence of any infectious STD is always preceded by a number 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 does not have resistance.

Types of analyzes

Depending on the data of the initial examination, the dermatovenerologist 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 is bacteria and fungi. It is highly accurate, but requires a lot of time (about 14 days), so it often only serves as confirmation of the established diagnosis. In venereological practice, samples for tank cultures are taken from the vagina, cervical canal, urethra, and ejaculate.
• Serological analysis is the detection of specific antibodies in the blood for a specific pathogen. Such an analysis for hidden infections of the genital organs quite accurately and quickly identifies pathogens, and in some cases, determines the degree of development of the disease (chronic or acute).
• PCR is the detection of DNA fragments of the pathogen, even if it has not yet led to the development of pronounced symptoms.

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Patient preparation

Test results largely depend on proper preparation of the patient before the examination. To reduce the likelihood of distortion of the obtained data and increase the accuracy of the study, specialists of the EUROMEDPRESTIGE clinic recommend adhering to the following rules:

• When testing for sexually transmitted infections with a blood test, you should refrain from eating 8 hours before collecting biomaterial. It is best to undergo the procedure in the morning.
• During serological analysis with suspected syphilis, it is not recommended to eat fatty foods 24 hours before sampling. Violation of this recommendation may lead to a false positive result and the prescription of incorrect treatment.
• Urogenital swabs are taken only after 3-4 hours of abstaining from urination. This will ensure that a sufficient amount of biomaterial is present on the urethral tissue, which would otherwise be washed away by urine.
• Bacteriological studies exclude the possibility of taking antibiotics in any form. Even taking medications a week before the test will affect the accuracy.
• Rashes on the genitals and adjacent tissues are indications for additional examination of scrapings from the affected parts. In this case, the patient is recommended to stop taking local and systemic medications that reduce itching and inflammation several days before the test.
• Testing for sexually transmitted infections in women is most informative in the first days after menstruation. It is also recommended to abstain from sexual intercourse for at least three days before donating biomaterial.

Provocation of pathology and its necessity in modern venereology

In some cases, when the disease is at an early stage and the doctor has doubts about the diagnosis, a “provocation” may be required - a temporary decrease in the body’s defenses, increasing the activity of the pathogen. Due to the accuracy of modern laboratory tests for sexually transmitted infections, provocation is resorted to quite rarely, most often if there is a suspicion of a latent form of the disease.

The simplest option is nutritional provocation by consuming certain foods and dishes: spicy, salty, smoked, alcohol. For example, in the absence of other contraindications, the doctor may recommend drinking one or two glasses of beer with the usual snacks (smoked or salted fish, bacon, etc.) 1-3 days before taking tests for hidden infections. This will help the pathogen to manifest itself, and it will be detected during laboratory tests. For some STD pathogens, there are specially developed provoking 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 STD, we recommend that you consult a dermatovenerologist at the EUROMEDPRESTIGE clinic. Here you will find modern diagnostic methods, precision equipment and highly qualified personnel who can quickly determine the cause of the problem and eliminate it.

Gonorrhea is an infectious disease of the human body that primarily affects the mucous membranes of the urogenital tract, caused by gonococcus and transmitted mainly through sexual contact.

What is gonorrhea:

• Pathogen is gonococcus (discovered in 1879 by Neisser)
• Sources of infection: a sick person, his household items.
• How is gonorrhea transmitted? The following are ways you can become infected with gonorrhea:
  • Sexual
  • Extrasexual– through household items, in newborns – when passing through the birth canal. It is rare, more often from mothers to girls.
  • Transplacental– gonococcal meningitis and various joint inflammatory processes develop.

Immunity from gonorrhea

There is no innate or acquired immunity against 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 the 14th day. But this immune response is not sufficient.

Classification of gonorrhea:

1. Forms of gonorrhea:
   1. Genital
   2. Extragenital
   3. Metastatic
2. According to the time criterion:
   1. Fresh
      1. Acute
      2. Subacute
      3. Torpidnaya
   2. Chronic
   3. Latent
3. According to the anatomical features of the organ involved in the process:
   1. Urethritis (in men)
      1. front
      2. rear
      3. total
   2. Endocervicitis (in women)

Separately allocate gonococcal carriage.

ABOUT fresh gonorrhea they 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 can 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 riding in bumpy vehicles and alcoholism.

Symptoms and course of gonorrhea

Typically, the first symptoms of gonorrhea are mild itching in the urethra and burning during urination. Then swelling of the foreskin and glans penis may appear, and light discharge from the urethral canal in the morning. After some time, the situation worsens, the discharge becomes purulent, severe pain appears during urination, frequent urge to urinate, and pain on palpation of the urethra.

Incubation period of gonorrhea(from the onset of infection to the first manifestations). The duration of the incubation period ranges from 1 day to 2-3 weeks, with an average of 3-5 days.

The infection can penetrate through the intercellular spaces subepithelial into the connective tissue and cause inflammation. In addition, the lymphatic system is affected (there may be lymphadenitis). The infection can also spread hematogenously (through the bloodstream). Such a spread can provoke, for example, gonococcal arthritis.

After 2-3 weeks, the severity of urethritis symptoms decreases, which is mistakenly taken for recovery.

Based on clinical signs only diagnosis of gonorrhea can't bet. It is placed 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 to find out:

• when the possible infection occurred
• possible source of infection
• were any measures taken that could change the course of the disease
• whether treatment was carried out for this or other diseases, whether this disease occurred in the past
• there may be a recurrence of the disease
• clarify the possibility of infection of other persons and other questions at the discretion of the doctor.

Clinical picture

Clarification of the etiological factor:

• microscopy method
• bacterioscopy method
• enzyme immunoassay method
• immunofluorescent method
• method of allergy testing for gonococcal allergens
• setting up a 2 or 3 glass sample

2 glass sample

If the urine is cloudy, but this is normal, then it clears up when concentrated acids are added. In pathological urine there are threads of mucus and epithelium floating in the glass and at the bottom of it there are crumbs of pus. Urethritis is characterized by turbidity, which does not go away after exposure to acids, mucus, and crumbs. If there is turbidity in only 1 glass, then it is acute anterior urethritis, if in 1 and 2 glasses, then it is chronic (anterior and posterior) urethritis.

Taking a smear from the urethra

A “Volkmann spoon” is used. It is inserted into the urethra 1.5 cm, with the convex part downwards, turned 180 degrees and a careful scraping is made along the urethral mucosa. Smears are stained with Gram or methylene blue. It is possible to sow a loop from a scraping of the urethra onto a nutrient medium. All laboratory diagnostics are carried out against the background of urinary retention for at least 2 hours.

The “Volkmann” spoon is intended for taking samples of secretions from the mucous membrane of the vagina, cervix and urethra for preparing smears

Chronic gonorrhea occupies a special place in diagnosis, 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. All that remains is the anamnesis, the clinical picture disappears or is minimal (scanty mucous discharge from the urethra in the morning, sticking of the urethral sponges).

Provocation

Gonococcus may be present in the form of L-forms, capsulated forms. It can hide in the mucous membrane and during microscopy and bacterioscopy there is a possibility of not getting the pathogen. There are methods of provocation for this. Everything is aimed at enhancing the inflammatory response at the expense of the body. Several types of provocations:

• nutritional (alcohol consumption)
• physical methods of irritation (palpation, physiotherapy)
• mechanical irritation (bougienage)
• chemical irritation (introduction of silver, protargol into the urethra)
• biological irritation (administration of gonovaccine)

Most often in diagnosis of chronic gonorrhea They use a combined provocation – biological + chemical.

Gonovaccine– contains 8-12 killed gonococcus strains. 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. 60 million microbial bodies are administered intramuscularly as a diagnosticum.

After a combined provocation, an examination is carried out according to the following scheme: taking smears after 24 hours - 48 hours - 72 hours. You may get gonococcus, or you may not detect it. There are cases when gonococcus can be detected only after 5-8 provocations.

Treatment of gonorrhea

Now gonococcal infection is combined with other types of infection - trichomonas and chlamydia. If trichomonas urethritis is also added to this, then gonococci absorb part of the trichomonas - treatment must be carefully selected.

1. Treatment of fresh, uncomplicated gonorrhea - the antibiotic of choice is drugs from the penicillin and cephalosporin group. The dose and frequency of administration is determined by the doctor.
2. For chronic gonorrhea: immunotherapy and antibiotic therapy are performed. For immunotherapy, pyrogenal, prodigiosan, gonovaccine (150-200 million microbial bodies) are used.
3. When gonococcal and trichomonas infections are combined, they begin with treatment of trichomoniasis with tenidazole, then prescribe antibiotic treatment for gonorrhea for 2-3 days. When a gonococcal infection is combined with chlamydial infection, treatment is carried out with tetracycline antibiotics.

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 remains 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 in advance about the possible consequences of accidental unprotected sexual contact and take appropriate measures.

Two partners need to be treated at once. If left untreated, the infection can lead to more serious and chronic illnesses. In addition, gonorrhea can cause tubal adhesions in women, which can lead to infertility.

Criteria for curability of gonorrhea

Criteria for the curability of gonorrhea begin to be determined 7-10 days after the end of treatment. The absence of clinical manifestations is assessed during examination, palpation and according to the patient. Then a combined provocation is carried out in order to objectively assess curability. Gonovaccine and protargol are administered intraurethrally. A smear is taken after 24 hours – 48 hours – 72 hours. If there is nothing in the smears, then this is objective curability. A month later, the prostate gland is examined, urethroscopy, and blood tests for RV (Wassermann reaction). If these indicators are normal, then the patient is removed from the register. The Wasserman reaction (WR) is mandatory.

Prevention of gonorrhea

The main method of preventing gonorrhea is choosiness in sexual intercourse and the use of barrier contraception (condom). In case of accidental unprotected sexual intercourse, prevention is carried out at prevention points at dermatovenerological institutions, preferably in the first 2-3 hours.

Method for preventing gonorrhea after unprotected sex

1. The visitor washes his hands, urinates, and washes the genitals with warm water and soap, including the skin of the thighs and perineum.
2. After drying with a napkin, wipe these areas with a napkin soaked in hibitan or miramistin solution or mercuric chloride solution 1:1000.
3. From Esmarch's mug, the anterior part of the urethra is washed with 0.5 l of a 0.05% solution of hibitan or a 0.01% solution of miramistin.
4. 1-2 ml of 0.05% hibitan or miramistin is injected into the urethra, and 6-8 drops of a 2-3% aqueous solution of protargol using an eye pipette. Do not urinate for 2-3 hours.
5. Place a sterile gauze pad to remove soiled linen. All this is carried out in the first hours.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is gonorrhea?

Today, gonorrhea is considered a rather serious social problem, as more and more people of working age are becoming ill with this pathology. Gonorrhea can occur in all age groups, but adolescents and young, able-bodied people aged 18 to 30 are most at risk of infection. It is also worth noting that among adolescents women are most often affected, while among adults it is men.

The spread of gonorrhea can be facilitated by:

• Increase in the population at risk.
• Social disasters ( wars, natural disasters and others), associated with deterioration of sanitary and hygienic living conditions.
• Promiscuous sexual intercourse.
• Alcohol and drug abuse.
• Prostitution.

The causative agent of gonorrhea

After fixation on epithelial cells, gonococci pass through the intercellular spaces under the epithelial tissue, which leads to activation of the body’s immune system and the development of the inflammatory process. Cells of the immune system ( neutrophils) are delivered through the bloodstream to the site of infection and begin to actively absorb pathogens. However, gonococci absorbed by neutrophils usually do not die, and sometimes can even continue to multiply, supporting the inflammatory process. The purulent masses that form as a result are many dead neutrophils, inside of which active ( contagious) gonococci. The resulting pus accumulates on the surface of the affected mucous membrane and can be discharged from the genitourinary canal.

As the disease progresses, gonococcal infection spreads to new areas of the mucous membrane, affecting new organs ( prostate gland and seminal vesicles in men, uterus, fallopian tubes or ovaries in women), leading to the development of complications. Also, gonococci can penetrate the lymphatic vessels and spread to distant organs with the lymph flow. It is extremely rare that gonococci can penetrate into the blood, leading to the development of severe purulent complications.

It should be noted that gonococci are highly resistant in the human body. When exposed to unfavorable factors ( including when using antibacterial drugs) they can turn into the so-called L-forms, which are not able to reproduce, but can survive for a long time in unfavorable conditions and then be activated again. However, under environmental conditions ( outside the host) resistance of gonococci decreases. They die when the fluid with which they were excreted from the body dries out ( pus, sperm and so on). When heated to 41 - 55 degrees, they die almost instantly, as when they get into soapy or salty water. Also, gonococci are very sensitive to many antibiotics and antiseptics ( disinfectants).

Ways of infection with gonorrhea

You can get gonorrhea:

• Sexually. The most common ( more than 95% of cases) a 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 one sexual contact with a sick woman, a man can become ill with a probability of 17–20%, while a woman, upon contact with a sick man, will become infected with a probability of 80%. This difference is due to the peculiarities of the anatomical structure of the male and female urethra ( urethra). In women, the urethra is shorter and wider, which facilitates the entry 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 spread of gonorrhea occurs in less than 1% of cases, which is due to the low resistance of infectious agents in environmental conditions ( outside the host body).
• Vertical way. This route of transmission is characterized by infection of a newborn during passage through the birth canal of an infected mother. In this case, gonococcal infection can affect the mucous membrane of the baby’s eyes, mouth or genitals.

Incubation period of gonorrhea

After infection with gonococcus, the incubation period lasts from 12 hours to several weeks ( extremely rarely up to 3 months), which is due to the characteristics of the infectious agent, 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 3–4 days after infection, and in women 8–10 days after infection. Longer incubation periods may occur in older people and in people with AIDS ( acquired immunodeficiency syndrome), since 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 infectious to others. This is why frequent changes of sexual partners are one of the most important factors in the spread of gonococcal infection.

Forms of gonorrhea

Depending on the time since infection, there are:

• fresh gonorrhea;
• chronic gonorrhea;
• hidden ( latent, asymptomatic) gonorrhea.

Fresh gonorrhea

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 ( ulcerations).
• In subacute 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 and 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 weak or absent altogether.

Chronic gonorrhea

The chronic form of the disease is characterized by a sluggish, recurrent or even asymptomatic course ( in 95% of men, it is difficult to identify any subjective symptoms 3 months after infection). Obvious signs of the disease can be detected during the period of exacerbation of the disease, progress over several days and disappear on their own, which significantly complicates the diagnostic process. In this case, proliferative changes occur in the urethra itself, that is, there is an excessive growth of connective tissue, which can block the lumen of the urethra, complicating the outflow of urine.

Hidden ( latent, asymptomatic) gonorrhea

It is worth noting that in men, even with a latent form of gonorrhea, certain nonspecific signs may be observed ( sticking of the urethral sponges after a night's sleep, the appearance of a small amount of cloudy discharge from the urethra after prolonged walking, running or having sex). However, these manifestations do not cause the patient any inconvenience and are extremely rarely a reason to consult a doctor. The person continues to live a normal life, exposing sexual partners or family members to the risk of infection.

Symptoms and signs of gonorrhea

Symptoms of gonorrhea in men

• 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 over its entire surface ( in this case we are talking about total urethritis). With the development of the inflammatory process, dilation of blood vessels, increased blood flow and swelling of the mucous membrane are noted. Externally this is manifested by hyperemia ( redness) and swelling of the sponges of the external opening of the urethra, discomfort when urinating and other symptoms.
• Pain and itching. Pain and itching in the urethra are among the first symptoms of gonorrhea. The 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 explained by inflammation and swelling of the urethral mucosa. Also in the inflamed tissue changes ( rises) sensitivity of pain 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 with the first portions of urine). As the disease progresses, pus can be released from the urethra and outside of urination, staining underwear and bed, 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. Hemospermia may also occur ( the appearance of blood in semen).
• Urinary disorders. Impaired urination with 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 and inflammatory process can spread to the posterior parts of the urethra, which will be manifested by frequent urge to urinate, during which a small amount of urine and/or pus will be released.
• Increasing temperature. Body temperature during gonorrhea can remain normal, but in some cases the development of acute gonorrheal urethritis is accompanied by an increase in temperature 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 surrounding tissues during the development of the inflammatory process, affecting the thermoregulation center in the brain and thereby increasing body temperature.

Symptoms of gonorrhea in women

Gonorrhea in women can manifest itself:

• Copious purulent or mucopurulent discharge from the urethra, worsening 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, which gets worse when you start urinating or during sexual intercourse.
• An increase in body temperature to 37 - 38 degrees.

Skin lesions due to gonorrhea

Eye damage due to gonorrhea

Clinically, eye damage due to gonorrhea is manifested by gonococcal conjunctivitis ( inflammation of the conjunctiva, the thin transparent membrane covering the outside of the eye). The incubation period usually lasts from 3 to 5 days, after which a person develops characteristic manifestations of the disease.

Gonococcal conjunctivitis can manifest itself:

• pronounced redness of the conjunctiva;
• bleeding of the conjunctiva;
• pronounced swelling of the eyelids;
• purulence from the eyes;
• increased lacrimation;
• photophobia.

Damage to the throat and mouth due to gonorrhea

Damage to the oral cavity with gonorrhea can manifest as 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 ( rectal gonorrhea)

Anal gonorrhea can manifest itself:

• Itching and burning in the anus and rectum.
• Tenesmus. Tenesmus is a frequently repeated, very painful false urge to defecate, during which a small amount of mucopurulent or feces is released ( or nothing stands out at all).
• Constipation. Constipation can develop due to damage and destruction of the rectal mucosa.
• Pathological discharge. 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 the first portion of stool).

Symptoms of gonorrhea in newborns and children

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 damage ( ophthalmia of newborns);
• damage to the nasal mucosa ( rhinitis);
• damage to the urethra ( urethritis);
• damage to the vaginal mucosa ( vaginitis);
• septic condition ( developing as a result of the penetration of pyogenic microorganisms into the blood).

Methods for diagnosing gonorrhea

• smear for gonorrhea;
• methods of provoking gonorrhea;
• culture for gonorrhea;
• laboratory methods for diagnosing gonorrhea;
• instrumental methods.

Gonorrhea smear

It is worth noting that this research method is effective only in acute forms of the disease, when the infectious agent is released from the urethra ( or other affected area) along with pus. In chronic gonorrhea, it is not always possible to isolate gonococcus using a regular smear, and therefore additional tests are often prescribed.

Methods of provoking gonorrhea

Provocation for gonorrhea can be:

• Biological. The essence of biological provocation is that the patient is injected intramuscularly with an inactivated gonococcal vaccine. This drug contains inactive gonococci, on the surface of which special antibodies are preserved. These antibodies stimulate the body's immune system, promoting more active absorption of gonococci by neutrophils ( cells of the immune system) and excreting them with pus. Also, biological stimulation can consist of intramuscular or rectal ( into the rectum) administration of the drug pyrogenal, which is an immunostimulant ( activates the body's immune system).
• Chemical. The essence of this method is the introduction of various chemicals into the urethra ( 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.
• Nutritional ( food). Its essence lies in the intake of spicy and/or salty foods, as well as alcohol.

Culture for gonorrhea

It is important to remember that the collection 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

The following may help in diagnosing gonorrhea:

• General blood analysis. A general blood test 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 in men and 15 mm per hour in women. This is explained by the fact that during gonorrhea, so-called acute phase inflammatory proteins are released into the bloodstream. They are attached to the surface of red blood cells ( red blood cells) and promote their gluing, as a result of which the latter more quickly settle to the bottom of the test tube during the study.
• General urine analysis. A general urine test 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 red blood cells in the urine.
• Three-glass Thompson test. This is a special urine test that is prescribed to men to determine the location of the pathological process. Morning urine is taken for analysis ( the day before the test, the patient should not take red vegetables and fruits, which can change the color of the urine). The material is collected into all three glasses during a single urination ( the patient urinates first in one, then in the second and then in the third glass, without interrupting the stream of urine), after which each sample is examined separately. If pus is detected 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 portions, there is a high probability of damage to the posterior urethra, prostate gland and seminal vesicles.
• Direct immunofluorescence reaction. This study makes it possible to identify gonococci in the test material in a fairly short period of time. Moreover, the direct immunofluorescence method is effective if the material being studied contains many other microorganisms in addition to gonococci. The essence of the method is as follows. A smear is prepared from the resulting material, fixed on glass and stained with special dyes, and then treated with a special fluorescent antiserum. This antiserum contains antibodies that will interact with ( unite) only with antigens present on the surface of gonococci. Also, special tags are attached to these antibodies, which glow when examined under a special microscope. If the test material contains gonococcal flora, the antibodies will combine with the antigens, as a result of which the gonococci will begin to glow, while other microorganisms will remain “invisible”.

PCR for gonorrhea

For gonorrhea, a set of enzymes is added to the material under study, which should 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 you to detect gonococci even at their minimum concentration in the biomaterial.
• Specificity– probability of erroneous ( false positive) result is practically zero ( This is possible if safety rules in the laboratory are not followed, when sections of DNA from the environment may enter the material being studied.).
• Speed ​​of execution– a positive result can be obtained within a few hours after collecting the material from the patient.

Instrumental research methods

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 urethroscope - a special apparatus consisting of a long flexible tube with a camera at the end. During urethroscopy, the doctor can assess the condition of the urethral mucosa, identify erosions, sources of bleeding or places of pathological narrowing.
• Colposcopy. In this study, the doctor examines the mucous membrane of the vaginal opening using a special device - a colposcope, the optical system of which allows you to study different areas of the mucous membrane under multiple magnification.
• Cervicoscopy. A method of 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 with video cameras at the ends are inserted into the patient’s abdominal cavity through small punctures in the anterior abdominal wall. This allows you to visually examine the condition of the fallopian tubes and ovaries, assess their patency, and, if necessary, carry out some therapeutic manipulations.

Currently, the following provocation methods are recommended: chemical (lubricating the urethra with a 1-2% lapis solution, and the cervical canal with a 2-5% lapis solution or Lugol's solution on glycerin); biological - intramuscular administration of gonovaccine in a dose of 0.5 ml (500 million microbial bodies) or simultaneously with pyrogenal (200 MID), if gonovaccine has already been used (for treatment), then the last double therapeutic dose is prescribed, but not more than 2 ml (2 billion microbial bodies), as a biological method, intramuscular injections of sinestrol (0.5 ml of 2% solution) can be used for 3 days; nutritional (salty, spicy foods, beer); thermal (prescription of inductotherapy, diathermy).

It is advisable to carry out provocation immediately after menstruation.

The best is a combined provocation: women are given a single intramuscular injection of 500 million microbial bodies of gonococcal vaccine or gonovaccine with pyrogenal (200 MTD). The urethra and lower segment of the rectum are lubricated with 1% Lugol's solution on glycerin, and the cervical canal is lubricated with a 5% solution of silver nitrate. Over the next 3 days, swabs are taken.

B. S. Kaliner ()