Gonorrheal urethritis

Description:

Gonorrheal urethritis - a venereal disease which causative agent is гонококк, a gram-negative diplococcus of the Neisseriae family.

Reasons of a gonorrheal urethritis:

At a laboratory research in a smear diplococcuses often find and consider representatives of normal microflora of respiratory tracts of a nasopharynx, but sometimes they serve as the inflammation reason in Neisseriae urethra - the gram-negative diplococcuses who do not have mobility and not forming a dispute; strict aerobes.

At the chronic course of gonorrhea, and also at insufficient influence of antibiotics microorganisms can get the unequal size and a form.

Gonorrhea is transmitted at the sexual intercourses. Most often it arises after genitogenitalny contacts, but both orogenitalny and anogenitalny infection is possible. Also household way of infection is described: in a thick layer on household objects гонококк can keep viability to 24 h. Depending on reaction of an organism to implementation of gonokokk the incubation interval of gonorrhea lasts about 3-4 days. Now the tendency to its lengthening is noticed.

Symptoms of a gonorrheal urethritis:

Depending on duration of a disease and expressiveness of symptoms distinguish fresh (if infection occurred within 2 months) and chronic (if infection occurred over this term) gonorrhea forms.

On degree of intensity of symptoms of a gonorrheal urethritis distinguish 3 options of fresh gonorrhea:
acute at which there are plentiful allocations from an urethra with a sharp dysuria:
subacute at which there are also a lot of allocations from an urethra, but almost completely there is no dysuria;
torpid, characterized by total absence of subjective symptoms and that is very important, the imperceptible allocations from an urethra found accidentally.

Chronic gonorrhea can proceed like torpid, and in an aggravation stage - as one of two acute options of fresh gonorrhea.

Directly after infection гонококк gets to a navicula of a balanus and from there begins to extend through an urethra passively as has no ability independently to move. Inflammatory process usually extends kanalikulyarno on a bigger or smaller extent. In both cases the inflammation takes only a spongy part of an urethra to an outside sphincter (a front gonorrheal urethritis). But sometimes inflammatory process extends through all urethra up to an entrance to a bladder (a back gonorrheal urethritis). Gonokokki breed on a surface of an epithelial layer, then get deep into between epithelium cells, causing inflammatory reaction of fabrics which is followed by expansion of capillary vessels and plentiful migration of leukocytes. Glands and lacunas of an urethra are also involved in inflammatory process. Their epithelium is loosened, in places is desquamated and инфильтрирован leukocytes, the gleam of glands of an urethra is filled with the torn-away epithelium, leukocytes. Mouths of glands are quite often corked with inflammation products as a result of inflammatory hypostasis. Pus, without having an exit outside, accumulates in gland gleam owing to what small pseudoabscesses are formed.

The first symptoms of a gonorrheal urethritis - discomfort in an urethra at a long delay of an urination, then appear grayish-yellow (mix of epithelial cells and leukocytes), later - yellow purulent discharges. The first portion of urine muddy, urethral threads - long whitish settling on a bottom are visible; second portion of urine transparent.

During the beginning of an urination of the patient notes sharp, quickly disappearing pain. To one of signs of transition of a gonokokk for an outside sphincter serve imperativeness of the arisen desire on an urination which the urination, speeded up, painful at the end of the act, quickly joins. At the end of an urination explain to Bol with pressure of cross-striped muscles of a crotch upon back department of an urethra. There are also painful ejaculations. Urine grows turbid in both portions.

Quite often desires on an urination become intolerable, by the end of the act of an urination several drops of blood (a terminal hamaturia) appear. The frequent erection, emissions sometimes with blood impurity in sperm join the above-stated symptoms in acute cases of a back urethritis (hemospermia) that indicates an inflammation in a seminal hillock. The discharge from an urethra decreases or disappears absolutely. Pus from a prostatic part of an urethra comes to a bladder. When conducting tryokhstakanny test urine in all three portions muddy (a total pyuria).

In series of observations the acute gonorrheal urethritis passes in chronic at which acute and subacute symptoms of a gonorrheal urethritis disappear, and inflammatory process in an urethra gains long, torpid, sluggish character. Transition of an acute gonorrheal urethritis to a chronic stage is promoted by irrational treatment of a gonorrheal urethritis, breaks in treatment and disturbance of its mode, self-treatment, anomalies of an urethra, chronic diseases (a diabetes mellitus, tuberculosis, anemia, etc.).

Subjective symptoms of a chronic gonorrheal urethritis are usually much less expressed, than at acute.

Patients complain of unpleasant feelings (an itch, burning) in an urethra. At defeat of its prostatic part frustration of an urination and sexual functions are observed (increase and strengthening of desires on an urination, pain at the end of the act of an urination, painful ejaculations, impurity of blood and pus in sperm). Allocations from an urethra usually insignificant also appear mostly in the mornings.

Proceeding inertly, the chronic gonorrheal urethritis under the influence of various reasons periodically becomes aggravated and can simulate a picture of an acute gonococcal urethritis. However unlike the last aggravation of a chronic gonococcal urethritis soon spontaneously pass.

The chronic gonococcal urethritis can be connected with a gonococcal adenosis of an urethra - a prostate and seed bubbles.

Diagnosis:

In clinical practice apply bacteriological and bakterioskopichesky methods to diagnosis of a gonorrheal urethritis more often, immunofluorescent, immunochemical and serological tests are more rare. At a bakterioskopichesky research of smears from an urethra the gram-negative diplococcuses differing in a polychromatophilia and polymorphism, existence of the capsule find.

The bacteriological research consists in allocation of true culture of a gonokokk on a beef-extract agar.

Treatment of a gonorrheal urethritis:

Treatment of a gonorrheal urethritis consists in prescription of antibiotics,  kotoryeokazyvat bactericidal and bacteriostatic action on gonokokk. At acute gonorrhea for obtaining therapeutic effect of rather etiotropic treatment.

Complex pathogenetic therapy is shown to patients with the complicated, torpid, chronic forms of gonorrhea at post-gonorrheal inflammatory processes.

Basic principles of treatment of a gonorrheal urethritis:
careful clinical and laboratory inspection of patients for the purpose of detection of associated diseases (syphilis, trichomoniasis, a chlamydial infection, etc.) and their simultaneous treatment;
the complex nature of treatment including causal, pathogenetic and symptomatic treatment;
individual approach taking into account age, sex, a clinical form, weight of pathological process, complications;
observance by the patient in time and after treatment of a certain diet, abstention from sexual contacts, an exercise stress.

At the choice of means of antibacterial therapy it is necessary to consider sensitivity of a gonokokk to medicine, indications and contraindications to its appointment, pharmacokinetics, a pharmacodynamics, the mechanism and a range of antimicrobic action, and also the mechanism of its interaction with other antibacterial drugs.

Etiological treatment of a gonorrheal urethritis:

For treatment of gonorrhea (uncomplicated) recommend the following modes of antimicrobic therapy.
Drugs of the first line consider цефтриаксон 125 mg intramusculary once or tsefiksy 400 mg inside once.
Drugs of the second line - ciprofloxacin on 500 mg inside, or once ofloxacin on 400 mg inside once, or levofloxacin on 250 mg inside once.

According to the latest data of a ftorkhinolona do not apply in the USA to treatment of gonorrhea because of high resistance an infestant to them any more. In Russia the high level of resistance of strains Neisseria gonorrhoeae to ciprofloxacin is also revealed: the quantity of resistant strains makes 62,2%. Comparison of the provided data with L. S. Strachunsky's results and соавт. (2000) showed significant growth (practically by 9 times!) Neisseria gonorrhoeae antibiotikorezistentnost indicators in relation to ftorkhinolona.

Alternative treatment of a gonorrheal urethritis:

Spektinomitsin of 2 g intramusculary once or cephalosporins (except a tseftriakson) - tseftizoksy on 500 mg intramusculary, цефокситин on 2 g intramusculary, then on 1 g in and tsefotaksy on 500 mg intramusculary. However any of the listed cephalosporins has no advantages before tseftriaksony.

As gonorrhea is often combined with a chlamydial infection, patients of this group need to carry out additional treatment of S. of Trachomatis.

In case of inefficiency of therapy it is necessary to assume existence of an infection. the caused Trichomonas vaginalis and/or Mycoplasma spp. The recommended treatment. a metronidazole combination (2 g in once) and erythromycin (on 500 mg in 4 times a day within 7 days) in cases of the mixed mecotic and gonorrheal infection carry out simultaneous treatment of gonorrhea and trichomoniasis. At a gonorrhea combination to a mycoplasmal or ureaplazmenny infection appoint a course of treatment of gonorrhea then antimycoplasmal or protivoureaplazmenny means in the beginning. Immunotherapy

As specific immunotherapeutic drug use a gonococcal vaccine which is entered intramusculary: on 200-250 million microbic bodies at the first injection; the following injection - in 1-2 days, every following time a dose is increased by 300-350 million microbic bodies. The single dose can reach 2 billion microbic bodies, and quantity of injections - 6-8.

For nonspecific stimulation of an organism use the drugs activating a number of cellular and humoral factors of immune system.
Definition of an izlechennost of gonorrhea

The Izlechennost of the patients who had fresh gonorrhea is defined in 7-10 days after the termination of a course of treatment. In the absence of inflammatory changes in an urethra it is necessary to make a palpation of a prostate, seed bubbles and laboratory diagnosis of their secret. In the absence of a gonokokk in the studied material carry out the combined provocation - enter into an urethra 6-8 ml of 0,5% of solution of silver nitrate and at the same time intramusculary 500 million microbic bodies of a gonovaccine. Instead of a gonovaccine it is possible to enter intramusculary 100-200 MPD pyrogenals. Apply also bougieurage and massage of an urethra together with the spicy food irritating a cover of urinary tract. In 24-48-72 h for a laboratory research take a secret from a prostate and seed bubbles. In the absence of gonokokk and other pathogenic microflora the following control with clinical and urological inspection is carried out after the combined provocation in 3-4 weeks. The third (last) control - similarly, in 1 month after the second.

The gonorrheal urethritis is considered  cured at resistant lack of gonokokk at a microscopic and bacteriological examination of the quantity of leukocytes separated urinogenital bodies, lack of palpatorny changes in a prostate, seed bubbles, and also increased in their secret, unsharply expressed inflammatory changes (or their absence) in an urethra at an uretroskopiya.