Gonorrhea is an infectious disease transmitted by Neisseria gonorrhoeae through sexual intercourse, which is mainly caused by diseases of genitourinary system.
Disease is the oldest, most prevalent and highest incidence of sexually transmitted diseases in the world. It is reported that the whole world
There are 654.38+0.5 billion new cases of gonorrhea in the world every year. Among infectious diseases, gonorrhea is second only to influenza.
Gonorrhea should be treated under the guidance of a professional doctor in order to achieve the purpose of cure, and patients should also cooperate with the treatment.
As long as the drugs are used on time and regularly, they can generally be cured. Please also note:
1, bed rest, no strenuous activity and excessive excitement.
2. No sex life.
3. Underwear should be disinfected, cleaned and replaced every day. Keep genitals clean.
4. Spouses and sexual contacts should be investigated and treated together.
5, comply with the doctor's advice, timely and adequate medication, not to find a doctor or self medication.
Prevalence and transmission route of gonorrhea
1, popular function
(1) Man is the only natural host of Neisseria gonorrhoeae. It is not pathogenic to other animals. The main route of infection is sexual behavior, except vulvovaginitis and gonococcal conjunctivitis.
(2) The incidence of classical sexually transmitted diseases is high and the epidemic range is wide.
(3) Fast propagation speed. Gonorrhea has a short incubation period, usually 3-5 days, and it develops quickly after infection.
(4) In terms of occupational distribution, the prevalence rate in China is higher among salespeople and purchasers, followed by taxi drivers, self-employed, workers and others. In the United States, the incidence of soldiers, immigrants, homosexuals and prostitutes is relatively high. For example, at least 30% of prostitutes suffer from gonorrhea.
(5) In gonorrhea infection, women are more susceptible than men. Statistical reports show that about 20%~25% of men will be infected when they have sex with women with typical gonococcal infection. On the contrary, the probability of women being infected is as high as 80%~90%. Carriers of chronic asymptomatic gonorrhea are of great significance in the epidemiology of the disease, but they are difficult to find and rarely treated. After a woman suffers from gonorrhea, 80% may have no symptoms or only mild symptoms.
2. Transmission routing
(a) Almost all male gonorrhea is infected through sexual contact.
(2) Women are mainly infected through sexual intercourse, and the proportion of non-sexual intercourse infection is very small, such as using unsterilized clothes, sheets, bathtubs, toilets and fingers containing gonorrhea secretions used by patients.
(3) Newborns may also be infected through the birth canal of gonorrhea mothers, causing gonococcal conjunctivitis, which can quickly cause blindness if not treated in time.
Young girls often get infected through contact with gonorrhea mothers, causing acute inflammation around vulva and anus.
Clinical manifestations of gonorrhea
Men and women have different symptoms and complications due to different physiological and anatomical structures. Now described as follows.
male gonorrhea
(1) Acute gonorrhea: primary urethritis.
1, incubation period: the incubation period of acute gonorrhea is very short, usually 2-5 days after sexual contact, and the incubation period of very few patients can be as long as 10 day. There are three stages after gonorrhea invades male urethra. ① Invasion stage: It takes 36 hours for gonorrhea to infiltrate into superficial mucosa and start to reproduce and grow. ② Development stage: complete a life cycle in about 36 hours. ③ Detoxification stage: At the end of the life cycle, some Neisseria gonorrhoeae died and excreted endotoxin, which made the organism react to toxins and then showed clinical symptoms.
The factors that affect the incubation period are: the extensive effects of antibiotics; Physical weakness, decreased resistance, alcoholism, excessive sexual life, etc. The incubation period of alcoholics can be shortened, and that of those who use antibiotics can be prolonged.
2. Self-conscious symptoms
(1) Urodynia is often the early symptom of the disease. There is a burning sensation, tingling or burning pain in the front of the urethra, which is obviously aggravated when urinating, and even radiates to the lower abdomen or spine. When there is pain at night, patients may have a "painful erection" of penis.
(2) 12 ~ 24 hours later, the pain was slightly relieved, and thin mucus-like secretion began to be discharged, with a large amount. 12~24 hours later, a large number of purulent secretions are discharged, and pus can be discharged for 20~50ml in 24 hours. After 2~3 days, the amount of pus decreased and became thicker, and the color changed from white to yellow-white or yellow-brown. After 3~4 days, the pus becomes less and thicker. In the morning, pus gathers at the urethral orifice and forms a pus membrane, which is called "life". The pain is relieved, the urethral orifice is red and swollen, and the inner leaves of the foreskin are also swollen, which can develop into balanitis of the foreskin and incarceration of phimosis.
(3) Frequent micturition and urgency are similar to common urinary tract infections, which cause urethral sphincter contraction due to inflammation, especially at night. In addition, "end-stage hematuria" often occurs because inflammation spreads to mucosal small blood vessels there. Sometimes there is blood essence.
(4) perineal swelling pain clinically appears, indicating that the lesion has invaded the posterior urethra, prostate and seminal vesicle.
(5) Systemic symptoms Individual patients may also have systemic symptoms, such as fever (body temperature around 38℃), general fatigue, general malaise, loss of appetite, and even nausea and vomiting.
Physical examination: urethral orifice and fossa are red, swollen and edema, and sometimes there are small and superficial abscesses, erosions or small ulcers. In severe cases, the urethral mucosa is everted, and the swelling affects the entire penis head, glans penis and foreskin everted. The foreskin cannot evert, and pus can flow out when the urethra is pressed. It can also involve bilateral inguinal lymph nodes, causing swelling, spasmodic pain, suppuration, and obvious tenderness, which will be relieved with the decrease of urethral inflammation, and the lymph node inflammation will disappear 2~3 days after the inflammation disappears.
4. Course evolution: The symptoms are the most serious in the first week. If the treatment is not timely or thorough, the symptoms will be gradually relieved after about 2~3 weeks, the urethral secretion will decrease, the tissue swelling will also subside, and the symptoms will disappear completely after one month. But at this time, gonorrhea has invaded the deep gland, even slowly growing in the scar tissue, developing into chronic gonorrhea, and urethral stricture may occur in the later stage.
(2) Chronic gonorrhea: advanced urethritis.
1. Etiology: Most of them are transformed from acute gonorrhea, and a few of them can be infected and directly transformed into chronic persistent lesions. Neisseria gonorrhoeae is hidden in the folds and scar tissue of urethral mucosa of patients with chronic gonorrhea. When patients' general resistance decreases, their sexual life is unrestrained or they are complicated with other consumptive diseases (such as tuberculosis and diabetes) or drink alcohol for a long time, they will have another acute attack.
2. Symptoms: In chronic gonorrhea, Neisseria gonorrhoeae invades the anterior and posterior urethra (such as urethral bulb and mucosa), prostate and epididymis at the same time, and the symptoms are more complicated than those of acute gonorrhea.
Mainly includes:
(1) Urodynia. Similar to acute stage, but mild, end-stage hematuria can also be seen.
(2) Urethral secretions are still alive in the morning. The pus from the urethral orifice is thinner than that in the acute stage, and only a small amount of secretions can be seen when squeezing the penis root.
(3) Prostatitis, seminal vesiculitis, epididymitis, hematuria or hemospermia are easily complicated.
(4) Most patients have low back pain and perineal swelling pain, and are prone to sexual weakness, insomnia, nocturnal emission or premature ejaculation.
(5) Urine contains "drenching silk". Cotton fiber-like substance floats in urine, and silk shower is composed of skin scales, epithelial cells and pustules.
(6) Urethral stricture leads to fine urine or bifurcation.
Chronic gonorrhea often causes acute attacks due to overwork, alcoholism or sexual intercourse.
3. Complex gonorrhea
Gonorrheic prostatitis (1) is a common complication of urethritis after gonorrhea. In addition to fever, dysuria, frequent micturition, urgency, swelling of anus and perineum, oppressive feeling, and pain spreading to the waist after micturition, sexual dysfunction such as impotence and premature ejaculation may also occur. During physical examination, the prostate and anus showed obvious tenderness and swelling, and in severe cases, the middle groove disappeared. Laboratory examination showed that there were a lot of pus cells and lecithin in prostate secretion, and Neisseria gonorrhoeae could be found by microscopic examination and culture.
(2) Gonococcal epididymitis: This complication is acute. At first, there was traction pain in scrotum or testis, which gradually aggravated and spread to groin, resulting in systemic symptoms. The body temperature can rise to 39~40℃, the epididymis is swollen and tender, and the scrotal skin is flushed and burning. In severe cases, swollen spermatic cord and inguinal lymph nodes can be touched. The patient walked with his legs crossed because of testicular pain. The late stage of the disease can cause epididymal connective tissue hyperplasia, fibrosis and vas deferens atresia, and lose fertility.
(3) Other complications: men may also be complicated with parafrenal gland and paraurethral adenitis, periurethral abscess, cellulitis, cavernous inflammation, gonococcal balanitis or balanitis.
Female gonorrhea
Acute gonococcal urethritis
Usually occurs after sexual intercourse 10 days. Self-conscious symptoms include dysuria, urgency, frequent urination, burning sensation of urethra and other inflammatory symptoms, but they are mild. Physical examination shows that the external urethral orifice and vaginal orifice are red, swollen and congested, with purulent secretion, and the vestibular gland can also be red, swollen and tender, and gonorrhea can be detected by laboratory tests. This disease often coexists with primary cervicitis.
(2) Gonococcal cervicitis
The incidence rate is higher than urethritis. The conscious symptoms are increased leucorrhea, pruritus vulvae, slight vaginal pain and burning sensation. A few patients with systemic symptoms, such as fever and abdominal pain, are often accompanied by urethritis, so they may also have symptoms such as frequent urination and urgency. Physical examination showed congestion and edema of vaginal orifice and navicular fossa. There were a lot of purulent secretions at vaginal orifice, which smelled bad, and congestion, erosion or edema and tenderness of cervical orifice. When the urethra is pressed upward from the anterior vaginal wall with fingers, purulent secretions also overflow from the opening of the paraurethral gland.
(iii) Gonorrhea with complications
1, gonococcal bartholinitis (also known as Pasteurella): Vestibular glands open outside the vagina, which is easy to be infected. Symptoms include swelling of vestibular glands, heat pain, a small amount of pus overflowing from the mouth of glands, and even abscess formation of glands, which has a sense of fluctuation. The swelling of12 under the labia majora is obvious, and it may also be accompanied by systemic symptoms and inguinal lymph node enlargement.
2. Gonococcal pelvic inflammatory disease (complicated with gonorrhea): If gonococcal cervicitis is not treated or the short-term treatment is not standardized, about 20% of patients will be infected and become gonococcal pelvic inflammatory disease, including acute gonococcal salpingitis, endometritis, tubal ovarian abscess and peritonitis. Common in young women of childbearing age. Most patients with gonococcal pelvic inflammatory disease develop after menstruation, and the author may have increased menstrual blood before menstruation and prolonged menstruation. Leucorrhea is frequent, purulent or bloody, and has obvious systemic symptoms, such as chills, fever, headache, anorexia, nausea and vomiting, and bilateral lower abdominal pain, especially when one side and abdominal pressure increase. Physical examination showed that the tenderness and muscle tension of the lower abdomen were mainly on one side, and the bowel sounds were weakened. There are purulent secretions in urethra, paraurethral gland, vestibular gland and cervix, and bilateral appendages are also thickened and tender. The disease may also develop into tubal ovarian abscess or pelvic abscess. At this time, the tumor can be touched in the appendix and the posterior recess of the uterus, with obvious tenderness and a sense of fluctuation. If the abscess ruptures, peritonitis and even toxic shock will occur. Over time, it will also cause tubal adhesion and obstruction, leading to infertility or ectopic pregnancy.
Treatment of gonorrhea
In the acute phase, most western medicines are effective, such as cyanotoxins, tetracyclines, cephalosporins and erythromycin. The clinical symptoms disappeared before Neisseria gonorrhoeae turned negative. Husband and wife are treated at the same time.
Nongonococcal urethritis
Nongonococcal urethritis is the most common sexually transmitted disease in clinic. Seriously endanger human health. Nongonococcal urethritis is a disease in which urethritis exists, but gonococcus can not be found in urethral secretions. Mainly caused by chlamydia and mycoplasma, it spreads through sexual intercourse and invades the urogenital organs. So far, the incidence of this disease has surpassed that of gonorrhea in western countries, ranking first among sexually transmitted diseases.
40%-50% of nongonococcal urethritis is caused by Chlamydia trachomatis and 20%-30% by Ureaplasma urealyticum. Then the mycoplasma related to humans are mycoplasma pneumoniae, mycoplasma hominis and mycoplasma genitalium. Mycoplasma and chlamydia can exist in healthy carriers. Ureaplasma urealyticum can decompose urea into ammonia, which is toxic to cells. Because mycoplasma has no cell wall, it is resistant to antibiotics such as penicillin, which disturbs the cell wall.
clinical picture
The incubation period of nongonococcal urethritis is usually 7-2 1 day.
1. Male nongonococcal urethritis
The symptoms of (1) are pruritus, burning sensation and pain in urination, with a few frequent urination and slightly red urethral orifice. In the morning, there is a small amount of mucus secretion at the urethral orifice, or there is only a scab orifice, or the crotch is dirty, so the urine flow will diverge when urinating. Some patients need to squeeze hard with their hands before secretions overflow from the urethral orifice. Symptoms are similar to gonococcal urethritis, but to a lesser extent. Some patients have no symptoms. The patient also suffers from gonorrhea double infection.
(2) Complications ① Epididymitis: The infection extends along the vas deferens to the epididymis, with typical symptoms of urethritis and epididymitis coexisting. The common situation is acute epididymitis, mostly unilateral, which is often caused by biological variation of trachoma. ② Prostatitis: subacute prostatitis is more common, while chronic prostatitis may be asymptomatic or have perineal dull pain and penile pain. ③Reoter syndrome: 0.8%-3% of NGU patients occur, with more males than females. Include urethritis, polyarthritis and conjunctivitis.
2. Female genitourinary tract infection spreads to other parts with cervix as the center.
(1) Myxopurulent cervicitis is characterized by increased leucorrhea and no swelling or erosion of the cervix, but the clinical symptoms are not obvious.
(2) Urethritis, burning sensation of urethra or frequent urination. Check that the urethral orifice is congested, red or normal, and the secretion overflows when squeezing the urethra. Many patients have no symptoms.
(3) Complex pelvic inflammatory disease includes salpingitis and endometritis. This disease may be ectopic pregnancy or infertility.
3. Neonatal conjunctivitis and pneumonia are infected by the birth canal. For women suffering from trachoma-type cervicitis, 40%-50% of their newborns suffer from conjunctivitis, which mostly occurs within 5- 14 days after birth, and neonatal pneumonia occurs in 2-3 weeks after birth, but most of them are diagnosed in 6 weeks. D-K trachoma biotype can be separated from conjunctival nasopharyngeal and tracheal secretions.
How do patients find nongonococcal urethritis early?
Because the clinical symptoms of nongonococcal urethritis are not as obvious as gonorrhea, when patients have the following symptoms, we should think about whether they are infected with nongonococcal urethritis.
(1) Have had extramarital sex within 1 month, or the spouse has had similar sexual behavior, and recently have gradually developed discomfort of urethral itching, or have different degrees of urgency, pain and dysuria.
(2) Before urinating for a long time or when getting up for the first time in the morning, a small amount of watery mucus flows out of the external urethral orifice, and sometimes only a small amount of scab film seals the urethral orifice or a small amount of pus scab is stained on the crotch of underwear. Because the urethral orifice is closed by scab membrane, urine flow will be blocked or dispersed in the early stage of urination.
(3) Female symptoms are not obvious, and sometimes they only show an increase in leucorrhea, which is mucus purulent leucorrhea and pruritus vulvae.
In addition, there is another situation. After the patient was infected with gonorrhea, after regular treatment and taking penicillin, spectinomycin, cephalosporin and other drugs, the clinical symptoms were obviously relieved, and the laboratory examination showed that gonorrhea was negative, but a small amount of mucus purulent secretions still flowed out of the urethral orifice every day, and the urethra was slightly itchy and painful. This situation is likely to be infected with gonorrhea and nongonococcal urethritis. The reason is that the symptoms of gonorrhea are obvious, which masks the symptoms of nongonococcal urethritis. After gonorrhea is cured, the symptoms of nongonococcal urethritis are obviously manifested.
Therefore, both men and women, whenever the above symptoms appear, should go to a regular hospital for examination in time, and be treated in time after diagnosis.
What should I do if there are still symptoms after treatment of nongonococcal urethritis?
1 After the treatment of "non-gonorrhea", if the patient still has symptoms, it is necessary to further check whether there are inflammatory infections in other parts except "non-gonorrhea". If they are all negative, the treatment can be repeated again. If the symptoms do not disappear after re-treatment, the spouse's infection and abnormal sexual habits should be traced. Recurrent attacks and persistent symptoms are mostly related to the sexual contact of infectious sexual partners, so the key to successful treatment is to treat their spouses at the same time and terminate abnormal extramarital sexual relations.
What is the cure standard of nongonococcal urethritis?
The cure standard of nongonococcal urethritis is: the conscious symptoms disappear, and there are no white blood cells in urethral secretions and urine sediment smear.
Can you have sex before curing nongonococcal urethritis?
Because the treatment cycle of nongonococcal urethritis is long and the condition is repeated. In the meantime, although the patient wants to have sex, we have to tell the patient that he must not have sex until he is cured. Because in sexual life, the urogenital tract is congested, which can accelerate the reproduction of pathogens and even further infect internal genitalia. Therefore, sexual life will cause a waste of treatment.
How to treat nongonococcal urethritis?
Although the symptoms of nongonococcal urethritis are not obvious, if it is not cured in time, there will be a long-term risk of complications, so you should go to a conditional hospital in time after you get sick. Don't hide your medical history from the doctor, and don't abuse antibiotics yourself, so as not to delay treatment. As long as you cooperate with doctors and strictly follow the doctor's advice, nongonococcal urethritis can be cured. Because chlamydia has a long growth cycle and needs to be used for a long time, and because nongonococcal urethritis is easily mixed with other pathogens, broad-spectrum antibiotics are used for treatment, and it is emphasized that it should be sustained, regular, sufficient and thorough. The following are several commonly used antibiotic therapies:
(1) tetracycline 500 mg, four times a day, oral *** 14 days.
(2) Erythromycin 500 mg, 4 times a day for 7 days.
(3) doxycycline 100 mg twice a day for 7 days.
(4) Minocycline, 200 mg, twice a day, changed to 100 mg from the second day, twice a day, ***8 days.
(5) Norfloxacin has a certain curative effect on chlamydia, 400 mg per day for 7 days-10 days.
If you have gonorrhea at the same time, you should first treat gonorrhea with penicillin, and then use tetracycline or erythromycin. Because tetracycline has a good therapeutic effect on Chlamydia trachomatis, but it is poor on Ureaplasma urealyticum, erythromycin can be considered.
1 After the course of treatment, if the patient still has symptoms, various laboratory tests should be carried out again. If inflammation still exists, it is necessary to further check whether there are pathogens such as trichomonas vaginalis, candida or herpes virus infection. If it is still positive, it can be treated again. If the symptoms still do not disappear after re-treatment, we should trace the infection of their spouses and whether they have abnormal sexual habits. Because most patients with recurrent and persistent symptoms are related to maintaining sexual contact with infectious sexual partners, their spouses must be treated at the same time to terminate abnormal extramarital sexual relations. This is the key to successful treatment.
If nongonococcal urethritis is not treated, the symptoms of about 70% patients can disappear completely within 6 months, but the disappearance of symptoms does not mean that the disease has been cured, which needs to be confirmed by secretion culture.
The cure standard of nongonococcal urethritis is: the conscious symptoms disappear, there is no urethral secretion, there is no white blood cell in urine sediment smear, and there is no chlamydia inclusion body in iodine staining smear. Only the test results of regular hospitals are the basis to measure whether the treatment is cured or not, and we can't interrupt the treatment at will just by our own feelings.
Prevention and expert loyalty
Nongonococcal urethritis is mainly caused by sexual contact with chlamydia and mycoplasma infected people. In order to prevent nongonococcal urethritis and prevent its resurgence, the following preventive measures can be taken:
( 1)。 Avoid extramarital sex and stop promiscuity.
(2)。 Adhering to regular treatment and avoiding giving up halfway are conducive to eliminating the source of infection and preventing complications. Sexual intercourse is forbidden before and at least 2 weeks after treatment, which is helpful for the complete recovery of the disease.
(3)。 After the treatment is completed, a reexamination is needed to evaluate whether it is really cured.
(4)。 Patients and sexual partners should be examined at the same time and receive formal treatment.
(5)。 Avoid sexual contact until the sexual partner is completely cured.
(6)。 If the symptoms persist or recur, you should go to the relevant specialist of a regular hospital for examination.
(7)。 Advocate the use of condoms and other barrier tools.
(8). Eliminate anxiety and actively cooperate with doctors for treatment.
(9)。 Drink plenty of water during treatment, reduce urine concentration and reduce irritation to urethra.
( 10)。 Don't drink alcohol, because drinking alcohol will aggravate the congestion of urethra and make inflammation more acute.
( 1 1)。 Pay attention to the hygiene of normal sexual life and establish good personal hygiene habits.
References:
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