Gonorrhea is a genitourinary infection caused by Neisseria gonorrhoeae, which is transmitted mainly through sexual intercourse and occasionally through indirect contact, and is one of the common sexually transmitted diseases. The clinical manifestations of gonorrhea vary depending on the population and site of infection, and are usually divided into gonorrhea in men, gonorrhea in women, gonorrhea in children, other gonorrhea, and asymptomatic gonorrhea. The causative agent of gonorrhea is Neisseria gonorrhoeae, a gram-negative diplococcus, which is ovoid or kidney-shaped, arranged in pairs, 0.6-0.8umm in diameter, and often located in the cytoplasm of polymorphonuclear leukocytes. The optimal growth temperature of gonococcus is 37 ℃ ~ 38 ℃, not heat-resistant, dry environment can survive 1 ~ 2 hours, 55 ℃
5 minutes to die, general disinfectants can easily kill it, attached to clothing and bedding gonococci can only survive for up to 24 hours.
Human is the only natural host of gonococcus, which usually resides in the columnar epithelial cells on the surface of mucous membrane and is mainly transmitted through sexual contact.
Clinical manifestations
Gonococci can cause not only purulent inflammation of the urinary and genital tracts, but also hematogenous dissemination causing gonococcal bacteremia. Only men with urethritis caused by gonococci are described here.
The incubation period of gonorrhea is generally 1 to 10 days, with an average of 3 to 5 days, and occurs mainly in sexually active young and middle-aged people. Clinically, 5% to 20% of men and 60% of women have no obvious clinical symptoms. This part of the patients is also the main source of infection.
Male gonorrhea is almost exclusively contracted by sexual contact. It can cause urethritis, epididymitis, prostatitis, etc. in men.
1.Gonococcal urethritis
Gonococcal urethritis is the main clinical manifestation of gonococcal infection in men, mainly manifested as acute urethritis, 90% of infected people have symptoms. The first is the redness and swelling of the urethral orifice, itching, slight stinging and other discomfort, and thin transparent mucus outflow. 1 to 2 days later, the secretion becomes viscous, dark yellow or yellow-green pus, due to purulent secretions more, underwear often dirty yellow secretions. There are also symptoms of urethral irritation such as frequent urination, urgent urination and painful urination, and inguinal lymph node enlargement, prepuceitis and glansitis.
2.Epididymitis
Epididymitis may appear in 5% to 10% of male patients with untreated gonorrhea, manifesting as epididymal tenderness and swelling.
3.Gonococcal prostatitis
The gonococcus enters the prostate excretory ducts and glands causing acute prostatitis, with discomfort in the perineum, swelling, radiating pain and difficulty in urination, and pressure pain in the prostate.
4. Gonococcal cervicitis
Most infected individuals are asymptomatic. Women with symptoms often have abnormal and increased vaginal discharge, abnormal menstrual bleeding, pain and tenderness in the mid and lower abdomen, and cervical redness, tenderness and purulent discharge seen on gynecological examination.
Laboratory tests
1.Direct smear
A smear of urethral discharge is taken and stained for Gram stain. Microscopically, a large number of polymorphonuclear leukocytes are seen, and Gram-negative diplococci are seen in the cytoplasm. For symptomatic male patients, this method is highly specific (>99%) and sensitive (95%). However, the sensitivity for asymptomatic gonococcal infection is low, and a negative smear does not exclude male infection.
2.Gonococcal culture
Urethral swab or pus inoculation on selective medium, positive can appear typical colonies, oxidase test positive, colony microscopy can see gram-negative diplococci.
3.Other methods
For gonococcal culture negative, but the history and signs are suspicious, polymerase chain reaction can also be used to detect gonococcal DNA, and direct immunofluorescence test can also be used to help confirm the diagnosis.
Diagnosis and differential diagnosis
The diagnosis is not difficult based on clinical manifestations and laboratory tests. In atypical patients, it needs to be differentiated from chlamydial urethritis. The latter has a long incubation period of about 1 to 3 weeks. The symptoms of urethritis are atypical, often manifesting as stinging urethra and varying degrees of pain and burning sensation, less painful than gonorrhea, mild redness and swelling of the urethral orifice, often with plasma or plasma-purulent discharge, thinner and less than gonorrhea discharge, or only in the morning when the urethral orifice is found to have a “paste” phenomenon, and there are patients with no obvious symptoms or no symptoms.
Treatment
The principle of timely, adequate and regular medication should be followed, and the corresponding treatment plan should be adopted according to different conditions. If you have multiple pathogens, you should test for other pathogens of non-gonococcal urethritis at the same time and treat them together if they are positive. Sexual partners should be treated at the same time if they are infected. Follow-up should be done after treatment.
For gonococcal urethritis, ceftriaxone sodium 0.25g, one intramuscular injection; or daikonin 2.0g (4.0g for cervicitis) one intramuscular injection; or cefotaxime sodium 1.0g, one intramuscular injection is preferred.