Gonorrhea is an infectious disease of the genitourinary system caused by gonorrhea bacterium infection, mainly through sexual intercourse, and is most prevalent in young adults and has the highest incidence among sexually transmitted diseases in China.
Pathogenic bacteria
Neisseria gonorrhoeae, a Gramnegative bacillus, is suitable for growth in humid conditions and at a temperature of 35-36 degrees C. The resistance of gonococcus to external physical and chemical factors is poor, and it can only survive for 1-2 hours in a completely dry environment.
Drug-resistant strains of gonococcal bacteria
Due to the mutation of cell chromosomes and with the use of antibiotics, especially the unreasonable use of drugs, drug-resistant strains are gradually produced, and currently there are known penicillin-resistant gonococcal strains and chromosome-mediated drug-resistant strains.
Transmission route
Transmission is mainly through sexual intercourse, and the chance of transmission from female to male is 20%, while the chance of transmission from male to female is more than 90%.
Fetuses can be infected with gonococcal ophthalmia when they pass through the birth canal of a mother with gonorrhea, and medical infections can also occur through the hands and instruments of medical personnel.
Clinical manifestations
1. The incubation period is 2-10 days, with an average of 3-5 days, and can be slightly longer in women.
2.Gonorrhea in men
In the acute stage, the main symptoms of urethritis are redness and swelling of the urethra, itching, pain, frequent urination, urgent urination, painful urination, difficulty in urination, incomplete urination, urethral discharge is thin mucus at first, but after 1-2 days, it is thick yellow pus, due to the stimulation of pus, the urethral orifice is turned out, the glans is red and swollen, it is difficult to move, and walking is groveling; some patients may have fever, weakness, poor performance and other systemic symptoms. In the acute stage, without treatment, the symptoms will be relieved in 1-2 weeks and will basically disappear after one month.
If the acute stage is untreated or improperly treated, or if there is alcoholism or excessive sex with poor health such as anemia or tuberculosis, most patients will have posterior urethritis, and the symptoms are not as obvious as the acute stage, mainly manifesting as urethral irritation, such as frequent urination, painful urination, embarrassment of urination, feeling of falling up in the pubic area, soreness and discomfort.
Male gonorrhea can be combined with prostatitis, vesiculitis, epididymitis, urethral balloon adenitis, etc. Due to repeated attacks of inflammation, the urethral scar is narrowed and some patients have vas deferens, which can cause infertility.
3.Female gonorrhea
It often invades the cervix, urethra, paraurethral glands, etc., and most of the conscious symptoms are not significant and easily ignored. The clinical symptoms can be manifested as increased leucorrhea, lower abdominal cramps, urethritis with varying severity, frequent urination, urgent urination, painful urination, redness and swelling of the urethra, redness and swelling of the cervix, tenderness, and purulent discharge at the mouth of the cervix.
In women, gonorrhea can be combined with vestibular adenitis, pelvic inflammatory disease, endometritis, tubal inflammation, etc. Due to recurrent inflammation, narrowing of the tubal scars can cause secondary infertility.
4.Gonorrhea in children
It is rare, mainly in young girls aged 3-7 years old, and is mostly transmitted indirectly through contact with objects contaminated with gonococcus such as commodes, towels, bath tubs, etc. It can also be transmitted directly due to sexual abuse, manifesting as vaginitis, vulvitis and urethritis, with symptoms such as redness and swelling of the vulva and urethra, purulent vaginal discharge, painful urination and urgency.
5. Gonorrhea ophthalmia
The fetus is infected by passing through the birth canal of the mother with gonorrhea during childbirth, which is manifested by red and swollen eyelids and conjunctiva with purulent discharge 2-3 days after birth, and may cause corneal perforation and lead to blindness.
6, pharyngitis, proctitis
The former is seen in oral sex, as acute pharyngitis, acute tonsillitis; the latter is mostly seen in homosexuality, anal sex, the lighter the perianal redness, discomfort, the heavier the emergence of the lining, with mucus and purulent discharge.
7. Disseminated gonococcal infection
It often occurs in menstruating women, and the gonococcus spreads to the whole body through the bloodstream. Patients have symptoms such as high fever, chills, scattered small pus blisters on the skin, arthritis, endocarditis, tenosynovitis and meningitis.
8. Asymptomatic gonorrhea
Patients infected with gonorrhea do not show clinical symptoms, but they are infectious, so they can become the source of gonorrhea transmission and should be taken seriously.
Laboratory tests
1.Smear microscopy of secretion or pus
The smear is stained with gram, and there are gram-negative stained diplococci in polymorphonuclear leukocytes, and the diagnosis can be confirmed by combining with the clinic, but negative does not exclude the diagnosis of gonorrhea, and the positive rate of smear detection is only about 50-60% for female patients, and the detection rate of gonorrhea of the throat, rectal gonorrhea and chronic gonorrhea is also low.
2.Culture of gonococcus
Positive culture can confirm the diagnosis, gonococcus is carbon dioxide loving aerobic bacteria, special culture medium is needed.
3.Polymerase chain reaction
It is a new detection method established by molecular biology technology, which has the advantages of high sensitivity, high specificity, and fast detection speed.
Diagnostic points
1.History of unclean sex or spouse infection, or history of infection through indirect contact.
2, clinical manifestations, typical symptoms of urethritis, pus at the urethral opening, women also appear cervical opening, vaginal opening purulent discharge.
3, laboratory tests: male acute urethritis symptoms, pus smear with gram-negative diplococci can confirm the diagnosis, in other cases for reference, to confirm the diagnosis relies on gonococcal culture.
Treatment
The principle of timely, adequate, regular medication and post-treatment follow-up should be followed to select effective antibiotics.
Currently, oral antimicrobial therapy is given for one week with a combination of penicillin antimicrobials such as Amytin and erythromycin.
Pre-visit and precautions
1.Keep the good tradition of monogamy, forbid sexual promiscuity, suspend sexual life if one spouse is sick.
2, once the disease, should go to a regular hospital for thorough treatment and review after cure.
3, within 30 days of contact with gonorrhea sexual partners, should be examined, if necessary, for anti-sexual treatment.
4.Serological examination of syphilis should be done routinely after 6 weeks of illness, and HIV antibody test should be done if necessary.