- Causative agent
- Ways of transmission
- Incubation period and symptoms
The diagnosis of “gonorrhea” was first made at the dawn of the second century AD, then this ailment was considered exclusively male. Translated from the Greek, it means “seed impulse”, since the external symptoms of the disease are expressed in the appearance of muddy droplets from the urethra. An infectious agent was later detected and isolated, not only in the urethral discharge, but in the conjunctival.
Gonorrhea (in everyday use “ tripper ”) in men is an inflammatory process in the urethral canal (gonorrheal urethritis), all other types of lesions caused by the activity of an infection are considered complications.
The causative agent of gonorrhea is Neisseriagonorrhae gonococcus . In the external environment, the infection dies, but inside the human body it becomes invulnerable thanks to a special capsule (2 bacteria each) protecting it from immunoglobulins, the cells responsible for maintaining immunity. Another distinctive feature of Neisser’s gonococcus is the ability to produce lactomase – a substance that levels the effect of antibiotics. Beta-lactam strains are not amenable to treatment with a number of drugs effective against other types of infection.
With the help of special villi, the gonococcus is attached to the tissues of the mucous membranes of the genital tract, as a result of which purulent inflammation of the urethra occurs in men. The organism reacts to such an invasion by accumulating a large number of macrophages (protective cells that neutralize pathogens). However, the immune defense is powerless against the gonococcus capsule, macrophages die. That is why gonorrhea is accompanied by the formation of purulent secretions consisting of dead immune cells and live gonococci.
Ways of transmission
Gonorrhea is transmitted by any means of intimate contact . A man does not have to perform a full-fledged sexual intercourse, contact between mucous membranes is enough.
Gonococcus can move both from the genitals to the oral cavity, and in the opposite direction, since the infection tends to spread throughout the body. A typical example: gonococcal pharyngitis.
If your partner has gonococcal stomatitis, then the man has every chance of getting gonorrhea through a normal kiss. The rectum is also colonized with gonococcus, so anal contact with the carrier is no less dangerous than the traditional one.
Cases of domestic infection is rare, but still recorded. Gonococcus dies quickly in the external environment, but if it falls on a wet surface (sponges, towels, toothbrushes), it will remain viable for several hours. For men, the risk of infection in a household way is almost eliminated, since the opening of the urethra is narrow. If even the gonococcus got into it in a household way, then, most likely, it will be thrown out by mucus or washed with urine.
Incubation period and symptoms
The man may feel the first signs of infection within 3-4 days after the introduction of the infectious agent. The incubation period can last for 2-3 weeks, during which there will be slight discomfort in the urethra.
The duration and nature of the manifestations distinguish the following forms of gonorrhea:
- no more than 2 weeks with pronounced signs – acute ;
- from 2 to 8 weeks with characteristic symptoms – subacute ;
- up to 8 weeks, but sluggish, almost without signs – torpid (subclinical);
- more than 2 months or with an unspecified period is chronic .
There is another form of gonorrhea – latent (latent) , which does not manifest itself until the disease passes into the chronic stage. Often with latent gonorrhea, infectious agents are concentrated in the enclosed foci within the tissues, they can be found there with great difficulty. But this nature of the development of gonococcal infection is typical mainly for women, men are more likely to suffer from acute or chronic form.
There is also the so-called “donation” – gonococci are present on the mucous surfaces, but without a reaction from the tissues: the cellular elements do not come out, the inflammatory fluid is not released.
The main signs of infection :
- discomfort, burning in the urethra, aggravated during urination, because the mucosa of the canal is inflamed and irritated;
- the appearance of mucus from the urethral canal with pressure on the head of the penis. Soon the discharge becomes purulent, more abundant, appear arbitrarily;
- inflammation of the foreskin and head, the appearance of erosions;
- possible release of blood droplets with sperm;
- probably an increase and inflammation of the inguinal lymph nodes.
For the chronic form of gonorrheal urethritis, the syndrome of the “morning drop” is characteristic – purulent discharge in small amounts appears on the head of the penis only in the morning.
As the infection progresses through the urethra, signs of cystitis are added : frequent false urge to urinate , soreness in the lower abdomen. Further, if untreated, the gonococcus spreads throughout the body, and gonorrhea becomes chronic.
Depending on the location of gonococcus in men, the following types of complications are distinguished:
- rectal gonorrhea . There is itching, soreness during stool. May flow hidden;
- gonococcal pharyngitis, tonsillitis . Often manifested only mild discomfort when swallowing;
- lymphangitis – inflammation of the lymphatic vessels of the penis;
- gonorrheal arthritis – damage to the joints, in which the pain is accompanied by swelling of tissues, rashes, stiffness of movements. The most susceptible to gonococcal infections are the knee, ankle, elbow, and small joints of the hands;
- Cavernitis – inflammation of the cavernous bodies of the penis, causing a painful erection. Periurethral abscess is possible – localized suppuration, leading to the curvature of the penis;
- Phimosis – swelling of the foreskin, in which it can not be pulled from the head;
- paraphimosis – compression of the head due to edema of the foreskin, possible tissue death;
- deferentitis – defeat of the vas deferens;
- colliculitis – inflammation of the seed tubercle. Symptoms: blood in semen (not always), frequent painful erection;
- narrowing (stricture) of the lumen of the urethra due to scarring, resulting in impaired urination;
- damage to the eyes (adults blepharrhea). Symptoms: lacrimation, inflammation of the conjunctiva, discharge of pus. Possible partial or complete loss of vision.
Gonococcus often penetrates the testicles. In this case, the appendage is first affected (gonorrheal epididymitis), and then the testis itself (gonorrheal orchidididimitis). The following symptoms are characteristic of this complication:
- redness and swelling of the skin of the scrotum;
- swelling and tenderness in the testicle;
- significant increase in total body temperature.
Gonococcus can affect only the testicular shells, causing overrush . The testicle becomes dense, enlarged and extremely painful. Often joins and funiculitis – inflammation of the spermatic cord.
Prolonged inflammation of the testicles is fraught with sterility, as well as the formation of ulcers, which often have to be surgically eliminated. Therefore, for signs of discomfort in the scrotum area, it is necessary to consult a urologist or venereologist.
A frequent consequence of the chronic course of gonorrhea is prostatitis , since the prostate gland is connected by ducts to the urethral canal. A painful involuntary erection, frequent urge to urinate, and the appearance of blood impurities in urine and semen is indicative of the colonization of the prostate by colonies of gonococcus.
Gonococcal prostatitis is dangerous with serious consequences :
- oophoritis (inflammation of the prostate);
- chronic impotence.
Often, gonorrhea is associated with candidiasis (thrush). Read: How does thrush manifest in men.
Without proper treatment, there is a high risk of transition of gonorrhea to the generalized form, in which there are extensive lesions of the skin, myocarditis, meningitis, hepatitis.
Proper diagnosis of gonorrhea determines the success of treatment, since it is important to determine the type of infection and select effective drugs. At the first signs of infection, you should contact your urologist or venereologist.
First, the doctor conducts a visual inspection of the penis, makes it palpation for the presence of seals, nodules and infiltrates in the urethra.
With a large amount of purulent discharge, a urine sample is taken by a two-glass method (a Thompson test). If purulent filaments, opacities are found only in the first portion, then the gonococcus is localized in the anterior part of the urethra. The presence of dregs and flakes in both glasses means the spread of infection above: in the prostate, seminal vesicles, upper urinary tract.
To identify gonococcus using a smear from the urethra, the anal canal, prostatic juice, scraping from the walls of the pharynx. Materials are investigated in several ways:
- bakposev (sample detachable is sown on a nutrient medium);
- smear examination under a microscope (bacterioscopic method).
Blood tests also determine the presence of gonococcus, using the immunofluorescent rapid method. It allows you to identify antibodies to the pathogen. This method is considered the fastest and most reliable, but not used in all clinics.
For the diagnosis of gonorrhea, immunological sensitization can be used, which consists in the introduction of a gonococcal allergen into the upper layers of the patient’s epidermis. If there is an infection for about a day, a local reaction manifests itself in the form of reddening of the skin area. The result is interpreted depending on the diameter of the hyperemia:
- up to 10 cm – weakly positive;
- 11-20 cm – positive;
- more than 20 cm – significantly positive.
If necessary, other types of studies are appointed, for example, urethroscopy.
For the accuracy of the analysis, it is better to take a smear in the morning before hygienic procedures and going to the toilet. If this is not possible, then from the time of the last urination to the procedure, an interval of at least 2-3 hours should be maintained.
A gonorrhea treatment regimen prescribed by a doctor will be more effective if the patient adheres to a set of rules:
- do not ride a bicycle, avoid increased physical activity, since an increase in both local and general body temperature will lead to the activity of pathogens;
- exclude all types of intimate contacts;
- not to drink alcohol, coffee, soft drinks, spicy and salty foods (all this irritates the urinary tract and exacerbates pain);
- reduce the number of cigarettes smoked ;
- avoid overheating and overcooling.
Therapy is carried out on an outpatient basis, but transfer to the hospital is possible. A patient is admitted to the hospital if he has:
- frequent recurrences of gonorrhea;
- generalized infection;
The following types of antibiotics are used to treat gonorrhea :
- tetracyclines (Unidox, Dosycycline);
- cephalosporins (Cyfiximum);
- penicillin (Amoxicillin);
- macrolides (Josamycin, Sumamed);
- ftorhinolonı (Abaktal, Ofloxacin).
However, researchers in some countries have already documented cases of gonococcus insensitivity to cephalosporins and tetracyclines. As for penicillin preparations, its effectiveness for the treatment of gonorrhea is currently rather low, especially in case of L-forms of gonococcus. If Trichomonas are present in the body, they absorb the gonococcus, which remains active, but completely resistant to penicillin.
In developing new anti-gonococcal infection regimens, the results of clinical trials on patients in the USA showed that 100% cure occurs when Azithromycin (Hemomitsin, Sumamed, Azitroks) is administered orally with Gentamicin Injections . Simultaneous oral administration of Azithromycin with Hemifloxacin is slightly less effective.
The above data was announced in Vienna during the 20th Conference of the International Society for the Study of Sexually Transmitted Diseases. From this point on, many doctors began to apply the newly developed regimens for treating patients with allergies to cephalosporins, as well as in the absence of positive dynamics from classical therapy (Azithromycin + Ceftriaxone).
Treatment of uncomplicated gonorrhea with antibiotics takes 1-2 weeks, and both pills and injections can be prescribed. Since these drugs often cause side effects in the form of nausea, gastrointestinal disorders, in parallel, the doctor prescribes auxiliary means for the prevention of dysbacteriosis (Linex, Hilak forte).
Complicated or chronic gonorrhea therapy requires an integrated approach. In addition to antibiotics, immunomodulators are prescribed (Pyrogenal, Prodigiosan), anti-inflammatory drugs, and a special gonococcal vaccine is administered. With long-term treatment, hepatoprotectors are used. Depending on the location of the complication, rheumatologists, cardiologists and other specialized specialists are connected to the treatment.
Of particular difficulty is the treatment of chronic gonorrheal prostatitis. The inflammatory process often fails to stop drugs. Sometimes iron becomes a source of latent infection.
Self-medication for gonorrhea is unacceptable. The independent use of even those antibiotics, in the annotations to which the efficacy against gonococcal infection has been established, can lead to the blurring of symptoms and the transition of gonorrhea to the chronic form.
Folk remedies for the treatment of gonorrhea is not. Independently, you can drink herbal preparations to strengthen the immune system, temporarily relieve discomfort by washing the urethra with antiseptics (Miramistin, Chlorhexidine, manganese solution). However, all these measures are nothing more than an addition to drug therapy.
All drugs and dosage prescribed by the doctor, who necessarily controls the dynamics of the reaction analysis. If necessary, an ineffective antibiotic is replaced by another.
In men, a control smear for microscopic analysis and seeding is taken 7-10 days after the cancellation of antibiotics, and then again after 2-3 weeks.
A man can avoid infection with gonorrhea only with a responsible approach to the choice of a partner for intimate relationships and the use of high-quality means of barrier contraception. If the unprotected contact did occur, then you can reduce the risk of penetration of the pathogen into the body as follows:
- urinate immediately after the act, in order to wash the infection from the urethra;
- as soon as possible, flush the urethral canal with chlorhexidine, which has a detrimental effect on the gonococcus.
Some venereologists tend to believe that even a condom does not provide 100% protection against gonococcus, and frequent washing of the urethra with antiseptics can cause an imbalance of the microflora and provoke urethritis. Therefore, the most reliable measure of protection are monogamous relationships.
Check out: How to choose the right condom in size and quality
It is also necessary to observe hygiene and elementary precautions in public places such as baths, saunas, and also not to use other people’s toothbrushes and other similar attributes.
Video about gonorrhea:
The only way to cure gonorrhea in a timely manner and reliably is to consult a doctor and complete the entire course of therapy with subsequent analyzes. Otherwise, the speed and scale of the spread of the infection will depend on the immunity. The longer the gonococcus is in the body, the more damage it will cause to health. Self-treatment for periodic relapses will not only not completely destroy the infection, but will also significantly complicate the task for doctors. Progressive progressive gonorrhea can be fatal.