Gonorrhea in men is a common venereal disease of an infectious-inflammatory nature, affecting the cylindrical epithelium of the mucous membranes of the urethra and paraurethral glands. Less commonly, there is a lesion of the pharynx, soft palate, tonsils, rectum and conjunctiva of the eyes.
Causes and risk factors
The disease is caused by gonococci - gram-negative diplococci of the Neisseria gonorrhoeae species, which are located on the surface of epithelial cells, red blood cells and spermatozoa, in the extracellular and subepithelial space. Also, bacteria can be located inside leukocytes, epithelial cells and other microorganisms, in particular Trichomonas.
Infection with gonorrhea in men occurs mainly through sexual contact; the probability of infection with a single contact with a sick woman is 25–50%. Susceptibility to gonococcal infection increases with the tightening of sexual intercourse, ejaculation and during menstruation at the partner. Contact transmission of gonorrhea for men is not typical.
Personal prevention of gonorrhea in men involves the observance of sexual hygiene: unprotected contact and casual relationships should be avoided.
The peak incidence occurs at the age of maximum sexual activity - from 20 to 30 years. After infection, the body produces antibodies to gonococci, however, immunity to gonorrhea does not develop.
Gonococcal infection is characterized by a large variety of manifestations. Depending on the location, there are several forms of gonorrhea:
- gonorrheal urethritis (gonococcal infection of the lower genitourinary system) with and without complications,
- ascending gonorrhea - gonorrheal pelviperitonitis and the defeat of the upper urinary tract (in men is extremely rare),
- gonococcal infection of the anorectal region (gonorrheal proctitis),
- gonococcal pharyngitis, tonsillitis and stomatitis,
- gonococcal infection of the musculoskeletal system (gonarthritis),
- gonococcal infection of the eye (blénéria), etc.
Most often, gonorrhea in men occurs as urethritis. The infection spreads throughout the urogenital tract, seizing seminal vesicles, prostate, testicles and appendages, in severe cases, the peritoneum is affected.
Gonorrheal pharyngitis, stomatitis and tonsillitis occur as a result of infection during genital-oral contact, gonorrheal proctitis is more common in people of non-traditional sexual orientation. Extragenital foci appear due to the generalization of the infectious process. The joints are first affected, gonorrheal meningitis or endocarditis is less common.
The transition of the disease to the chronic form, the addition of other infections, the occurrence of complications, attempts at self-treatment and, in particular, the unauthorized use of antibiotics increase the likelihood of infertility.
Depending on the duration of the flow, there is a fresh and chronic gonorrhea. Fresh gonorrhea in men is diagnosed with a manifestation of the disease for less than two months, a chronic form - if symptoms persist or alternate exacerbations with remissions for two months or more, as well as for an unidentified duration of the disease.
Fresh gonorrhea, in turn, is subdivided into acute, subacute and torpid, ie, erased or asymptomatic. In the chronic form of the disease, gonococci often form L-forms, which have partially lost their antigenic properties and therefore are insensitive to treatment. When infected with gonococcal strains that produce r-lactamase, atypical forms of gonorrhea, resistant to beta-lactam antibiotics, develop. There are also cases of gonokokonositelstva, when the ability to spread the infection is not accompanied by the development of pathological processes in the carrier.
Symptoms of gonorrhea in men
The clinical picture of the primary gonococcal infection depends on the site of entry of the pathogen. In gonorrheal urethritis, patients complain of frequent urge to urinate, dysuric phenomena (pain, stinging, and burning during urination), turbidity of urine, and profuse purulent or purulent-serous leucorrhoea. In the case of a torpid course of gonorrheal urethritis, dysuric and exudative phenomena are mild and disappear without treatment after a few days, however, they can return under the influence of provoking factors — alcohol and sexual activity.
Gonorrheal pharyngitis is characterized by a sore throat, difficulty swallowing, swelling and redness of the mucous membranes of the soft palate and tonsils. Gonorrheal proctitis is most often asymptomatic, occasionally itching or burning in the anorectal region, purulent discharge from the anus, tenesmus and painful defecation can be felt. As a rule, the incubation period of gonorrhea in men with a primary infection lasts from 3 to 15 days, with mixed infections - about a month or more.
Most often, gonorrhea in men occurs as urethritis.
Chronic gonorrhea in men usually takes a protracted nature with periodic exacerbations. Patients are disturbed by frequent urge to urinate at night, scanty mucous discharge from the urethra in the morning, in the first portion of urine strands of exudate secreted from the excretory ducts of the lobules of the glands are found. Urinary spraying and a decrease in the jet's flight distance indicate the presence of adhesions in the urethra. At the same time, sexual dysfunctions are observed: premature ejaculation, erectile dysfunction, anorgasmia, and decreased libido. When the inflammatory process spreads to the seminal vesicles, the prostate gland and the Cooper gland, patients experience pain along the urethra and in the head of the penis, in the perineum, pubis and sacrum, paresthesias, discomfort during sitting, and foreign sensation appear in the rectum.
Gonorrhea in men is diagnosed by a venereologist or urologist on the basis of a clinical examination, urethroscopy, anamnesis and laboratory findings. For a fresh gonococcal infection of the lower part of the urogenital system, there is a picture of acute anterior urethritis: hyperemia and swelling of the sponges of the urethra, edema of the mucous membrane, thickening and smoothing of the folds. Torpid forms are manifested in both anterior and total urethritis with a general smoothing of the symptoms of the inflammatory process and moderate exudation. In chronic gonorrhea in men during urethroscopy, congestive hyperemia and infiltration of the urethral sponges are detected.
Currently, gonorrhea occurs mainly in the form of mixed infections. As a result, marked signs of gonorrhea in men are rare. To confirm the diagnosis, laboratory tests are obligatory - bacterioscopy and bakposev scrapings and washes from the urethra and rectum. At the same time, other sexually transmitted diseases are diagnosed: syphilis, HIV, hepatitis B and C, trichomoniasis, chlamydia, etc.
With timely treatment and adequate therapeutic measures, fresh gonorrhea in men is cured without consequences for health and reproductive function.
The bacterioscopic method is most effective for fresh gonorrhea. After drying and fixing, biopreparations are stained with methylene blue and Gram, however, due to high variability, it is not always possible to detect the pathogen by bacterioscopy.
Erased and asymptomatic forms of gonorrhea are diagnosed by the method of bakposev on artificial media. To obtain reliable results, the purity of the material and strict adherence to the biomaterial selection technique are important. In the case of contamination of the bioprobes microflora of the urethra using selective media with antibiotics.
Sometimes gonorrhea is diagnosed using the polymerase chain reaction, rarely refer to the ELISA and immunofluorescent methods.
When fresh gonorrhea is detected in a man, a survey of all his sexual partners is shown, intimate contacts with which were carried out for 14 days before the onset of symptoms. In the case of an erased or asymptomatic gonorrhea, women and men who have been in intimate relationships with the patient for two months prior to the onset of symptoms are examined. If the patient lives with female children, they are examined to exclude the transmission of the disease by household contact.
Treatment of gonorrhea in men
The strategy for treating gonorrhea in men depends on the form and duration of the course of the disease. With fresh uncomplicated gonococcal infection of the lower urinary tract, a single intramuscular or oral administration of the antibiotic is sufficient.
Complicated gonorrhea requires longer treatment. In this case, antibiotics are administered intravenously or intramuscularly every day, every 12 hours or every 8 hours, depending on the drug during the week. Etiotropic treatment of gonorrhea in men in acute cases should be continued for at least 48 hours after the disappearance of the symptoms of the disease. For mixed infections, another antibiotic or antiprotozoal drug is added to the regimen. At the time of antibiotic therapy, the patient should completely eliminate alcohol and refrain from sexual intercourse. In order to increase the effectiveness of antibiotic therapy, it is recommended to use a bacteriological method to control the sensitivity of the pathogen to the prescribed drugs.
When infected with gonococcal strains that produce r-lactamase, atypical forms of gonorrhea, resistant to beta-lactam antibiotics, develop.
For subacute, torpid and chronic gonorrhea in men, in addition to general antibacterial therapy, local agents are prescribed - instillations of antiseptics into the urethra, and in the rectal lesion - microclysters with antiseptic solutions and anti-inflammatory candles. In the absence of exacerbation, physiotherapeutic methods can be applied:
In some cases, specific and non-specific immunotherapy is carried out: a gonococcal vaccine is administered to patients, immunomodulators are prescribed, and autohemotherapy is sometimes performed. Immunotherapy treatment is started either after the attenuation of the acute inflammatory process, or before a course of antibiotics for the subacute, torpid and chronic course of the disease.
To monitor the effectiveness of therapeutic measures, bacteriological and bacterioscopic studies are repeated 7–10 days after the start of treatment, serological - after 3, 6 and 9 months. The decision on the use of provocative methods of monitoring the effectiveness of treatment is taken individually. The effect of provocation is achieved in the following ways:
- lubrication of the urethra 1-2% solution of silver nitrate,
- exposure to high-frequency electromagnetic field,
- the use of spicy and salty food or alcohol before taking the biomaterial,
- the introduction of gonococcal vaccine,
- combined provocation - a combination of several methods described above.
With timely treatment and adequate therapeutic measures, fresh gonorrhea in men is cured without consequences for health and reproductive function. The transition of the disease to the chronic form, the addition of other infections, the occurrence of complications, attempts at self-treatment and, in particular, the unauthorized use of antibiotics increase the likelihood of infertility. In the case of generalization of the infectious process, the prognosis is cautious.
Complications and possible consequences
Fresh gonococcal infection, left unattended, spreads over the entire length of the urethra, provoking inflammatory diseases of the organs of the urogenital tract. Typical complications of acute gonorrhea include:
- epididymitis and defferenditis - inflammation of the epididymis and vas deferens,
- funnikulitis - the spread of the inflammatory process throughout the deferens tract,
- periorchitis - an infectious-inflammatory lesion of the testis shell, externally manifested by a sharp increase in the scrotum, smoothing the boundaries between the testicle and the epididymis,
- prostatitis - inflammation of the prostate gland,
- Cooperite - an inflammatory lesion of the Cooper gland with the formation of a dense, painful pea-shaped node,
- spermatocystitis, or vesiculitis - inflammation of the seminal vesicles,
- paraurethritis - exudative inflammation of the paraurethral glands. Patients have noted a narrowing of the lumen of the urethra and the appearance of false abscesses due to blockage of paraurethral passages with purulent exudate,
- Cavernitis - the formation of an inflammatory node in the cavernous body, causing penile curvature in an erection state.
Acute inflammatory processes in the organs of the male reproductive system are often accompanied by fever and general intoxication of the body. The appearance of a jerking pain may indicate the development of an abscess, in such cases, you should immediately seek medical help.
Infection with gonorrhea in men occurs mainly through sexual contact; the probability of infection with a single contact with a sick woman is 25–50%.
In chronic gonorrhea, men develop chronic inflammatory diseases of the vas deferens. Chronic vesiculitis is manifested by dull pain along the urethra and painful sensations in the process of ejaculation, radiating to the sacrum and lower back. Chronic cooperite provokes a strong soreness of the rectum, discomfort when sitting on hard chairs and difficulty with bowel movements. For men planning paternity, chronic prostatitis is particularly dangerous, causing impaired spermatogenesis, which leads to a decrease in mobility and, as a result, the fertilizing ability of spermatozoa.
Personal prevention of gonorrhea in men involves the observance of sexual hygiene: unprotected contact and casual relationships should be avoided.
In order to avoid the spread of infection, laboratory diagnostics of gonorrhea is included in the program of routine medical examinations of food industry workers, medical personnel and employees of children's institutions.
The source of the disease is a sick person. The disease is transmitted sexually from the patient or carrier of the infection. During sexual intercourse with a sick partner gonococci fall on the mucous membranes of the genital organs, after which they are introduced and the development of the disease.
The incubation period for gonorrhea is up to 15 days. Initial manifestations may be noted already after 2 days from the moment of contact with the carrier of the infection. They manifest as unpleasant sensations along the urethra, after which there is itching and purulent discharge from the urethra.
Scientists are concerned about the progression of this disease throughout the world. For example, according to experts in the UK, gonorrhea is the leader among venereal diseases and in 2011 the number of patients with an incurable form of the disease was 20 thousand people. The government was forced to implement a program to combat this venereal disease.
According to statistics, 30% of patients with a diagnosis of gonorrhea are homosexuals. The progression of the disease, as well as an increase in the development of pathogen resistance to antibiotics, poses a serious threat not only to the population of Great Britain, but also to the entire world community.
Symptoms in men
On average, the first symptoms of gonorrhea appear within one week from the moment of infection.With the deterioration of immunity, as well as with antibiotic treatment in irrational dosage, this period can increase and reach 3 weeks.
The disease in men occurs in two forms: acute and chronic. This separation is conditional, since the duration of the acute phase in different patients depends on the individual characteristics of the organism. It is believed that the acute phase lasts for 2 months from the moment of the first symptoms, after which the disease becomes chronic.
With the development of gonorrhea in men, the symptoms of the disease are due to the anatomical features of the structure of the urogenital system. The first occurrences of the infection are:
- Discomfort, burning and itching along the urethra, aggravated by urination
- Purulent discharge occurs first only when pressing on the head of the penis.
- In the subsequent stages of the disease, excretion becomes permanent.
- The upward spread of the infection to the back of the urethra leads to the development of signs of cystitis - the frequent painful urge to urinate.
Chronic gonorrhea is accompanied by a further spread of infection to the prostate gland and testicles. Gonorrheal prostatitis is characterized by frequent urination and prolonged painful erection. In the most severe advanced cases there is pain in the rectum during bowel movements.
The defeat of the inguinal organs is manifested in the form of inflammatory diseases of the testicles. Inflammation is accompanied by swelling of the surrounding tissues and inguinal lymph nodes. Sexual intercourse is accompanied by painful sensations and the appearance of bloody discharge.
Since the cause of the disease is an infectious agent, its development is accompanied by common manifestations of intoxication: fever, chills, headache.
Symptoms of chronic gonorrhea can be obliterated, and for a long time can not cause the characteristic manifestations. In this regard, the patient does not receive proper treatment, and the disease gradually progresses, giving a detailed clinical picture only in the later stages. This is due to the increase in chronic complications.
Complications - consequences of gonorrhea
Due to the long erased course of the disease, patients with the chronic form of the disease are more susceptible to the development of complications. The lack of treatment at the initial stages leads to the spread of infection to various internal organs of the patient and the formation of inflammatory changes in them.
A common complication of gonorrhea is the addition of secondary infections: chlamydia, ureaplasmosis, candidiasis, and others. When they appear, the clinical picture of the underlying disease is complemented by signs of other infections, which significantly weights its course and complicates the diagnosis process.
Among the serious consequences of gonorrhea, men are in the first place:
- orchiepididymitis (testicular inflammation with appendage)
With the development of gonorrheal epididymitis, the patient is worried about fever, hyperemia in the scrotum, swelling and severe pain in the groin, aggravated by movement. This disease leads to impaired sperm production in the affected testicle, and with bilateral epididymitis - to infertility.
Gonorrheal prostatitis is the most common complication. It is characterized by a chronic course and responds poorly to treatment. This is one of the common causes of impotence and infertility in men all over the world. As prostatitis progresses, the disorders affect not only the genitals, but also the urinary system, causing a narrowing of the lumen of the urethra.
A specific complication of gonorrhea is also gonorrheal conjunctivitis, which can lead to blindness and necrosis of eye tissue.
The penetration of gonococci into other internal organs is characterized by the development of severe generalized infection characterized by inflammatory skin manifestations, myocarditis, hepatitis, meningitis.
For the treatment of complications, enhanced antibacterial therapy is used. Early detection of complications at an early stage has a positive prognosis and, if properly administered, leads to a cure.
Growth of resistance of the causative agent of gonorrhea and antibiotics
In 2012, WHO expressed concern about the increase in the development of resistance to the antibiotic gonorrhea and called upon scientists to develop alternative treatment regimens and methods to combat the disease, while doctors recommended rational use of antibiotics in the treatment of gonorrhea.
To date, according to WHO, gonococci are resistant to many antibiotics, while maintaining sensitivity to cephalosporins. Moreover, in many countries of Europe, as well as in Japan and Australia, gonorrhea pathogens were found with the development of resistance to cephalosporins.
Sally Davis, the main UK health expert, in early 2013 clarified that in 80% of cases the causative agent of gonorrhea is resistant to tetracyclines.
Specialists from the United States proposed 2 new combination therapy regimens. Over 400 people of different ages (16–60 years) with severe advanced forms took part in the tests. They were divided into 2 groups that received different treatment methods. The most frequent side effects in patients were abdominal pain, nausea, diarrhea. The results of these clinical trials of genital gonorrhea treatment regimens were announced at the 20th conference (in Austria in Vienna) of the International Society for STDs:
- 100% effectiveness has been shown to be used orally in the treatment of Azithromycin (Sumamed, Azitroks, Azitsid, Hemomitsin, Zi-factor, Ecomed) + Gentamicin injections.
- 99.5% effectiveness showed the use of a combination of Azithromycin and Hemifloxacin orally.
- These treatment regimens showed 100% efficacy when gonococcal mucous membranes of the oropharynx and rectum are affected.
The standard recommendations of the US Centers for Disease Control and Prevention (CDC) for the treatment of gonorrhea were as follows: Azithromycin (Sumamed) or Doxycillin intake combined with Ceftriaxone injections. Now, new 2 treatment regimens will be offered if the patient has an allergy to cephalosporins or drug resistance to them and to tetracyclines. The tests inspired specialists, because the results have shown the effectiveness of new treatment regimens in the context of the growing level of antibiotic-resistant forms of gonorrhea in the last decade.
Myth 2 - Infected in a public toilet, crouching on the toilet
Also impossible, for the same reason. There are descriptions of cases of "domestic infection", but the reliability raises strong doubts, "pick up" a live gonococcus in the toilet is almost impossible. Another possible way of contracting gonorrhea besides sexual contact (this applies only to women) is the transmission of infection from a sick woman to a child at birth.
Myth 4 - Donated blood from a vein in the clinic and became infected
Impossible. The causative agent of gonorrhea outside the human body quickly dies, it is extremely unstable in the external environment, dies when exposed to direct sunlight, and heated to 56C. When blood is taken in medical institutions, disinfectants are used, which has a detrimental effect on the causative agent of gonorrhea. Temperatures below 36 ° C (human body temperature) do not tolerate gonococcus, and die at 18 ° C.
Myth 6 - Every day I go to the subway, dirty handrails - a lot of infections
It's impossible. The causative agent of gonorrhea is capable of vital activity only in a humid environment, when the environment is dry, it dies. Such an instability of bacteria in the environment explains that the likelihood of infection through any objects is very unlikely, it requires only a human body for further activity, therefore its transmission is possible only through close direct contact with the source of infection - a gonorrhea carrier, a sick person.
Myth 7 - I had a girlfriend before you and gonorrhea "got" from her
This explanation is possible if the "former girlfriend" was a man recently. The first symptoms of gonorrhea occur during the first 1-2 weeks after infection and it is impossible not to notice them. Chronic gonorrhea is considered to be a sluggish inflammatory process that lasts over 2 months. In addition, when provoking factors (hypothermia, not hygiene), there is a relapse (exacerbation) with all the characteristic symptoms that are not impossible to feel - purulent discharge from the penis, itching, pain, burning during urination.
Characteristic of the disease
For gonorrhea, as for many STDs, it is not uncommon to manifest itself immediately after sexual intercourse, which has become the cause of infection. Some time it exists in the patient's body without any manifestations - this is the so-called incubation period. Duration depends on the state of health and strength of immunity.
It affects not only the mucous membranes of the genital organs, but also other organs and systems:
- Respiratory, nervous, cardiovascular system. Such infection is unlikely, but still possible.
Gonorrhea is one of the most common genital infections, it appears in both men and women. But it is believed that more often it is the man who infects her partner. The problem is that men are more disregarding the state of their health. If there was gonorrhea, and then it disappeared, as if by itself, they would not go to the doctor. In fact, she just moved to the chronic stage, and the man will be the carrier of the infection.
Pathogens - gonococci (can be seen in the photo) can not exist outside the body, the temperature of 56 degrees is deadly for them. They belong to the category of gram-negative bacteria. Getting on the mucous membranes, provokes swelling, infiltration, fever, scarring, suppuration, destruction of the epithelium.
Important! Immunity against the disease is not developed, so you can get as many times as you wish throughout life.
The pathology can be acute or chronic. In the first case, the symptoms appear relatively quickly within 3-14 days. The farther from the day of infection, the more intense and painful they are. As for the chronic course, the expression of this form is often hidden, without obvious symptoms. They are characterized by waviness - the symptoms appear and disappear. Many men believe that they have already recovered, so they don’t go to the doctor. It should be understood that such a state is very dangerous, because it is chronic gonorrhea that leads to serious and often irreversible consequences.
The source of the disease is a sick person. There are several ways of transmission, among them:
- Sex - through unprotected sex. Infection is possible with both anal and vaginal contact. More often they catch the infection in this way, 4-5 times less often with oral contact. In saliva gonokokku uncomfortable. Therefore, he can not adapt to it.
- Vertical mode of transmission from a woman to her newborn child when passing through the birth canal. In this case, the baby after birth often suffers from gonorrheal conjunctivitis. Its complete cure manifests itself in scarring.
- Recorded cases of transfer from parents to children, subject to the use of their personal belongings.
It is worth noting that infection cannot exist in the external environment. Therefore, the following transmission options are not possible:
- Household appliances and personal care products, including a toothbrush, washcloth, towel.
- Kisses, that is, in the saliva of gonococcus no.
Mechanism of action of the pathogen
As soon as gonococcus enters the body, it does not immediately act. On the mucous membrane of the urethra, it lasts no more than 2 hours - this is the initial stage. If we assume that infection is possible during this period, it is worth trying to wash the pathogen from the mucous membrane. If this is not done, the infection agent multiplies very quickly. It is embedded in the space between the epithelium, connective tissues, glands and lacunae of the urethra.
Further, penetration into the posterior urethra occurs, and therefore, the seminal vesicles, prostate gland, and epididymis are at risk. If against this background there is a decrease in immunity, the risk of sepsis and gonococcal arthritis is high.
Symptoms and signs are quite specific, so sometimes just a visual inspection and survey. Difficulties arise when the disease is chronic or asymptomatic. The following methods are used:
- Bacteriological. Direct bacterioscopy is performed, that is, a smear from the urethra and anus is taken from the person being diagnosed. Such a study is the most accurate, the confidence indicator reaches 90%.
- Dvukhskatnaya test. The patient passes urine in two portions. Changes, that is, the pathogen, are found in only one portion. This indicates damage to the anterior and posterior urethra.
- PCR is a polymerase chain reaction method.
- Immunofluorescent method. At the same time, antibodies to the pathogen are determined in the blood.
- Immunological sensitization. Its essence is that the patient is injected with a protein preparation, which contains a gonococcal allergen. If there is an infection in the body, then after 24 hours, the patient has a delayed-type hypersensitivity. This reaction is local, at the injection site.
Some features of therapy
For the treatment of gonorrhea in acute form, that is, it is not enough to take a single dose of a medicine prescribed by a doctor. You can do it at home. In some cases, you need an injection, but you can often get by with oral administration. If the form is chronic, then it is necessary to take a course of antibiotics. In any case, the dosage and duration of treatment is determined by the doctor.
In rare cases, inpatient treatment is necessary. Indications for him:
- The presence of complications of any type and localization.
- Generalized infection, sepsis.
- Frequent relapses of gonorrhea.
- The lack of therapy at home.
Important! An indispensable condition for treatment is the absence of sex in any form. You should also avoid physical exertion, hypothermia, give up bad habits.
To say that a man is healthy, if the following points are observed:
Complications and consequences
If for a long and erased there is a risk of developing dangerous diseases. If the first stages are not treated or do it wrong, all organs and systems will suffer. Among the most difficult consequences for men are the following: prostatitis and testicular inflammation with an appendage. Gonorrheal epidermis manifests itself in the form of fever, fever in the scrotum, pain in the groin. The consequences of this condition - a violation of the volume and quality of produced sperm. If the damage is bilateral, then there is a risk of infertility.
Another pathological condition is gonorrheal prostatitis. This complication occurs most often. It is characterized by a chronic form and complexity of therapy. It leads to infertility, but that's not all. If not treated for inflammation, all organs of the urinary system are affected.
A specific complication is gonorrheal conjunctivitis, it leads to blindness.
Important! Detection of complications in the early stages, their development is almost guaranteed to be treated with antibiotics. The prognosis for recovery in most cases is positive.
Preventing genital tract infections is easier than curing. Gonorrhea can also be prevented. Prevention methods:
- The presence of one, permanent, trusted partner.
- For casual sexual intercourse, always use a condom.
- Intimate hygiene.
- If the contact was unprotected, wash the genitals immediately with soap and water. Also, an antiseptic solution should be introduced into the urethra within 2 hours after sex.
Gonorrhea is an STD that occurs most often. Its symptomatology in men is so pronounced that it is impossible not to notice the manifestation. You may not know where it came from, but it is necessary to treat it. You should not resort to self-treatment, which can result in serious complications, up to infertility and impotence.
What is the causative agent of gonorrhea?
The causative agent of gonorrhea was discovered in 1789 by A. Neisser, and in 1885 it was isolated in pure culture by Bumm. It is Neisser's gonococcus, which is a diplococcus and is shaped like a coffee bean with a characteristic groove in the middle between the two halves. Under the microscope, these halves are almost the same in acute gonorrhea, but may have different sizes in the chronic form.
If an infected person took antibiotic treatment in insufficient doses or irregularly, then gonococci can change their shape, becoming large spherical, resembling the size of an erythrocyte, as well as small, pulverized. Among the gonococci there are many individual species - strains, including those that have become resistant to treatment with various drugs, and today this gonorrhea is practically incurable, accounting for about 20% of all infections.
Gonococcus lives predominantly on the mucous membranes of the urinary organs, however, it can be found in the prostate secretion, seminal vesicles, oral cavity, on the mucous membrane of the eyes, rectum, or spread to other places (the so-called extragenital forms of gonorrhea). The pathogen does not penetrate into the cells of the mucous membrane, but remains on the surface or in the intercellular space. If the gonococcus got into the blood, then it dies there quickly enough.
Also, the gonococcus is often absorbed by leukocytes, but in most cases it does not die, but continues to live inside it. Similarly, he lives in Trichomonas, which makes him practically insensitive to treatment: antibiotics used to treat gonorrhea cannot get into Trichomonas, and what is detrimental to the latter does not affect gonococci at all. This determines the possibility of recurrence of the disease.
Outside the body, gonorrhea pathogens are unstable and die as the secret dries out. On wet sponges, towels can maintain their viability during the day and lead to infection. Heating to 41–50 ° C leads to their death within 6 hours, and at 39 ° C - after 12 hours. However, in the body, fever, even at 41 ° C, causes only some weakening of their viability and temporary cessation of purulent secretions. The optimum temperature for maximum reproduction of diplococcus is 36.5–37 ° C.
After suffering gonorrhea, persistent immunity is not maintained, so gonorrhea can be infected many times in a row.
How does the infection occur?
The source of infection is exclusively a person suffering from gonorrhea, including her poor symptom, chronic forms or not at all noticing any signs of such.
The most famous transmission routes are:
- sexual intercourse (for example, vaginal, rectal, oral)
- during childbirth from mother to child (development of eye lesions in the newborn - blenney),
- through common hygiene items and things contaminated with secretions that contain the pathogen (towels, bed linen, etc.).
The possibility of transmitting gonorrhea with passionate kisses is not excluded.
The period from the moment of infection to the onset of the first signs of the disease averages 3-5 days, but can vary from 1 day to 3 weeks.
After the urinary organs enter the mucous membrane, the gonococci multiply rapidly and cause inflammation, accompanied by purulent secretions. Later on, scars are formed in these places, leading to a narrowing of the urethra. If such scarring occurs in the appendages of the male testicles, then they become impassable for spermatozoa, and the man becomes infertile.
Most often in men, gonococcus affects the urethra, and in homosexuals it also affects the rectum, pharynx, tonsils, oral mucosa. Gonorrheal conjunctivitis in men can develop in cases where the pathogen was accidentally carried by the hands of the genitals by the patient himself.
If gonococcus enters the bloodstream, it dies very quickly there, releasing toxin that causes loss of appetite, damage to the joints, tendons, and nervous system (other researchers dispute this: they consider these symptoms to be a manifestation of the local action of gonococcus in these organs). Untreated gonorrhea often acquires a chronic course, aggravated by taking alcohol, spicy foods, as well as sexual intercourse or sexual arousal.
The most common among men are the following groups:
- having a lot of casual sex,
- alcohol abusers
- having a certain social setting.
Types of gonorrhea
By the time since infection:
- Fresh gonorrhea (duration of flow - up to 2 months).
- Chronic gonorrhea (disease duration over 2 months).
According to the intensity of the disease:
- Acute gonorrhea - signs of inflammation are pronounced.
- Subacute - symptoms of the disease erased.
- Torpid (sluggish) - subjective symptoms are absent, but gonococcus is detected by laboratory methods.
- Latent (carriage) - the symptoms of gonorrhea are absent, the pathogen can be isolated by laboratory methods with difficulty.
Localization men distinguish gonococcal:
- Urethritis - inflammation of the urethra (urethra).
- Balanitis (balanoposthitis) - gonococcal affection of the penis head and the inner leaf of the foreskin.
- Epididymitis - gonorrhea of testicular appendages.
- Orchitis is an inflammation of the testicle.
- Prostatitis - gonorrhea of the prostate gland.
- Vesiculitis - gonorrheal defeat of the seminal vesicles.
- Some other forms.
- Extragenital Gonorrhea:
- conjunctivitis (adult disease),
- arthritis - gonococcal joint damage,
- endocarditis - inflammation of the inner lining of the heart,
- peritonitis, meningitis, sepsis, etc. - in men can occur only with a strong decrease in immunity and changes in the bactericidal properties of the blood.
Often gonorrhea occurs in conjunction with other infections, which masks its manifestations, for example, with:
Local symptoms of acute gonorrheal urethritis when examining the penis:
- pain on palpation of the urethra (in this way the doctor can reveal small painful lesions of the size of a millet grain, which are the inflamed glands of the mucous membrane),
- swelling and redness (hyperemia) of the sponges of the urethral opening,
- frequent addition of balanoposthitis with the subsequent development of phimosis,
- involuntary release of droplets of yellow-green pus from the opening of the urethra, which leads to a permanent laundry,
- the appearance of erosion on the head of the penis,
- in some cases, there is a semi-registered state of the penis with blood in the discharge from the urethra.
If, in acute gonorrheal urethritis, one begins to urinate in one glass and finish in the other (the so-called two-glass test), then the first one will have urine that is cloudy with admixture of pus, and the second is light, transparent.
The general condition of the patient usually does not suffer, the temperature does not rise.
Regardless of whether treatment is applied or not, the signs of urethritis gradually subside, the amount of discharge decreases. Then, without adequate therapy, gonorrhea gradually becomes subacute, and then - in the chronic form. In some cases, there is a spontaneous cure.
Often, gonorrheal urethritis occurs precisely in subacute form and is characterized by more blurred symptoms:
- the head and foreskin remain of the normal color,
- purulent discharge less abundant (usually observed after a night's sleep or just a long break in urination),
- pus spots on underwear,
- whitish urethral discharge
- with palpation pain is much less than with the acute form,
- general condition does not suffer.
When dvuhstakannoy sample: in the first glass there is a cloudy, opalescent urine and pus threads, in the second - transparent.
Balanoposthitis and phimosis, paraphimosis with gonorrhea
It is found as a complication of acute urethritis, when another infection joins the gonococcus that is released from the external urethral orifice, causing inflammation of the internal sheet of the foreskin, as well as the head of the penis.
- discomfort in the penis head,
- increased sensitivity during intercourse,
- all sorts of specks, bumps, erosion on the mucous head,
- unpleasant smell of discharge.
Balanoposthitis can show one or more symptoms in any combination. In advanced cases, balanoposthitis may increase the inguinal lymph nodes, increase body temperature.
If, as a result of inflammation, scars are formed between the sheets of the foreskin, then phimosis develops - the impossibility of moving the foreskin backwards from the head of the penis. In cases where it was possible to move the foreskin away, paraphimosis can occur - pinching of the head of the penis and the inability to correct it back.
Cavernitis is an inflammation in the penis of the corpus cavernosum and is manifested by pain and possible penile curvature during erection, as well as difficulty urinating.
It is characterized by inflammation of the epididymis, pain in the groin area, fever up to 40 ° C, chills, general weakness, headache. To the touch, the epididymis is enlarged, of a dense consistency, painful. The skin of the scrotum is hyperemic, tense. If scars form as a result of gonococcal inflammation, then a complication such as infertility will occur.
In fact, it is a gonorrheal inflammation localized in the vas deferens or spermatic cord. It occurs with simultaneous lesions of the epididymis. It is manifested by soreness, increase, swelling (it is palpated, as a dense and painful cord).
Gonorrheal inflammation of the testicle is quite rare, manifested by severe pain in the scrotum, its swelling, fever, deterioration of the general condition.
Gonorrheal prostatitis can occur in acute and chronic forms, and there are 3 types:
When catarrhal gonorrhea prostate inflamed lobules of the prostate, there are frequent urge to urinate, burning or slight itching in the perineum, weak pressure in the anus. Urine is transparent, there are single threads or flakes of pus. In a smear of prostatic juice - gonococci.
Excretory ducts of the prostatic glands are blocked, insulated follicles are formed, which are filled with pus. Patients have a sensation of heat in the perineum, pain at the end of urination. A doctor during palpation examination through the rectum will notice an enlarged prostate, as well as individual spherical painful seals.
In this case, the muscle-elastic stroma of the prostate is involved in the process of gonorrheal inflammation, in which separate purulent cavities are formed with the subsequent formation of one large abscess.
- urinary retention or difficulty urinating,
- feeling of pressure in the anus,
- pain during stool,
- Irradiation of pain in the penis, pelvis, sacrum,
- enlarged prostate by palpation through the rectum.
It has less pronounced symptoms, but over time there are:
- weakening of erection
- reduction of orgasm
- premature ejaculation.
Also, periodically, such patients complain of decreased performance, rapid fatigability, irritability.
Vesiculitis is an inflammation of the seminal vesicles and is often combined with epididymitis or prostatitis.
- in the urethra: itching, pain, discharge,
- blood and soreness at the end of urination,
- frequent wet emissions
- painful ejaculation
- pus or blood in semen,
- pain on palpation of the seminal vesicles.
Proctitis of this type usually proceeds in disguise or it is manifested by slight itching in the anus, as well as pain during a bowel movement.
Gonorrheal pharyngitis and tonsillitis
It develops after unprotected oral sex. It manifests a slight soreness when swallowing or is generally asymptomatic. However, even in this situation, such a person can infect his sexual partner during oral sex.
Gonorrheal conjunctivitis is characterized by purulent discharge from the palpebral fissure, lacrimation. Launched and untreated can lead to total or partial blindness.
Gonorrhea can manifest as joint pain (arthritis), damage to the liver, kidneys, and heart, but this is extremely rare, as is meningitis, sepsis.
This diagnostic is suitable for quick determination of the presence of gonococci at home in case of an emergency. As a rule, outwardly such a test resembles a test for determining pregnancy (the same 1 and 2 strips).
The mechanism of action of the test is based on the method of counter electrophoresis, when at the merging of the corresponding antibodies and gonococcus staining of the second strip occurs.
When using this test, one should remember that it can give a false positive result in the presence of microorganisms similar to gonococcus, as well as a false negative if gonococci are too small.
Examination of the smear under a microscope in case of detection of gonococci confirms the diagnosis.
On the eve of 4-5 days abolish antibiotics. For the study carried out the sampling of material from the discharge of the urethra, prostatic juice, semen, rectum, mucous membranes of the mouth in 2 copies. In the case of taking a smear from the urethra on the eve of the material intake should refrain from urinating for 3-4 hours.
The first smear is usually stained with brilliant green or methylene blue to detect cocci in general. Then the second smear is dyed Gram, as a result of which the gonococci turn bright pink.
This diagnostic method allows you to detect gonococci in 40-86% of cases due to the fact that some subspecies of gonococci are not painted as it should. Also a great role in the diagnosis of gonorrhea in this way is played by the qualifications and experience of the laboratory assistant.
If gonococcus is detected by this method, then the diagnosis of gonorrhea is considered confirmed.
It is a culture of discharge from mucous membranes on special media that are suitable for the growth of gonococcus. The indisputable advantage of this method is the absence of false-positive results, its sensitivity is close to 98%.
The disadvantage of bacposev is a long waiting time for results, however, in the case of chronic persistent gonorrhea, this method is one of the most reliable.
The reaction of immune fluorescence should be carried out in the presence of high-quality reagents, a special fluorescent microscope and appropriate training of medical staff.
For RIF, a smear is taken in almost the same way as for conventional microscopic examination, but then stained with special dyes containing gonococcal antibodies. These antibodies, with attached dye molecules, bind to antigens on the surface of the Neisser diplococci and form immune complexes, which are detected under a microscope as luminous circles.
This method allows you to identify gonorrhea in cases where it occurs in conjunction with other infections or if the disease is at an early stage. A significant drawback of RIF is its relative high cost, which limits its use.
The enzyme immunoassay is also not among the routine methods performed by each laboratory, as it requires highly qualified personnel and high-quality reagents.
The ELISA makes it possible to identify resistant forms of the pathogen, however, due to the fact that it is not able to distinguish dead gonococci from living ones, its value decreases somewhat, and it is used by a greater degree as an auxiliary method.
The mechanism of action of ELISA is based on the detection of antibodies in the patient's urine.
Molecular genetic diagnosis
Although polymerase and ligase chain reaction are expensive, they are highly accurate methods of detecting gonorrhea, including in the case of latent or sluggish flow. Can identify the causative agent of gonorrhea in combination in the same sample with chlamydia. The duration of the reactions ranges from 3-4 to 7-8 hours.
If gonococcus as a result of inadequate or incomplete treatment undergoes a series of transformations and becomes able to penetrate deeply, even to the muscle layer, then gonococcus on ordinary smears will not be detected.
Provocative tests force the gonococcus back to the mucous membranes and become accessible to standard methods of examination (for example, microscopic examination, bacteriological seeding).
Today there are various options for provocative tests.
The urethra is smeared with a 1-2% solution of silver nitrate, the rectum with a 1% solution of Lugol. After 24, 48, 72 hours take the appropriate scraping smear. On the third day they spend bacteriological seeding.
The patient is administered gonococcal vaccine alone or in combination with pyrogenal. Smears and backdoors are done at the same intervals as during chemical provocation.
As a provocation, diathermy is used for 3 days according to the following scheme, starting from 30 minutes and increasing in subsequent days by 10 minutes. Induction is also prescribed as a provocation for 3 days, 15–20 minutes daily.
Swabs are done every day an hour after the procedure.
In men, it is not carried out, as it is based on the menstrual cycle.
In this case, aggravation of gonorrhea will cause: alcohol in combination with salty, spicy and spicy foods. Smears are taken in the same way as in chemical provocation.
During the day several provocative tests are carried out. Bacteriological seeding is done 3 days later, and smears are taken a day, two after 72 hours after the provocation.
Despite the seeming simplicity in treatment, gonorrhea is gradually turning into a disease that is difficult to treat as gonococcus becomes resistant to antibiotics. For this reason, it is necessary to take a very serious approach to the choice of a sexual partner, since the latter, due to the presence of latent and weak-symptom forms, may not even guess about his illness. The best way out is to have a permanent sexual partner and mutual loyalty in marriage.