Signs of gonorrhea disease. Gonorrhea: symptoms and treatment regimen for gonorrhea. Treatment of pregnant patients

In some cases, gonococcal infection spreads through the bloodstream.

In newborns, vertical transmission of gonorrhea can cause blindness if left untreated.

Oral sex with an infected partner contributes to the appearance of; infection of the rectum can result from anal sex or local spread from the vagina.

Features of transmission of infection

The first signs of gonorrhea in men

A common gonococcal infection manifests itself as follows:

• rash;
• fever;
• arthralgia;
• polyarthritis;
• septic arthritis,
• tenosynovitis,

Ngonorrhoeae from the primary site (cervix, urethra, pharynx or rectum), spread through the bloodstream and affect other organs. Neisser's gonococci multiply in the blood due to many predisposing factors. These include:

• premorbid background;
• virulence factors of the microorganism itself;
• disruptions in the functioning of the immune system.

For example, changes in vaginal pH that occur during menstruation, pregnancy, and the postpartum period make the vaginal environment more conducive to pathogen development and allow greater access to the bloodstream.

note

• eye pain;
• redness;
• photophobia;
• purulent discharge.

In severe cases, a common gonorrheal infection may be associated.

For newborns, a 2-sided process is typical; in adults, the conjunctiva of one eye is more often affected.

Adults can get an infection in the eyes after contact with the mucous membrane affected by gonococci.

Victoria Mishina, urologist, medical columnist

(from the Greek term " gonorrhoia", first used by the physician Galen in the meaning of "expiration of semen") - infectious venereal disease, usually transmitted sexually.

The disease is caused by a special microorganism - Neisser's gonococci or Neisseria gonorrhoeae. Neisser discovered gonococcus in 1879. Gonorrhea is especially common among people at a young active age; more than 200 million people worldwide become ill with gonorrhea every year. The ratio of women to men with gonorrhea is, according to research, 2:1.5. When gonorrhea occurs, damage occurs genital mucosa, less often - eyes, tonsils, rectum.

In the case of advanced gonorrhea, vital organs are affected - the heart, lungs, and brain. May even develop gonococcal sepsis . Such complications of gonorrhea require immediate treatment. The sources of the disease are patients with gonorrhea. Girls can also become infected with gonorrhea through infected towels, washcloths, diapers, and dirty hands.

There are the following forms of gonorrhea: fresh, if the disease lasts less than 2 months, which in turn happens acute , subacute , torpid , and chronic, i.e. lasting more than two months.

Infection occurs during sexual intercourse, and the disease is transmitted through vaginal , and at anal , and at oral sex . Women get sick in almost all cases of contact with a patient with gonorrhea, but men do not always, which is associated with the narrowness of the urethral opening. Infection occurs significantly less frequently by contact, for example, from a mother with a disease to a child, during the passage of the fetus through the birth canal.

At the end of the brief description, we will debunk one of the common myths. Since gonococci live only on the mucous membrane, and most often die outside it, it is therefore theoretically possible to become infected with gonorrhea in the pool, but it is unlikely.

gonorrhea symptoms

Typically, the incubation period of the disease lasts from 2 to 5 days in men and 5-10 days in women.

The main symptoms of gonorrhea in men are:

• sharp pain and burning sensation when urination;
• yellowish discharge from the urethral duct spontaneously or with pressure;
• increased urge to urinate;
• redness of the skin of the urethra around the external opening;
• cloudy urine with “flakes” or blood in it;
• erection may be painful;
• sometimes rises temperature , appears chills .

If left untreated, the infection spreads to prostate And testicles .

Symptoms of gonorrhea in women:

• pain when urinating;
• frequent;
• irregular, dirty yellow, thick, sometimes with an unpleasant odor;
• frequent urge to urinate;
• between menstruation;
• chills and fever are possible.

Quite often, gonorrhea occurs in women without the main symptoms, and if they do appear, the discharge is identified as, and pain during urination is identified as.

Diagnosis of gonorrhea

The doctor diagnoses gonorrhea based on familiarization with the patient’s complaints, examination of the genital organs, and the results of general vaginal smear, urethra, discharge from the eyes, examination of the anus, data urinalysis. The patient's sexual activity, recent sexual intercourse, the appearance of discharge from the urethra, and whether he has previously suffered from sexually transmitted diseases are determined.

If the patient has not used disinfectants, it may be prescribed bacterioscopic analysis. In the early stages of the disease, i.e. for “fresh” gonorrhea, the direct method is effective immunofluorescence, allowing you to additionally identify other possible ones. Before starting the main treatment, tests are also carried out. In the case of chronic gonorrhea, a more accurate study is prescribed - PCR, polymerase chain reaction or culture.

gonorrhea treatment

It is imperative that treatment of the disease is carried out by a venereologist in a hospital setting. Usually the doctor prescribes a set of procedures that contribute to the patient’s recovery. This includes local treatment and methods.

Antibiotics that are used in the treatment of gonorrhea belong to the penicillin group -,. Antibiotics classified as tetracyclines can also be used - sometimes azalides (,), cephalosporins and some others. used to increase immunity and the body's resistance to infection, in this case vaccine therapy, autohemotherapy, prodigiosan , . Physiotherapeutic methods for treating gonorrhea include electrophoresis, , laser therapy, UHF, Ural Federal District.

Local treatment of gonorrhea is carried out by introducing a solution (0.5%) into the vagina or urethra, microenemas with chamomile tincture. With timely treatment, the disease can be cured quite quickly, otherwise it can become chronic. During treatment, the patient must adhere to the recommended diet and not drink alcohol. You can’t play sports, you need to avoid sexual intercourse.

If the disease is combined with chlamydia or, then treatment of gonorrhea is accompanied by the use of medications for concomitant infections - azithromycin , doxycycline . Because antibiotics almost always contribute to the destruction of normal intestinal microflora, then at the same time patients are prescribed lacto- and bifido-containing drugs (, Bifilong ).

It should be noted that self-medication of gonococcal infection usually leads to chronic gonorrhea and other irreversible complications. So at the first signs of the disease or if any unpleasant sensations appear in the genital area, you need to contact a specialist as quickly as possible.

When treating chronic gonorrhea, the infection itself is destroyed, and drugs that strengthen the immune system are also prescribed, for example, and immunomodulatory drugs .

If the disease has become chronic, then the main symptoms of gonorrhea may disappear, the pain will go away, but the “morning drop syndrome” will remain, etc. discharge of cloudy fluid from the opening of the urethra. Exacerbations of the disease caused by hypothermia and menstruation are often observed.

With timely treatment, the prognosis is favorable. Gonorrhea is considered cured if the symptoms of the disease have completely disappeared, and laboratory tests are negative and show the absence of the pathogen.

The doctors

Medications

Personal prevention of gonorrhea consists of excluding casual sexual intercourse and mandatory use. If accidental sexual contact occurs, it is recommended to contact a venereal disease clinic or a personal prevention center operating there as soon as possible to implement the necessary measures to avoid the development of the disease.

Complications of gonorrhea

Among the complications of advanced gonorrhea in men is a violation spermatogenesis , and inner layer of the foreskin, as well as damage to the testicle and its epididymis orchitis , epididymitis or, which can lead to infertility. In a woman, inflammation spreads to the uterus (), fallopian tubes, and further to the ovaries and appendages ( salpingo-oophoritis ), which can lead to infertility, as well as various sexual disorders, frigidity , development.

If a pregnant woman becomes infected with gonorrhea, then it is likely that premature birth , fetal death. Gonorrhea is especially dangerous for newborns, who may develop eye diseases that lead to blindness. If gonococci have spread to other organs, then serious diseases such as damage to the joints, heart, skin and brain are possible.

For prevention, it is necessary to follow the basic rules of personal hygiene, especially after using the toilet, and regularly wash the genitals with soap and water. It should be noted that with timely treatment and compliance with all doctor’s recommendations, complications of the disease can be avoided.

Diet, nutrition for gonorrhea

List of sources

• Adaskevich V.P. Sexually transmitted diseases. - Vitebsk: Publishing House of the Vitebsk Medical Institute, 1996;
• Vasiliev M.M. Gonococcal infection/ M.M. Vasiliev // Med. Newspaper. -2003.-No. 51, 52;
• Dermatovenereology / Edited by A.A. Kubanova. - M.: DEX-PRESS, 2010.

Gonorrhea is an infectious disease that is sexually transmitted and affects the mucous membranes of the external and internal genital organs, urethra, rectum, pharynx, and eyes.

The causative agent of gonorrhea is the bacteria Neisseria gonorrhoeae. A feature of gonococci is that they can live on the membranes of body cells and in the cells themselves. There are strains of gonococci that are resistant to antibiotics and antibodies produced by the body. This significantly complicates the treatment of the disease.

The disease is transmitted sexually and is therefore considered venereal. Infection with gonorrhea is possible through any type of sexual contact - vaginal, anal and oral. Women are more likely to contract gonorrhea. Statistics show that women have an up to 80% chance of contracting gonorrhea through contact with an infected partner, and up to 40% for men. The male genital organs are more protected from gonorrhea: the urogenital canal is narrower, and urine can wash away gonococci during urination.

Infection with gonorrhea through household means is very rare, since the bacteria die in an aggressive external environment when exposed to the sun and household chemicals. Infection is possible through hygiene items, such as a towel, or a shared restroom. Women are also more likely to become infected at home than men.

Another way of infection is during childbirth. An infected mother can pass gonococci to her baby as the baby passes through the cervix and vagina. In this case, the eyes of newborns and genitals are affected. Genitourinary congenital gonorrhea is diagnosed mainly in girls. In boys, the conjunctiva of the eyes often suffers from gonorrhea, which can cause vision loss.

Types of gonorrhea

Gonorrhea can affect different parts of the body.

Depending on the location of gonorrhea, several types of the disease are distinguished:

• gonorrhea of ​​the urethra and genitals;
• gonorrhea of ​​the anal and rectal area;
• gonorrhea of ​​the skeletal and muscular system;
• gonococcal pharyngitis;
• gonococcal eye infection;
• gonorrheal endocarditis;
• gonorrheal meningitis.

Gonorrhea of ​​the genitourinary organs affects the mucous membrane of the urethra, cervical canal, uterus, fallopian tubes, ovaries, periurethral glands and peritoneum. In men, the urethral area is most often affected. In rare cases, when the local immunity of the vagina is reduced, the vaginal epithelium may be damaged by gonorrhea.

Gonorrhea of ​​the anal and rectal area is diagnosed as gonococcal proctitis. The rectal mucosa is affected. This type of gonorrhea is more often diagnosed in gay men and during genital-anal contact in traditional couples.

With gonococcal pharyngitis, redness of the throat, formation of purulent plaque, and enlarged lymph nodes are observed. Can be transmitted through genital-oral contact. In some cases, infection occurs through the use of dishes from infected people. It is most often transmitted through oral contact with patients.

Gonorrhea of ​​the skeletal and muscular system is also called gonoarthritis. It affects the joints, which leads to impaired mobility and pain. Develops with untreated chronic gonorrhea.

Gonococcal eye infection is called blenorrhea and affects the conjunctiva of the eyes. It is often diagnosed in newborns - on the second or third day after birth, if the mother is sick or is a carrier of gonorrhea. It is very rarely transmitted through sexual contact.

According to the duration and severity of the disease, fresh and chronic forms of gonorrhea are distinguished:

• with fresh gonorrhea, infection occurred less than 2 months ago;
• with chronic gonorrhea, infection occurred more than 2 months ago.

Fresh gonorrhea is further divided into acute (with pronounced symptoms), subacute (with less pronounced symptoms) and torpid (with minimal symptoms).

With chronic gonorrhea, the symptoms of infection are less pronounced than with acute gonorrhea, but the likelihood of complications is high.

In rare cases, a person can become a carrier of gonococci, but not get sick. Gonorrhea carriage can only be determined through laboratory testing. This is a dangerous option, since a person is a source of infection for a sexual partner and people around him. With a decrease in immunity, symptoms of gonorrhea may also appear in the carrier.

How does gonorrhea manifest?

The onset of symptoms after infection does not occur immediately. The incubation period for gonorrhea can last from 1 to 14 days. The duration of the incubation period depends on the method of infection, the location of the gonococci and the immune status of the patient.

The clinical picture is different for men and women. Symptoms also differ for different types of gonorrhea.

Fresh gonorrhea of ​​the genitourinary organs in women has the following symptoms:

• purulent discharge from the vagina;
• frequent urination, accompanied by itching, burning and pain;
• intermenstrual bleeding;
• disruption of the female cycle;
• pain in the abdomen, in its lower part;
• the appearance of ulcers on the genital mucosa;
• discoloration and swelling of the genital mucosa;
• temperature rise above 39 degrees;
• indigestion - nausea, vomiting, diarrhea, abdominal pain.

The clinical picture of gonorrhea in women may change if other sexually transmitted infections are associated with gonorrhea.

Fresh gonorrhea of ​​the genitourinary organs in men has the following symptoms:

• narrowing of the urethra caused by swelling of the urethral mucosa;
• burning and itching in the genitourinary canal;
• purulent discharge from the urethra;
• frequent urination, accompanied by pain and burning;
• fever and chills.

Chronic gonorrhea of ​​the genitourinary organs manifests itself as follows:

• in men and women, adhesions appear in the pelvis, which can cause infertility;
• in men, libido decreases, erectile dysfunction is observed, including impotence;
• In women, the menstrual cycle is disrupted, there is severe inflammation of the internal organs of the intimate sphere, and fertility (the ability to conceive and bear a child) decreases.

Gonorrhea of ​​the anal and rectal area in men and women is accompanied by:

• painful bowel movements;
• itching, swelling and burning in the anus;
• fever;
• purulent discharge from the anus;
• ulcers of the rectum and anus;
• proliferation of polyps in the rectum (with chronic rectal gonorrhea).

Blennorea has the following symptoms:

• inflammation, swelling and redness of the conjunctiva;
• purulent discharge from the eyes;
• ulcers on the mucous membranes of the eyes;
• inflammation of the cornea of ​​the eyes;
• appearance of a cataract (rare);
• blindness (without treatment or with congenital blennorrhea).

When infected during childbirth, bilateral blenorrhea is usually diagnosed. In other cases, unilateral inflammation is possible.

Diagnostics

Diagnosis of gonorrhea is carried out by different specialists. Gonorrhea of ​​the genital tract in women is dealt with by a gynecologist, and in men by a urologist. A proctologist diagnoses rectal gonorrhea. An otolaryngologist deals with gonococcal pharyngitis. Blenorrhea is treated by an ophthalmologist, gonorrheal meningitis is treated by a neurologist. An infectious disease specialist is also involved in the diagnosis and treatment of gonorrhea. It may be necessary to consult an immunologist.

It is almost impossible to detect gonorrhea by visual examination, since it often occurs without pronounced symptoms, so laboratory diagnosis is necessary. For analysis, they take secretions from the genitals, anus, eyes, and make a smear from the mucous membrane of the throat. Next, the biological material is examined under a microscope, bacterial culture is carried out, and PCR diagnostics are performed.

Gonorrhea is often accompanied by other STDs, so additional testing is carried out for various infections and viruses. In women, cytology of the cervical canal mucosa is performed; in men, urethroscopy is performed.

Diagnosis of gonorrhea is carried out several times. This is necessary to track progress in treatment. After completion of treatment, a follow-up examination with collection of material for laboratory testing is indicated.

Sexual partners of the infected person should also be screened for gonorrhea, even if they have no symptoms. This is a delicate issue, but you cannot hide the fact of diagnosing the disease from your partner.

Treatment

Gonorrhea should be treated by a doctor, otherwise complications may develop. In adults, uncomplicated gonorrhea is treated at home; children are treated in a hospital under the supervision of several specialists. The prognosis for the treatment of this disease is usually positive. The difficulty in treating this disease is that gonococci often form strains that are resistant to antibiotics - this causes difficulties in selecting adequate treatment. Untreated gonorrhea always becomes chronic.

During treatment for gonorrhea, sexual activity is prohibited to avoid re-infecting each other. Alcohol, active sports training, and hypothermia are prohibited.

Antibiotics play a vital role in the treatment of gonorrhea. They are prescribed orally, intramuscularly, in the form of vaginal or rectal suppositories, in the form of ointments, solutions and creams.

Treatment of gonorrhea is carried out comprehensively. Along with other therapeutic methods, physiotherapy is also used - electrophoresis, UHF, magnetic therapy. Immunotherapy speeds up treatment and helps the body fight infection.

In case of acute purulent gonococcal process in the peritoneum or uterus, surgical treatment is necessary. The doctor opens the area of ​​the abscess, removes purulent masses and dead tissue, and treats the tissue with antimicrobial agents.

Without adequate treatment, gonorrhea can cause numerous complications:

• infertility;
• impotence;
• ectopic pregnancy in women;
• blood infection with gonococci with their subsequent spread throughout the tissues.

How to prevent gonorrhea

Prevention of gonorrhea - a healthy lifestyle, maintaining good hygiene and avoiding promiscuity. You should use only your own hygiene items - sponge, towel, toothbrush. You should not sit on toilets in public places; after visiting the restroom, you should wash your hands with soap or treat them with a disinfectant solution. During sexual intercourse, it is advisable to use barrier contraception.

When planning a pregnancy, be sure to be screened for gonorrhea. This will keep the baby and mother healthy. Perhaps the worst consequence of gonorrhea is the infection of children, because this often leads to irreversible blindness.

In Russia, regular screening for gonorrhea is mandatory for workers in the fields of education, medicine, and public catering. Medical examinations are carried out annually and the results of the examinations are recorded in the personal medical record.

Gonorrhea is an infectious pathology with a predominant purulent lesion of the mucous membrane of the genitourinary system. It refers to anthroponotic venereal diseases that are sexually transmitted. Self-healing is impossible; in the absence of adequate therapy, gonorrhea becomes chronic and leads to complications.

Etiology

The cause of the disease is the penetration and reproduction in the human body of a special bacterium, Neisseria gonorrhoeae, which was first described by A. Neisser in 1879. This pathogen is a gram-negative diplococcus, has a bean-shaped shape and is located in pairs. He does not have the ability to move independently.

The small villi (pili) present on the surface of the gonococcus contribute to its attachment to the surface of the mucous membranes and penetration into the cells. In addition, these pili carry antigenic information, which can change during the development of the disease and under the influence of factors unfavorable for the bacterium.

Gonococcus has the ability to transform into a protective L-form. This allows it to survive engulfment by phagocytes and insufficiently intensive antibiotic therapy. But the L-form does not protect against the action of antiseptics and environmental factors; outside the body, the gonococcus is quickly destroyed when the secretions dry out. Therefore, the household route of infection is rare; it is possible only when objects are heavily contaminated and there is a short period of time between the release of bacteria and their contact with another person.

Pathogenesis

Gonorrhea in men most often occurs during sexual contact with a partner with gonorrhea, who may not have obvious external pathological signs. The causative agent is contained in vaginal discharge and urethral secretion. During oral intercourse, the presence of gonococcal lesions of the nasopharynx is important, and during anal intercourse, gonorrheal prostatitis is important. The homosexual partner transmits the pathogen with sperm and prostate secretions. Infection occurs in 25-50% of cases and is not associated with the activity of the immune system.

After entering the body of a man, gonococci attach to the surface of the mucous membrane, without migrating far beyond the zone of penetration. In most cases, they affect the urethra and prostate gland, settle on sperm and sometimes enter the terminal portions of the vas deferens. With concomitant infection with trichomoniasis, gonococci can penetrate into trichomonas, in which case antibacterial drugs are not dangerous for them.

A characteristic feature of gonococci is the ability to multiply inside leukocytes, which is called endocytobiosis. Therefore, the protective phagocytic reaction of the immune system of an infected person is ineffective and even leads to the spread of the pathogen. Inside the cells, gonococci exist for quite a long time in an inactive form, which can lead to an erased clinical picture of chronic gonorrhea in men.

Bacterial infection causes inflammation of the mucous membranes with purulent discharge. The gradual destruction of the inner lining of the urethra leads to the release of gonococci into the lymphatic and blood vessels, spreading them to the underlying tissues. In response to the penetration of pathogens, the immune system begins to produce antibodies, but they are not able to protect the man’s body from further development of the disease. Gonorrhea does not lead to the formation of immunity; reinfection is often observed.

Symptoms of gonorrhea in men

The first signs of gonorrhea in men do not appear immediately. This is preceded by an absolutely asymptomatic period, although at this stage the pathogen strengthens on the surface of the urethra at its mouth, penetrates the cells of the mucous membrane and actively multiplies. Signs of the disease appear after the development of active inflammation against the background of a progressive increase in the number of bacteria. The incubation period usually lasts 3-5 days, but in some cases it extends to 2 weeks.

The first symptoms are discomfort along the urethra, quickly followed by itching and burning in this area. Soon, mucous and then purulent yellowish-white discharge appears from the opening of the urethra. The urethral sponges on the head of the penis become red and swollen, and painful nocturnal emissions are possible. At first, suppuration is intermittent and is associated with pressure on the penis and the beginning of urination, then it becomes almost continuous. With the rapid development of the disease, body temperature may increase with the appearance of nonspecific signs of general intoxication.

Symptoms of gonorrhea in men usually increase rapidly during the first week after the first manifestations, after which they often become dull and lose their severity. Self-treatment also contributes to an atypical course. Antibiotics, often taken haphazardly, without a doctor’s prescription and in insufficient doses, lead to a decrease in the activity of gonococci, but do not destroy them. As a result, the signs of the disease become erased, the man can consider himself cured, and the process becomes chronic. In this case, the suppuration is scanty, like a “morning drop”, changes on the head of the penis are poorly expressed.

In the first 2 months after infection, they speak of acute or fresh gonorrhea. If the disease is more than 8 weeks old, the chronic form is diagnosed. With an asymptomatic course of the acute process, gonorrhea is called torpid.

Possible complications

Over several weeks, inflammation can spread along the walls of the urethra to the bladder, prostate and seminiferous tubules. This causes complications of gonorrhea in the form of cystitis and prostatitis. Symptoms include frequent painful urination, nagging pain in the perineum during sexual arousal and ejaculation, and discomfort in the testicles. Prostatitis can lead to impotence and a decrease in the fertilizing ability of sperm.

Gonorrheal epididymitis appears when the epididymis is involved in a specific inflammatory process. It is usually acute and proceeds violently. This causes fever, redness and swelling of the scrotum, and sharp pain on the affected side. Epididymitis can be unilateral or affect both testicles to varying degrees. The development of epididymitis threatens subsequent cicatricial narrowing of the lumen of the vas deferens with the development of infertility.

Long-term urethritis, leading to deep lesions of the wall of the urethra, can be complicated by urethral stricture. Difficulty in the outflow of urine contributes to congestion in the bladder, reflux of urine into the ureters and ascending infection of the excretory system.

Massive penetration of the pathogen into the bloodstream leads to the generalization of gonorrhea. In this case, sepsis develops, foci of inflammation appear in other organs, and the heart valves are often affected.

Factors contributing to the development of complicated gonorrhea in men:

1. the presence of concomitant acute or chronic diseases of the genitourinary system (cystitis, urolithiasis, prostatitis, prostate adenoma);
2. infection with other STDs;
3. weakened local immunity, repeated infection with gonorrhea (reinfection);
4. eating spicy food;
5. frequent sexual arousal;
6. use of coitus interruptus as a method of contraception;
7. excessive physical activity;
8. alcoholism.

Often, a man suffering from gonorrhea consults a doctor not with the initial symptoms of anterior gonorrheal urethritis, but after the development of complications. In this case, even after intensive complex therapy, the consequences of gonorrhea often develop in the form of narrowing of the urethra, infertility and chronic prostatitis.

Diagnostics

In the classic course of the disease, the doctor may suspect the presence of gonorrhea already at the initial visit of a sick man, based on the existing symptoms of anterior urethritis with suppuration. The diagnosis must be confirmed by microbiological examination of a smear from the urethra and a portion of urine. Serological diagnosis of gonorrhea is rarely performed.

To begin treatment, it is sufficient to detect paired bean-shaped bacteria by microscopy of urethral discharge. But even in this case, culture is carried out on nutrient media, which makes it possible to confirm the diagnosis and determine the sensitivity of the isolated pathogen to the main antibiotics. Gonococci grow best on nutrient media with ascitic fluid and blood plasma, forming transparent round colonies with smooth edges.

A test for gonorrhea in men is taken not only in the presence of obvious clinical signs. It is carried out when other STDs are detected, in the presence of chronic prostatitis and urethritis of unknown etiology. In addition, the examination is carried out according to epidemiological indications, when tests are taken from all sexual partners of the sick woman. And on the initiative of the man, a smear is taken for gonorrhea after unprotected sexual intercourse with an unfamiliar woman. This takes into account how long it takes for gonorrhea to manifest itself and how long it takes for gonococci to penetrate the urethral mucosa and begin to reproduce. Therefore, the analysis is carried out a few days after questionable sexual intercourse.

To increase the reliability of the result, it is important to correctly obtain the material for the study. Before taking a smear from the urethra, a man must not urinate for 4-5 hours, not use topical antiseptics or take antibiotics. A smear is taken with a Volkmann spoon or a bacteriological loop. If there is scanty discharge and signs of prostatitis, a preliminary prostate massage is performed.

Chronic gonorrhea often causes difficulties in laboratory diagnosis; a false-negative examination result in this case is mainly due to the intracellular location of the pathogen. Therefore, before taking smears, a provocation is necessary - stimulation of the release of gonococci during an artificially induced exacerbation of chronic urethritis. For this purpose:

1. instillation of silver nitrate solution;
2. bougienage of the urethra, urethrography;
3. heating the inflamed area using inductothermy;
4. eating food with a lot of spices;
5. intramuscular administration of gonovaccine.

The provocative method followed by taking a smear is also used to monitor the treatment.

Treatment

Treatment of gonorrhea in men consists of etiotropic antibacterial therapy, symptomatic measures to reduce the severity of symptoms, sexual rest and diet. It is necessary to avoid physical activity, cycling, drink plenty of fluids and avoid the use of spices.

Antibiotics for gonorrhea are prescribed in a course; the duration of therapy depends on the nature and duration of the disease and is determined by the doctor. You should not stop taking medications after the condition improves, which usually happens after 2-3 days of antibiotic therapy. This can create resistance of gonococci to the drug used and will contribute to the preservation of the pathogen in the body intracellularly or in the L-form.

For the treatment of gonorrhea, preference is given to penicillin antibiotics and 3rd generation cephalosporins. If the pathogen is insufficiently sensitive to them or there are contraindications, drugs from other groups are used, based on the data of bacteriological research.

Systemic antibiotic therapy is supplemented with sanitation of the urethra. To do this, rinsing and instillation with various solutions with antimicrobial and anti-inflammatory effects are carried out. When acute inflammation subsides, physiotherapy is prescribed: UHF, phonophoresis and electrophoresis, laser and magnetic therapy, inductothermy, ultraviolet exposure. In case of chronic, recurrent and torpid course, immunotherapy is indicated, which can be specific (using gonovaccine) and nonspecific.

After 7-10 days and then immediately after completion of the course of treatment, a control bacteriological examination is carried out, which is repeated a month later.

Since it is necessary to treat gonorrhea in men together with the sexual partner, an epidemiological study is being conducted. All women who have been in contact with the sick person are sent to a gynecologist and dermatovenerologist; if they are diagnosed with gonorrhea, they also undergo specific therapy. In case of refusal of treatment, non-compliance with recommendations and the presence of a generalized infection, hospitalization is recommended.