Nowadays, non-gonococcal urethritis is like a hot stock that is known to everyone. When you see mycoplasma and chlamydia, you will be attacked, and various antibiotics will be used to attack and bombard you. And gonorrhea seems to be gradually forgotten, many patients clearly refuse to check gonococcus when they visit the clinic, and some people think that gonorrhea can be effective with a shot, the disease will soon disappear, so they can not be afraid. Unbeknownst to them, this can make the gonococcus, which is causing trouble, secretly happy, leaving room for its long-term presence in human genitourinary organs – chronic infection and carriers.
What is the definition of gonorrhea?
The pathogen of gonorrhea is gonococcus, which was first discovered by Neisser’s in 1879 and is also known as Neisser’s gonococcus, a gram-negative diplococcus, to which humans are susceptible and which is the sole host of gonococcus. Gonococcal urethritis (GC), also known as atopic urethritis, is a purulent infection of the genitourinary system caused by S. gonorrhoeae. Such as gonococcal urethritis and cervicitis. It can also infect the eyes, pharynx, rectum, pelvis, and gonococcus entering the bloodstream leading to disseminated gonorrhea infection. Gonorrhea accounts for the first place among sexually transmitted diseases in China, and its incubation period is short and its infection is strong.
What are the ways of transmission of gonorrhea?
Gonorrhea is a sexually transmitted disease and can be transmitted to others regardless of whether the patient has clinical symptoms or not, almost always through sexual contact. The infection rate is proportional to the number of times of sexual intercourse. The average infection rate of male to female patients is 19%-25%, 35% for 2 times, 49% for 3 times and 57% for 4 times. Gonococcal ophthalmia can occur in newborns through the birth canal of the affected mother. In a few cases, infection can be caused by contaminated clothing, bath towels, or toilet seats.
What are the clinical manifestations of gonorrhea?
1, male acute gonorrhea: incubation period is generally 2 to 10 days, often 3 to 5 d. About 10% of infected people have no symptoms. At first, the urethral orifice is itchy, red and swollen, and it turns out. After 3 to 4 days, most focal necrosis of the urethral mucosa epithelium occurs, producing a large amount of purulent discharge, stinging pain when urinating, and redness and swelling of the glans and foreskin are prominent. The urethra can be seen with gonorrhea or blood, and the urethral orifice can be crusted with pus in the morning. There are mild and severe systemic symptoms. Occasionally, urethral fistulas and sinus tracts are seen. A few patients may develop posterior urethritis with marked urinary frequency, perineal swelling, and painful penile erection at night. Patients with obvious signs and symptoms, even if untreated, generally have a gradual reduction of symptoms in 10 to 14 d. Symptoms basically disappear after 1 month, but are not cured and can continue to spread to the posterior urethra or upper genital tract, and even complications occur.
2, male chronic gonorrhea: generally no obvious symptoms, when the body resistance is low, such as excessive fatigue, alcohol, sexual intercourse, that is, the symptoms of urethritis, but lighter than the acute phase of inflammation, urethral discharge less and thin, only in the morning in the urethral orifice with pus crust adhesion, that is, the “burnt mouth” phenomenon. The urethra has been inflamed for a long time, the urethra wall fibrous tissue hyperplasia and scar formation, the front urethra formed multiple scar, so that the secretions can not be discharged smoothly, inflammation is easy to the posterior urethra, prostate and seminal vesicles extension, complications of prostatitis, seminal vesicles, and even retrograde spread to the epididymis, causing epididymitis. As the secretions from the prostate and seminal vesicles are discharged into the posterior urethra, they constantly stimulate the posterior urethra and make it thicken, which in turn affects the poor drainage of the glandular ducts. This interaction has contributed to the prolonged course of gonorrhea, which is not easily cured and has become an important source of infection.
What are the various comorbidities of gonorrhea?
1. Epididymitis: It is often unilateral, with swelling and pain in the epididymis, and reflex pain in the groin and lower abdomen on the same side. Examination reveals enlargement of the scrotum on one side, edema, redness and fever of the scrotal skin, swelling of the epididymis on palpation, obvious tenderness, and purulent discharge visible at the urethra.
2. Seminal vesiculitis: fever, frequent urination, urgent urination, painful urination, terminal hematuria, hematospermia, and pain in the lower abdomen in the acute stage. Rectal examination may palpate enlarged seminal vesicles with severe tenderness.
3. Prostatitis: in the acute stage, there are chills and fever, frequent urination, urgent urination, painful urination or difficulty in urination, terminal hematuria or purulent discharge from the urethra, discomfort in the perineum or suprapubic area, rectal distention, and a feeling of defecation. Rectal examination shows an enlarged prostate with tenderness. In severe cases, it can be complicated by acute urinary retention and prostate abscess.
4. paraprostatic glands (Tyson’s glands) or paraurethral gland inflammation and abscess: rare (< 1%), painful swelling on one or both sides of the tether, with pus draining through the ducts.
5. urethral bulbous gland (Cowper’s gland) inflammation and abscess: rare, with throbbing pain in the perineum, painful defecation, acute urinary retention, and a palpable mass on rectal examination.
6. periurethral cellulitis and abscess: rare, with pain and swelling on the side of the abscess and rupture to produce a fistula. Fluctuating masses with tenderness can be found on physical examination. Commonly found in the navicular fossa and bulb.
7. urethral strictures: rare, due to periurethral cellulitis, abscesses or fistula formation resulting in urethral strictures. Presence of urethral obstruction (weakness, difficulty in urination, dribbling) and frequent urination and urinary retention.
Gonorrhea can be classified according to the course of the disease
1. acute gonorrhea: the duration of the disease is within 2 months, the inflammation is obvious and easy to detect.
2, chronic gonorrhea: if the disease period is more than 3 months, the gonorrhea symptoms are mild and the lesions are mostly limited to the mucous membrane of the genitourinary system.
3, latent gonorrhea: that is, no clinical symptoms occur, but the gonococcus is latent in the urethral gland, cervix, prostate, seminal vesicles, fallopian tubes, etc. When drinking alcohol, excessive sexual intercourse or childbirth, the gonococcus can be active and cause the symptoms of gonorrhea.
The main reason why gonorrhea changes from acute to chronic?
First, the patient has not received formal treatment; second, there are two or more STDs that have not been taken seriously; third, the sexual partner has not been cured, recurrent episodes; fourth, the patient is not properly conditioned, drinking alcohol and staying up late, the body’s resistance decreases; fifth, encountering drug-resistant strains of infection; sixth, older, weaker people; seven is a post-gonorrhea syndrome patients, mainly psychological factors. Therefore, the treatment of this disease wring, for the above causes, on the basis of catching each link, it is best to do a bacterial culture plus drug sensitivity test, targeted medication, do not just increase the dose, alternately with all kinds of antibacterial agents. Otherwise, long-term medication will lead to dysbiosis of body flora, which is not conducive to the treatment of this disease.
Diagnosis of gonorrhea
1.History of unclean sexual contact.
2.Symptoms and physical signs.
3.Laboratory examination
①Smear of secretion, Gram stain, Gram-negative diplococci can be found in polypoidal leukocytes. Acute male patients have a positive rate of 95% or more, while female patients have a positive rate of less than 60%.
②Gonococcal culture.
③Nucleic acid testing: PCR and other techniques are used to detect positive gonococcal nucleic acid in various clinical specimens. The nucleic acid test should be carried out in a laboratory accredited by the relevant institution.
Laboratory diagnosis manual of gonorrhea
1, gonorrhea diagnosis steps: gonococcal infection male patients, often appear urinary pain and urethral discharge and other clinical symptoms. At this time, take urethral secretions for smear, and after Gram staining, if Gram-negative intracellular diplococci conforming to the morphological characteristics of gonococci are seen, the initial diagnosis is positive and the patient can be treated; if the smear is negative, specimens should be taken from the urethra for gonococcal culture. After the specimen is cultured, the colony form is typical, oxidase test is positive, the bacterium is gram-negative diplococcus, the initial diagnosis is positive culture, if there are some traits do not match, it can further use sugar fermentation test and direct immunofluorescence method for identification to confirm the diagnosis.
2, specimen collection and delivery: when taking material for smear, the urethral orifice should be washed with sterilized isotonic saline first, then squeeze out the pus from the back to the front with fingers, and then gently spread on the slide after dipping the pus with cotton swab or white gold ear. Allow to dry naturally and then stain. If the anterior urethra is taken from male patients for culture, platinum ear or calcium alginate swab should be used to penetrate 2cm~4cm into the urethra, and the removed secretion should be slightly mucous membrane. Gonococci are very weak against external environmental factors such as dryness. Therefore, to ensure successful culture, the specimen should be isolated for as short a time as possible. In the hospital outpatient department, the specimen should be inoculated onto the culture medium immediately after it is taken from the patient for culture. If the specimen is taken far from the laboratory, the specimen can be transported to the laboratory in a non-nutritive Stuart or Amies transport medium or selective growth culture tomb such as Trmlsgrow.
3.Smear test of gonorrhea: Smear test is simple, effective, inexpensive and has a certain sensitivity and specificity.
4, gonococcal isolation culture: culture to obtain success, the site and method of taking material to be accurate. When taking material from the anterior urethra of male patients, a fine cotton swab or calcium alginate swab or platinum ear should be used to reach 2cm~4cm into the urethral orifice, and the removed secretions should be slightly mucous membrane. This is because gonococci are more likely to be found in columnar epithelial cells than in compound squamous epithelial cells. The front end of the male urethra including the navicular fossa is covered with compound squamous epithelium, so it is necessary to go 2cm~4cm deep into the urethra and dip a small amount of mucous membrane to have a high positive rate.
For male patients with atypical symptoms to take samples, it is best to do so before or after 2~3h after urination in the morning. In addition, the sampler should be skilled in prostate massage and make prostate massage sampling when necessary. The culture method is applicable to both male and female specimens and is the only method recommended by the World Health Organization for screening gonorrhea patients and is the gold standard method for diagnosing gonorrhea.
5.Glucose fermentation test: confirmatory identification test. Gonococcus has enzymes that decompose glucose, and when it decomposes glucose, it produces acid, which lowers the pH of the medium, thus changing the color of the indicator in the medium, such as phenol red to yellow and bromocresol violet to yellow. The glycofatol test is one of the tests for the identification of gonococci. It confirms and distinguishes other Neisseria species.
Differential diagnosis of gonorrhea: non-gonococcal urethritis Is there any difference between the manifestations of non-gonococcal urethritis and gonorrhea?
Generally speaking, the onset of non-gonococcal urethritis is slow, occurring 1 to 3 weeks or more after infection, while gonorrhea mostly develops within 1 to 3 days after infection.
The onset of non-gonococcal urethritis is generally slow, occurring 1 to 3 weeks or more after infection, while gonorrhea usually develops acutely within 1 to 3 days after infection. The symptoms of non-gonococcal urethritis are relatively light, with less urethral discharge, mostly thin mucus, sometimes just scabs or dirty crotch, but it lasts longer and tends to recur, while gonorrhea has heavy symptoms, thick discharge, relatively short duration, and less recurrence after cure. If a smear or culture of the discharge is done, gonorrhea can see gonococcus, while non-gonococcal urethritis does not, but often chlamydia or mycoplasma can be cultured.
Why should gonorrhea patients not rub their eyes?
Gonococcal ophthalmia is not common in clinical practice, but it turns out that gonorrhea patients have a habit of rubbing their eyes, picking their nose, and digging their ears. The patient did not wash his hands after urinating and habitually rubbed his eyes, and this bad habit inoculated the eyes with gonococci from purulent urethral secretions, causing the conjunctiva of both eyelids to become congested and edematous and flow yellow purulent discharge. If left untreated, corneal ulceration and perforation can occur, leading to blindness. Adult patients should pay attention to eye hygiene, avoid rubbing their eyes, and develop good habits of washing hands before and after meals. The living utensils of gonorrhea patients should be strictly disinfected and used exclusively by the patient.
Treatment principles of gonorrhea
1, early diagnosis and early treatment.
2.Take timely and adequate medication.
3.Prevent transmission to others.
4.Consult and treat sexual partners at the same time.
5.Follow up examination after treatment.
6. Pay attention to whether other sexually transmitted diseases are combined.
Treatment measures for gonorrhea
1. ceftriaxone sodium is preferred for uncomplicated gonorrhea, and the guidelines call for 250mg, im, given as a single dose; I recommend generally 1g, intramuscular or intravenous infusion, once daily for 3 days or every other day for 3 days.
2. The preferred alternative treatment for ceftriaxone allergy is spectacularin 2g for men, 4g for women, intramuscular injection, once daily for 3 days. Subsequently continue with oral antibiotics for 1 week, such as macrolides and cephalosporins.
3. If gonorrhea recurs after treatment, be sure to add an examination for non-gonorrhea. Sometimes gonorrhea can be combined with chlamydia, or mycoplasma infection, and when gonorrhea is serious, the symptoms of non-gonorrhea are masked, and once the treatment is effective, the manifestation of non-gonorrhea appears instead.
4, to literature inquiry, the resistance of our gonococcal isolates to penicillin, tetracycline, quinolone antibiotics has been very common, partly up to 75-99%, so the above drugs are not recommended.
5, if complications arise, such as gonococcal epididymitis, seminal vesiculitis, prostatitis, encephalitis, or disseminated gonococcal infection, etc., the course of treatment need to be extended to more than 10 days; if chlamydial infection cannot be ruled out, add anti-chlamydia trachomatis infection drugs.
6, pelvic inflammatory disease, need to add metronidazole 400mg twice daily for 2 weeks of treatment.
Cure criteria of gonorrhea
1. All symptoms and signs disappear.
2.Morning urine routine examination is negative
3.After stopping the treatment for 3-7 days, the smear stain and culture taken from the affected area are negative.
Prognosis of gonorrhea
The disease is not hereditary and is not immune. It can be repeatedly infected and can recur and become chronic if treatment is incomplete. It can be completely cured by timely diagnosis and anti-infection treatment.
Dietary considerations for gonorrhea
After suffering from gonorrhea, diet should be light, drink more water, avoid spicy food, also can’t drink alcohol, often some patients because of drinking alcohol to aggravate the disease or relapse, at the same time, during the treatment should pay attention to the patient’s diet health, then, gonorrhea patients should eat what is good?
1, light diet, avoid dry heat.
The diet of gonorrhea patients should be light, and patients should use more light and low-calorie diets such as porridge and noodles, and eat less hot and dry foods, such as leeks, squash, sherry red, cilantro, mutton and other foods.
2.Fresh vegetables and fruits mainly.
Gonorrhea patients can eat foods rich in protein and high in vitamins, especially fruits and vegetables that clear heat, detoxify and diuretic are better, while more water should be drunk to promote the discharge of toxins from urine and reduce the stimulation of bacteria on the urethra.
3.Avoid spicy and stimulating food.
Patients with gonorrhea should avoid spicy and stimulating foods, such as: chili, pepper, ginger, onion, mustard, wine, strong tea, etc., especially wine, if you drink alcohol during the disease, it will not only aggravate the symptoms of gonorrhea, but also affect the recovery process of gonorrhea.