How to choose the right analysis for gonorrhea. How to diagnose (determine) gonorrhea - blood test, PCR, provocation methods Reliable PCR test for gonorrhea
Quite often there are cases of atypical localization and clinical symptoms of the course of gonorrhea (in common parlance, this disease is called gonorrhea). Therefore, for a reliable diagnosis of infection with the establishment of the type of pathogen, laboratory diagnostics is mandatory. For this, an analysis is made for gonorrhea.
In men, the study is carried out using several methods, and the material is taken not only from the structures of the urogenital tract. Smears are also taken for gonorrhea from the mouth, anus, and even the discharge of the eye.
What methods are used to diagnose gonorrhea
If gonorrhea was suspected during a clinical examination by a doctor, the smear analysis is examined by several methods:
- Microscopy. In the classic course of gonorrhea, a significant number of gonococci accumulate on the mucous membrane, which are detected by microscopic examination.
- Tank sowing. The technique is a bacteriological study in which the material is applied to special nutrient media. Provided that bacteria are present in the test material, colonies grow on the media. Bacteria are identified by morphological, biochemical and antigenic properties,.
- Polymerase chain reaction (PCR). The study includes the identification and identification of the genetic material of the pathogen through the reaction of multiple doubling (amplification) of nucleotide bases.
How to establish a diagnosis of gonorrhea, what tests to pass , and also with the help of what methods to investigate them, the attending venereologist determines.
The choice is made depending on the course of the infectious process, its localization, as well as the capabilities of the laboratory.
Smear on flora for gonorrhea
Microscopic examination is one of the methods by which a smear is analyzed. Gonococci are detected during the determination of the microflora of the mucous membrane of the urethra or vagina. The determination of the microflora of the mucous membrane of the structures of the urogenital tract is more often carried out in women. In men this study performed to detect gonococci.
If there is inflammatory process, deciphering the analysis for gonococci, after microscopy includes several indicators:
- The appearance of bean-shaped microorganisms. They are located in pairs under one capsule, as well as inside leukocytes. When stained by Gram, these bacteria have a pink coloration (gram-negative bacteria). In a smear with an acute course of gonorrhea, the number of gonococci is very significant. Often they occupy the entire field of view.
- A significant number of leukocytes. Normally, the mucous membrane contains a large number of leukocytes (1–2 in the field of view of the microscope). With the development of gonorrhea, which is an infectious purulent process, the number of leukocytes increases dramatically. They can cover the entire field of view of the microscope and cannot be counted.
- Increase in mucus. Indicates the development of an inflammatory process, because cells respond to inflammation with an increase in functional activity and an increase in mucus production.
In the chronic or atypical course of the infectious process, such changes in the smear may not be. Therefore, other methods can be used to reliably diagnose gonorrhea. laboratory diagnostics.
Culture test for gonorrhea
An analysis for gonorrhea using bacteriological culture of a smear for gonorrhea is a very informative research method. It detects the pathogen in the material in 95% of cases. After the identification of gonococci, their sensitivity to the main groups of modern antibiotics is determined, which makes it possible to choose the most effective drug for the etiotropic treatment of gonorrhea.
The main disadvantage of bacteriological research is the long period required to obtain results. It can be several days, since it takes time for the accumulation of microorganisms on a nutrient medium and the growth of colonies. The test result can be positive or negative.
During diagnostics, the amount of pathogen per unit volume of biological material is counted, followed by indication of this value in the analysis results.
PCR analysis for gonorrhea
PCR is a specific and reliable diagnostic method. Thanks to the enzymatic amplification reaction (multiple doubling), the genetic material (DNA) of gonococcal microorganisms is accumulated and identified. To obtain the result of the study by PCR, a short period of time is sufficient.
The result can be positive or negative. Despite the high specificity of this technique, in some cases it is possible to obtain a false negative result of the study. With gonorrhea, the material contains a high number of leukocytes. Enzymatic systems of immunocompetent cells break down the genetic material of gonococci. This leads to a false negative result. Its probability increases with the wrong taking of the material and its long-term storage.
Express analysis for gonorrhea
To date, methods have been developed for the rapid detection of gonococcus in the test material.
For this it is used:
- Smear microscopy (results can usually be obtained within half an hour), .
- Special test strips in which gonococcus is detected using an immunochromatographic reaction (the result can be obtained within 5 minutes).
Express diagnostics has a low specificity, therefore, a subsequent full examination of a smear for gonorrhea is required.
How to get tested for gonorrhea
A swab is taken to test for gonorrhea. It is a scraping from the mucous membrane, taken from the area of \u200b\u200btypical or atypical localization of the pathogen. A typical localization of gonorrhea in men is the mucous membrane of the urethra. A urologist or andrologist takes a scraping from it using a sterile probe.
In case of suspicion of an atypical localization of infection in gonorrhea, scrapings can be taken from the mucous membrane of the rectum, pharynx and tonsils, conjunctiva of the eyes. In the chronic course of the infectious process, urine and sperm from men can be taken for microscopy and PCR.
The analysis for gonococci in gonorrhea is false negative. To minimize the risk of obtaining false test data, a provocation is carried out. It is necessary for the development of inflammation to increase the number of microbial cells per unit volume of biological material. The provocation is performed with the help of a local increase in body temperature, the use of special chemical compounds or intramuscular administration of gonovaccine.
Preparing for a smear test for gonorrhea
To obtain reliable analysis results, it is important for a man to follow a few simple recommendations before taking a smear.
These include:
To control the effectiveness of ongoing etiotropic therapy, the doctor prescribes control tests, the negative results of which are the basis for stopping treatment.
If you need to test for gonorrhea in men and women, contact competent venereologists.
Gonorrhea, or gonorrhea, is considered one of the most common sexually transmitted diseases. Against the background of active antibiotic therapy, the frequency of complications has recently decreased significantly. But at the same time, improper treatment of the disease, lack of examination before therapy leads to a large number of atypical and asymptomatic forms, so laboratory diagnosis of gonorrhea is very important.
Laboratory diagnosis of gonorrhea uses the following methods by which pathology can be determined.
- express test (they detect the pathogen by the method of counter electrophoresis);
- bacterial (bakposev is carried out by growing a culture of the pathogen);
- microscopic analysis of the microbes contained in the smear;
- immune fluorescence reaction;
- linked immunosorbent assay;
- calculus binding reaction;
- polymerase chain reaction;
- provocation in gonorrhea is used to identify a chronic variant of the course.
Each of these methods has its own advantages and disadvantages.
Is it advisable to do a rapid test
This diagnostic examination is very simple and can be done at home. Outwardly, such an analysis for gonorrhea is similar to a pregnancy test. In the same way, the decoding of the analysis for gonorrhea occurs: if there is one strip, then this indicates a negative result - the absence of gonococcus. The presence of two strips indicates that the test for gonorrhea is positive.
Is it advisable to do such an analysis for gonorrhea in women? Their reliability is quite high, and they should not be neglected. Diagnosis is simple: in the presence of an antigen-antibody complex, the second strip is stained.
It is not worth relying completely on the results of such testing. The fact is that a similar complex of antigen and antibody can also be formed in the presence of other types of microorganisms, and the decoding of such a test will be incorrect. There are cases when the resulting antigen-antibody complex is not enough to stain the strip. Therefore, patients need to take other types of tests.
What is smear microscopy
In order to take a smear, it is necessary to collect secreted from the urethra, vagina, cervix and rectum. This diagnosis will be reliable if the patient adheres to the following recommendations:
- approximately 4-5 days before the analysis, stop taking antibacterial drugs;
- for at least three hours before taking a smear, refrain from urinating.
The optimal time for taking a smear for women is the initial days menstrual cycle.
The smear is taken twice. The first is stained with methylene blue (or a brilliant green solution - it gives a more intense color). The other smear is stained using the Gram method. Deciphering the analysis after the Gram stain gives more accurate data, because this way it will be possible to determine the infection with gonococci.
The disadvantage of this technique is that its sensitivity varies greatly. The reliability of determining the disease with gonorrhea using Gram stain reaches 92 percent.
Features of the bacterial method
Tank culture for gonorrhea is currently the gold standard in the detection of infectious pathologies, including gonorrhea. The essence of the analysis on the flora is that the discharge from the genitourinary organs is placed in a nutrient medium. There are favorable conditions for the formation of a colony of microorganisms. With the help of a survey on the flora, you can reliably detect the presence of gonococcus. These are the conditions:
- increased concentration of carbon dioxide;
- high temperature - 37 degrees;
- nutrient content.
If a smear on the flora showed that the number of bacteria has increased significantly, this indicates that there is an infection in the body. The advantage of the flora analysis is that it gives almost a hundred percent correct result. False-positive test results can be very pronounced.
Today, bacteriological examination for flora is the most common among many diagnostic centers.
Advantages and disadvantages of RIF
The enzyme immunoassay method is not widely used today. During the course of the diagnosis, the presence or absence of antibodies is detected. Such an analysis can also detect dead pathogens of gonorrhea. This is the disadvantage of this method of diagnosing gonorrhea - it shows a positive result if the immune system has overcome the causative agents of this disease.
The advantages of RIF are that it detects a very high sensitivity and almost complete specificity. Despite the advantages, RIF is currently used by a limited number of clinics and diagnostic centers.
Significance of PCR in the detection of gonorrhea
PCR for gonorrhea is an accurate and highly informative way to diagnose this sexually transmitted disease. When diagnosing, the DNA of the gonococcus is determined. Just like a smear on the flora, it is very informative. If a patient is suspected of having gonorrhea, DNA will be detected within a few days.
The method is associated with some inconveniences. First of all, the high cost of such an examination should be mentioned. Research is also difficult to access for residents of small towns.
Blood test
A blood test for gonorrhea is more likely to rule out the disease. Gonococcus forms antigens of different classes in the blood. Their presence in the serum is detected a week after infection. The peak value of antigens is observed in the second week from the onset of pathology. Then the titer gradually decreases.
Blood for gonorrhea should be donated in cases where acute symptoms of pathology are observed: pain and pain during urination and an increase in overall body temperature. The presence of sepsis is also an unconditional indication for such a diagnosis.
But with chronic gonorrhea, there is no need to conduct a blood test. It still won't show anything. It is possible to determine the presence of such a pathogen by a blood test if the doctor uses the ELISA method.
Features of analyzes in men
An analysis for gonorrhea in men is performed using a urological smear. The indications for such an examination are as follows:
- the presence of secretions;
- sharp pain during and after urination;
- the appearance of swelling of the genitals;
- the presence of rashes on the skin and mucous membranes;
- frequent urge to urinate, especially when the amount of urine excreted is small;
- inflammation of the prostate, seminal vesicles;
- partner has an infection.
More accurate is the definition of the pathogen using the polymerase chain reaction. In this case, the infection can be accurately determined in the asymptomatic variant of the pathology.
Before taking a smear, a man should refrain from intimate contact for one or two days. In the evening you have to take a shower. In the morning, you should refrain from going to the toilet for several hours. Before taking a smear, it is necessary to toilet the genitals: remove plaque from the head of the penis.
To take a smear, a urological instrument is inserted into the urethra to a depth of several centimeters. In this case, you can take a sufficient amount of biological material for its study.
Analysis during pregnancy
Gonorrhea during pregnancy is a serious but treatable infection. Its danger is as follows:
- there is a high probability of miscarriage;
- there is a risk of premature birth;
- during pregnancy, infection of the amniotic fluid is possible;
- possible intrauterine infection of the child.
If you do not treat gonorrhea during pregnancy, then female body becomes extremely vulnerable to other infectious pathologies.
The doctor decides how to determine dangerous disease based on the presence of complaints of the patient and analysis of the anamnesis. Testing for gonococcal infection during pregnancy is prescribed for all women who first applied to women's consultation. The ideal option is to pass the necessary tests even before planning a child. For analysis, the doctor takes a smear from the urethra and cervix. During pregnancy, this procedure is safe for the woman and the fetus. In some cases, a urine test is performed instead of a smear.
If the results of the diagnosis are positive, then the woman will certainly be prescribed treatment. Please note that the choice of drugs for the treatment of gonococcal infection is limited. But with a timely visit to the doctor and the implementation of all his recommendations, a complete recovery is possible.
You should not be afraid of tests for a dangerous sexually transmitted disease, which is gonorrhea. Timely access to a doctor and the start of treatment can prevent the development of dangerous complications. Timely and complete analysis during pregnancy is especially important. You should not be afraid of disclosing the analyzes, because they are strictly confidential.
Gonorrhea is a sexually transmitted disease that is quite common in modern society. According to statistics, about 200 million people in the world are sick with it.
Pathology has a progressive course, which in advanced cases can lead to serious complications. Therefore, it is important, when the first symptoms of the disease appear, to sign up for an examination and find out how to get tested for gonorrhea.
Indications for examination
It is possible to suspect the presence of gonorrhea when a patient has symptoms characteristic of it. A triad of symptoms is distinguished, which is the reason for an urgent analysis for gonorrhea.
It includes:
- pain when urinating;
- itching and burning in the genital area;
- the occurrence of purulent discharge.
In addition, indications for the analysis of gonorrhea are:
- the presence of frequent changes of sexual partners;
- practicing unsafe sex;
- early pregnancy (mandatory to prevent infection of the child);
- infertility for unknown reasons.
In gonorrhea, analysis is also necessary during treatment to monitor its effectiveness.
Diagnostic search
When contacting a doctor, the examination begins with the collection of an anamnesis. The doctor asks the patient about when the symptoms of the disease began, how they progressed over time. An important part of the history is information about the patient's sexual life. After questioning, an examination is carried out, in which characteristic changes in the area of the external genital organs are revealed.
The data obtained enable the doctor to suspect gonorrhea and prescribe a set of laboratory tests. It includes:
- taking a smear and examining it;
- additional methods (blood test, enzyme immunoassay, biochemical analysis of serum).
Which tests are given in each case is determined by the attending physician.
Smear analysis
The main diagnostic method most widely used in hospitals is the smear. It is taken from the genitals: in women - from the vagina or from the cervical canal, in men - from the urethra.
In some cases, an atypical course of the disease is possible, when the infectious process also spreads to the pharynx, eyeballs, rectum. With this course of the disease, it is necessary to take several smears from all damaged organs at once.
The resulting material is examined using a number of laboratory techniques.
Bacterioscopy
Initially, the so-called bacterioscopy is carried out - a study that does not require a lot of time and resources. Secretions from the genital organs are applied to the surface of a glass slide, which is examined under a microscope.
When studying a micropreparation, the laboratory assistant notices a large number of bean-shaped bacterial organisms that are linked in a pair of 2 cells. This is the gonorrhea diplococcus.
After that, additional staining of the smear is carried out. Gram stain is usually used. It makes it possible to determine the morphological features characteristic of the microorganism found in smears.
According to the classification, all bacteria are divided into gram-positive and gram-negative. Gonorrhea diplococci belong to the group of gram-negative organisms, therefore, when examining preparations, they are stained blue.
With microscopy, one can clearly see the boundaries of the cells separated by the membrane, and the internal environment of the body - the cytoplasm. It has a dark blue core.
Gonococci are microorganisms that do not survive well in the environment. Therefore, it is important to send the material for bacterioscopy immediately after taking a smear. The waiting period should not exceed 15 minutes.
In general, bacterioscopy of secretions from the genital organs is an effective way to detect gonorrhea pathogens. The study is highly accurate, very easy to conduct and cheap. This makes it possible to use it as a routine method for confirming the diagnosis.
Read also related
What are gonococci and why are they dangerous
Cultural research method
Cultural analysis also involves the detection of microorganisms in a swab taken from the genitals. The study begins in parallel with bacterioscopy. It has great accuracy, but it takes quite a long time.
The resulting biological material is placed on a nutrient medium - a special agar-agar, which is poured into Petri dishes. It contains all the trace elements, organic substances and vitamins that are needed for the rapid reproduction of bacteria.
The Petri dish is placed in a thermostat in which microorganisms are kept for a day. After that, reseeding of the grown colonies and repeated daily incubation is carried out. When bacteria grow, their species is determined by the following features:
- microscopic picture;
- color features;
- types of colonies grown on agar;
- biochemical features.
Thus, sowing on gonorrhea makes it possible to identify microorganisms even if they are not detected in the smear. An obvious disadvantage of the method is the duration of the preparation of the analysis. On average, the results come at least 4-5 days later.
Culture analysis has another advantage that makes it an indispensable component in the diagnosis of gonorrhea. The grown colonies of the microorganism can be tested for antibiotic sensitivity using special techniques. This makes it possible to choose exactly the drug that will affect the strain of bacteria that multiply in the patient's body.
Gonococci may be resistant to certain groups of drugs, therefore, to prescribe proper treatment antibiotic typing of the obtained bacterial cultures is mandatory.
polymerase chain reaction
The polymerase chain reaction, or PCR, is the most accurate method for diagnosing gonorrhea. Its name means that the research is carried out using the possibilities of molecular biology.
The technique is based on the detection of DNA, which is contained in bacterial cells, and its multiple copying - replication. Thanks to this, even minimal amounts of microorganisms can be detected in a smear.
Diagnosis by PCR is used in cases where there is clinical picture diseases, and bacterioscopy and cultural examination of the causative agent of the pathology could not be determined. The polymerase reaction is the only effective method diagnosis of latent forms of gonorrhea. This avoids the progression of the disease and the development of complications.
The analysis is given in specially equipped laboratory complexes, which are not available in all settlements. This can be considered a disadvantage of PCR diagnostics. Another disadvantage of the method is the high cost of resources, and hence the high cost of the procedure.
Sometimes a polymerase chain reaction can lead to a false positive result. This error occurs in the following cases:
- When a sample of biological material has been contaminated with third-party microorganisms.
- When the rules for transporting smears are violated.
- When the immunity of the human body has already coped with the infection, and in fact the patient is healthy, but dead gonorrhea bacteria continue to be released from his body.
The likelihood of these errors occurring is minimal. However, in order to avoid misdiagnosis, it is recommended to perform a PCR test for gonorrhea several times.
Despite the disadvantages, a study using a polymerase reaction is considered the most accurate way to detect gonococci. Its efficiency is 95-98%, which is a very good result.
Serological research methods
For the diagnosis of gonorrhea, tests do not necessarily have to be aimed at detecting a gonorrheal pathogen. Upon contact with a microorganism, the patient's body begins to produce specific immune complexes - antibodies that bind to gonorrhea pathogens.
Developed immune complexes can be detected in the serum. For this, serological tests are given - blood for gonorrhea. These include.
Symptoms of gonorrhea in men
| gonorrheal urethritis - | Most common symptom is inflammation of the urethra - Inflammation is accompanied by a number of symptoms: | |
| Prostatitis- inflammation of the prostate gland | As a rule, it occurs a few days after the onset of gonococcal urethritis. Gonococcal infection reaches the tissues of the prostate via an ascending route through the urethra. Prostatitis is characterized by a number of symptoms:
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Symptoms of gonorrhea in women
| Symptoms of gonorrhea in women usually appear during the next period from the moment of infection. More often this disease is manifested by symptoms of vulvovaginitis and urethritis. | ||
| gonorrheal urethritis | Gonococcal urethritis has a number of symptoms similar to urethritis in men:
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| Vulvovaginitis - inflammation of the mucous membrane of the vulva and vagina | It often manifests itself a few days after infection or during menstruation. Signs characteristic of gonococcal vulvovaginitis:
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Complications of gonorrhea
As a rule, timely and adequately carried out treatment leads to a complete recovery of the patient. However, in some cases, the infectious process can progress, moving upward along the urinary and genital tract. In this case, lesions of the relevant organs occur, which can threaten the life, fertility and health of the patient.Among women, the development of such complications as:
Gonorrheal bartholinitis- inflammation of the Bartholin gland located in the posterior third of the labia majora and having excretory ducts that open into the external environment at the base of the labia majora. Their inflammation is accompanied by a sharp pain, a pronounced inflammatory reaction and swelling of the corresponding area.
Gonococcal endometritis- promotion of gonococcal infection in an upward direction along the genital tract can lead to infection of the uterine mucosa. This complication may be accompanied by pain in the lower abdomen, profuse bloody and purulent discharge from the genital tract, and a sharp increase in body temperature. This condition requires immediate seeking help from a gynecologist, as it threatens the life of the patient.
Gonorrhea fallopian tubes - when the infection advances from the uterine cavity in the lumen of the fallopian tubes, inflammation of the mucous membrane of the fallopian tubes occurs. This process is accompanied by pain in the lower abdomen, pain during sexual intercourse, infertility and menstrual irregularities.
Gonorrheal peritonitis- inflammation of the pelvic peritoneum is possible with the penetration of gonococci into abdominal cavity. This condition is accompanied by a rise in body temperature, pain in the lower abdomen. An ultrasound examination reveals the presence of fluid and abscesses in the pelvic cavity can be visualized.
With an inflammatory process in the female genital organs of the small pelvis, infertility may develop. This can be caused by a number of factors: the formation of adhesions in the pelvic peritoneum, tubal obstruction, chronic inflammation of the endometrium of the uterus, menstrual irregularities.
If any of the above complications occur, treatment is possible only in a hospital under the supervision of the attending gynecologist. Unfortunately, with any of the listed complications (the blood of gonococcal bartholinitis), there is a high probability of developing female infertility.
Among male population Infected with gonorrhea, the following complications are possible:
Epididymitis- inflammation of the epididymis. This appendage is an enlarged vas deferens in which semen accumulates before being expelled during ejaculation.
Inflammation of the vas deferens can lead to their subsequent obstruction and the development of male infertility.
Laboratory diagnosis of gonorrhea - rapid test, smear microscopy, immune fluorescence reaction (RIF), enzyme immunoassay (ELISA), complement fixation reaction (Borde-Gangu reaction), polymerase chain reaction (PCR), ligase chain reaction (LHC), culture method, provocative tests.
Features of gonococcus
Gonorrhea or gonorrhea is one of the most common sexually transmitted diseases in the world. Gonorrhea is caused by a specific bacterium gonococcus. Gonococcus is an acid-resistant microorganism, that is, its cell wall is able to protect it from exposure to the normal acidic environment of the female genital tract. The peculiarity of the cell wall of the gonococcus is such that it is able to form antibodies of various classes in the blood (IgG, IgM, IgA). Moreover, gonococcus forms a special state of the human body, in which re-infection occurs more easily than the first. High titers of antibodies against gonococcal infection can remain in the blood for quite a long time. Gonorrhea can be acute or chronic. Chronicization of acute gonococcal infection occurs with defective functioning immune system. From the point of view of diagnosis, the identification of chronic gonorrhea is of great difficulty. It should be remembered that in last years gonorrhea often proceeds, hidden, there are many stable forms. In this situation, high-quality and comprehensive laboratory diagnosis of gonorrhea plays an invaluable role. Currently, for the diagnosis of gonorrhea, the most widely used methods are microscopic examination of a smear, culture and immunofluorescence reaction. The polymerase chain reaction method is also being used more and more widely.
So, let's consider the main types of laboratory diagnostics that are currently used to diagnose gonorrhea.
Methods by which it is possible to identify gonococcus:
- rapid tests (immunochemical methods of counter electrophoresis)
- bacteriological (cultural, bacteriological inoculation)
- smear microscopy of urinary tract
- immune fluorescence reaction (RIF)
- linked immunosorbent assay
- serological method (Borde-Gangu reaction or complement fixation reaction)
- methods of molecular genetic diagnostics (ligase chain reaction, polymerase chain reaction)
- provocative tests (to detect chronic infection)
Rapid tests - sensitivity, specificity, advantages and disadvantages of the method
Rapid tests are simple, they can be used at home in an emergency. They look like a pregnancy test. The reading of the results is exactly the same: one strip - the result is negative (no gonorrhea infection), and two strips - the result is positive (presence of gonorrhea infection). Rapid tests for gonorrhea are quite sensitive and specific. In this case, the method of counter electrophoresis is used. When carrying out such a counter electrophoresis, the antigens of the gonococcus and the antibodies contained in the special serum merge. As a result, an antigen + antibody complex is formed, which stains the second strip of the rapid test. However, you should not completely rely on the result of such rapid tests, since an antigen + antibody complex may form not with a gonococcus, but with another similar microorganism. In this case, a positive result will be obtained, but there is no gonorrhea. Or in the opposite case, when the concentration of antigen + antibody complexes is too low, and the result will be negative, but gonorrhea is present. If you suspect gonorrhea infection, you should be examined using more accurate diagnostic methods.
Microscopy of a smear of the discharge of the genitourinary organs - sensitivity, specificity, advantages and disadvantages of the method
How and when to take a smear? Smear staining methodsFor examination under a microscope, a detachable urethra, vagina, cervical canal, and rectum are taken. At the same time, before taking biological material, it is necessary to stop taking antibiotics at least 4-5 days in advance, and refrain from urinating for 3-4 hours before sampling. Smears are taken in duplicate. The first copies of these smears are stained with methylene blue, brilliant green. The most common staining method is methylene blue. At the same time, gonococci are stained in an intense blue color against the background of a pale blue leukocyte cytoplasm. Gonococci can be inside leukocytes or outside. Brilliant green staining gives a stronger contrast between leukocytes and gonococci, staining gonococci more intensely. Both of these types of coloring serve as indicative, revealing cocci in general. Therefore, after detecting cocci, in a smear stained with methylene blue or brilliant green, the second copy of the smear is stained according to the Gram method. As a result of this method, gonococci turn bright pink. The diagnosis of gonorrhea is made only when gonococci are found in a Gram-stained smear. Methylene blue stain is used to better identify cocci, and Gram stain is used to differentiate gonococci.
Sensitivity, specificity of the method. Advantages and disadvantages
The sensitivity of this method is very variable and ranges from 40-86%. This variation is due to the fact that there are various subspecies of gonococci, some of which are not stained by this method. The specificity of the method is quite high and reaches 92%. Also, when studying stained smears under a microscope, the qualification of a laboratory assistant is of decisive importance. This method is widespread due to its availability, simplicity, speed and low cost.
If gonococci are detected in a Gram-stained smear, other diagnostic methods are not advisable. Bacteriological cultures can be performed to detect sensitivity to antibiotics.
Bacteriological method (cultural) - sensitivity, specificity, advantages and disadvantages of the method
The bacteriological or cultural method is considered to be the "gold standard" in the detection of various infectious diseases, including gonorrhea. The essence of this method is that the discharge of the mucous membranes of the genitourinary tract is sown on special nutrient media and placed in an incubator with conditions suitable for the growth of gonococcus colonies (high carbon dioxide content of 20-23%, temperature 37 ° C). A special medium is used on which gonococcus grows best. After some time (3-7 days), they check whether the colonies of gonococcus have grown. If the colonies have grown, then this is the undoubted result of the presence of gonococcal infection in the body. A huge plus of this method is almost one hundred percent specificity and the absence of false positive results. A false positive result is a result in which microorganisms are detected where they are not present. The sensitivity of the cultural method is also high and varies between 90-98%.
To date, standardized media are used, which give excellent results. A definite disadvantage of the cultural method is its duration. However, the duration pays off with accuracy, which is especially important when detecting a chronic persistent infection.
Immune fluorescence reaction (RIF) - sensitivity, specificity, advantages and disadvantages of the method
The immune fluorescence reaction requires careful training of personnel, the availability of a fluorescent microscope and high-quality reagents. When carrying out this method, a smear is also taken from the mucous membranes of the genitourinary tract and stained with special dyes that fluoresce (glow) under a microscope. The accuracy of staining of gonococci is achieved by an immune reaction of a dye containing antibodies to gonococcus. That is, dye-labeled antibodies bind to antigens on the surface of the gonococcus and form immune complexes. These immune complexes are visible under the microscope as luminous circles. The immune fluorescence reaction method allows to detect gonorrhea at an early stage of the disease, as well as to identify gonorrhea if it occurs in conjunction with other urinary tract infections (for example, syphilis or trichomoniasis). The immune fluorescence reaction is sensitive to gonococcus - 75-80% and highly specific. However, the use of this method is limited by a small number of specialists, as well as the high cost of equipment and reagents. At the same time, the method of immune fluorescence allows to conduct a study within 1 hour, which is its undoubted advantage. Enzyme immunoassay (ELISA) - sensitivity, specificity, advantages and disadvantages of the method
ELISA for the detection of gonococcus is not widely used. This method has an advantage and a disadvantage at the same time. During enzyme immunoassay, the presence of antibodies to gonococcus is detected. In this case, it is possible to identify an already dead pathogen that is still in the body, since leukocytes did not have time to eliminate it. In this case, a positive result will be obtained, since the method cannot distinguish between dead gonococci and living ones. This is the minus of enzyme immunoassay for the detection of gonococci. And the advantage is the ability of the method to detect the presence of resistant forms of gonococcus, which are difficult to diagnose. Also, the indisputable advantages of the method include its non-invasiveness, that is, the absence of the need to take smears, since the enzyme immunoassay is carried out in a urine sample. The sensitivity of the enzyme immunoassay for the detection of gonorrhea is 95%, and the specificity is 100%. However, today enzyme immunoassay is used as an auxiliary diagnostic method in most cases.Serological method (complement fixation reaction, Borde-Gangu reaction) - sensitivity, specificity, advantages and disadvantages of the method
Of all the variety of serological methods, only the complement fixation reaction (RCC) is used to detect gonococcus, which, in relation to gonorrhea, bears the name of its developer - the Borde-Gangu reaction. To date, the method is auxiliary, but it is invaluable in identifying chronic gonorrhea, in which the cultural method gives negative results. It is in such rare cases that the Borde-Gangu reaction is used to diagnose gonorrhea.Methods of molecular genetic diagnostics - sensitivity, specificity, advantages and disadvantages of the method
What methods are classified as molecular genetics?
These methods include polymerase chain reaction and ligase chain reaction. The peculiarity of all methods of molecular genetic diagnostics is their exceptionally high sensitivity and specificity. However, the implementation of these diagnostic methods is complex, high-tech, requires specialized laboratories and highly qualified personnel. So, let's look at each method in more detail.
Polymerase chain reaction (PCR)
The sensitivity of the method reaches 99%, and the specificity is 95%. As a biological material for the polymerase chain reaction, the discharge of the mucous membranes of the genitourinary tract, as well as urine samples, can be used. Polymerase chain reaction is a highly accurate diagnostic method that can compete even with the "gold standard" - the cultural method. The advantage of the polymerase chain reaction is also the possibility of simultaneous determination of the presence of gonococci and chlamydia in the same biological sample. The polymerase chain reaction method is faster than the culture method. However, PCR diagnostics is quite expensive due to the expensive reagents required for the reaction and complex expensive equipment.ligase chain reaction
The sensitivity of the ligase chain reaction exceeds that of the polymerase chain reaction, and the specificity reaches 99%. The ligase chain reaction is superior in its characteristics to the cultural method, but is not so widespread. This is due to the fact that specially equipped laboratories, highly qualified personnel and reagents are required. To date, ligase chain reaction is not even carried out in all major centers. However, its value is very high. The ligation chain reaction also allows detection of both gonococcus and chlamydia in the same biological sample. The duration of the ligase chain reaction is the same as that of the polymerase chain reaction, that is, a minimum of 3-4 hours, a maximum of 7-8 hours (depending on the equipment). As a biological sample, it is also possible to use urine or a smear from the mucous membranes of the genitourinary tract.
Provocation of gonorrhea - tests for the detection of chronic gonococcal infection
In what cases is it necessary to conduct provocative tests?In cases where the gonorrhea infection is neglected, has been subjected to inadequate treatment or repeated treatment with antibiotics, in a word, when the process is chronic, difficulties arise in the diagnosis of gonorrhea. In such cases, the gonococcus acquires a dense cell wall, which is called cyst, and goes into the deep layers of the genitourinary tract (up to the muscle layer). Inside the cells of the deep layers of the genitourinary tract in this state of the cyst, the gonococcus is able to live for a long time, and under favorable conditions for it, it will again enter the mucous membranes and cause a recurrence of gonorrhea. The course of such chronic gonorrhea is very long and persistent, and a smear or scraping does not reveal the presence of a microorganism, since the gonococcus is hidden deep in the tissues of the urinary tract.
To cause the appearance of gonococcus on the mucous membranes of the genitourinary tract, if it is present in the body in the form of a cyst, provocative tests are used. Provocation promotes the release of gonococcus on the mucous membranes of the genitourinary tract, and then it can be detected in a smear or bacteriological culture.
| Types of provocative tests | Methods of carrying out |
| chemical provocation | At the same time, the urethra is lubricated with 1-2% solution of silver nitrate, the rectum with 1% Lugol's solution in glycerin and the cervical canal (cervical canal) with 2-5% solution of silver nitrate. After one day (24 hours) from the moment of the provocation, a scraping-smear of the separated mucous membranes of the urethra, cervical canal and rectum is taken. Such scrapings-smears from the mucous membranes are taken 48 and 72 hours after the provocation. Three days after the provocation (72 hours), a bacteriological culture of the detachable mucous membranes of the genitourinary tract is also performed. In all scrapings-smears, the presence or absence of gonococcus is microscopically detected. Bacteriological culture allows you to identify the presence of a microorganism, and its sensitivity to antibiotics. |
| biological provocation | The essence of this type of provocation is the introduction of a gonococcal vaccine intramuscularly or at the same time a gonococcal vaccine is administered in combination with an immune system stimulant - pyrogenal. After such a provocation, scraping swabs are also taken after 24, 48 and 72 hours from the moment of the test. 72 hours after the introduction of biological provocateurs, a bacteriological culture is taken. In smears-scrapings and bacteriological culture, the presence or absence of gonococci is detected. |
| thermal provocation | During thermal provocation, a physiological procedure of diathermy or inductothermy is performed. In this case, diathermy is carried out for three consecutive days according to the following scheme - 30 minutes on the 1st day, 40 minutes on the 2nd day, 50 minutes on the 3rd day. Inductothermia is also carried out for three consecutive days for 15-20 minutes daily. Scrapings-smears of the separated mucous membranes of the genitourinary tract for bacteriological examination under a microscope are taken daily 1 hour after the physiotherapeutic procedure of diathermy or inductothermy. |
| physiological provocation | It does not require any special preparation and uses swabs on the days of menstruation. This provocation is natural, because during the period of menstruation there is a decrease immune protection woman's body. |
| alimentary provocation | This type of provocation is based on the use of salty, spicy food together with alcohol. Acceptance of incompatible products (for example, pickles with milk and beer, etc.) is welcome for maximum information content of the provocation. At the same time, after the provocation, scrapings-smears are taken after 24.48 and 72 hours and bacteriological culture after 72 hours, counting from the moment of the test - provocation. |
| combined provocation | Includes two or more provocative tests within one day. Scrapings-smears and bacteriological culture are carried out in the same way as when conducting each sample separately. That is, the discharge of the mucous membranes of the genitourinary tract is taken after 24, 48 and 72 hours, and the bacteriological culture of the discharge is carried out 72 hours after the combined test. |
gonorrhea treatment
Gonorrhea is an infectious disease, and therefore the treatment is based on the use of antibacterial drugs. Basic principles of gonorrhea treatment:
- Adequate treatment is possible only under the supervision of the attending gynecologist, urologist or venereologist.
- Treatment should be preceded by a full-fledged diagnosis, including laboratory tests (microscopic, bacteriological smear examinations), instrumental studies (ultrasound of the pelvic organs to exclude possible complications).
- Before prescribing treatment for gonorrhea, it is necessary to laboratory research on other sexually transmitted diseases - chlamydia, syphilis, mycoplasma, ureaplasma. As a rule, in our time, infection with only one venereal disease is rare - more often a bouquet of several infections is diagnosed. Only by identifying all concomitant infections, the attending physician will be able to prescribe adequate treatment.
- Independently start treatment, make your own changes to the treatment regimen and its duration, as well as interrupt it. This can lead to the development of chronic gonorrhea resistant to certain types of antibiotics.
- Treatment should be accompanied by a diagnosis of gonorrhea in all sexual partners.
- During the period of treatment, any sexual contact should be excluded.
- After the treatment, laboratory control of cure is mandatory. Only this study can confirm or refute the fact of recovery. The absence of purulent discharge or signs of inflammation does not mean the patient is cured.
We provide standard regimens used in the treatment of fresh gonorrhea:
- Ceftriaxone 0.25 g
- Ciprofloxacin 0.5 g. Inside once
- Ofloxacin 0.4 g. Inside once
- Lomefloxacin 0.6 g. Inside once
Treatment of chronic and latent forms of gonorrhea:
The use of antibiotics should be preceded by the use of a special vaccine, which is administered intramuscularly. This vaccine contains fragments of gonococci and contributes to the formation of specific immunity to gonococcal infection. The vaccine is administered in courses of 6-8-10 injections with a single dosage of 300-400 million microbial bodies and a total course dosage of 2 billion microbial bodies.
Along with vaccination, non-specific simulation of immunity is performed using medications: pyrogenal, streptokinase, ribonuclease.
After stimulation of the immune system and provocation, it is possible to prescribe antibacterial drugs according to standard treatment regimens.
Treatment of gonorrhea during pregnancy
The state of pregnancy imposes a number of restrictions on the use of immunostimulating and antibacterial drugs. However, the preference in treatment in this case is given to the following antibiotics: ceftriaxone, erythromycin, spectrinomycin, chloramphenicol.
Treatment of pregnant women is possible only under the strict supervision of the attending gynecologist.
Prevention of gonorrhea
The only reliable means of preventing gonorrhea is sexual contact with partners who have been diagnosed without this disease or who have used a condom. In the event that these conditions are not met, then the likelihood of infection with gonorrhea with each new sexual contact remains.Among pregnant women, preparation for childbirth includes testing for the presence of sexually transmitted diseases.
Also, all newborns after birth are instilled with antiseptic drugs that destroy gonococcus. These measures help to minimize infection of the newborn.
The use of individual hygiene products, underwear and towels will eliminate the household route of infection.
How long does gonorrhea treatment take?
Gonococcal infection, or gonorrhea, is a disease that has various clinical forms. Therefore, it is rather difficult to unambiguously answer how long the treatment of the patient will last. It depends on a number of different factors. Depending on the characteristics of the course of the disease in a particular patient, treatment can be reduced to a single injection of an antibiotic or drag on for several months. The main factors affecting the duration of treatment are:
- Features of the pathogen. Each microorganism, like each person, has its own unique characteristics. In particular, strains with different sensitivity to antibiotics are distinguished among microorganisms. If a microbe has come into contact with a certain drug but has not been destroyed, then there is a high probability that in the future it will no longer be susceptible to the same treatment. Such strains are called antibiotic resistant. Currently, among gonococci, they make up from 5 to 30% of all cases, depending on the locality ( countries, cities). Thus, the treatment of a susceptible strain will last less than a resistant one. Doctors do not always prescribe an analysis for sensitivity to certain drugs ( antibiogram). Because of this, the first course of antibiotic treatment may not be effective, and treatment will be delayed.
- Localization of infection. In most cases, gonorrhea occurs in the form of gonococcal urethritis ( inflammation of the urethra). In this case, her treatment will consist of a single injection of ceftriaxone or cefotaxime ( less than other drugs). In more than 95% of patients, this is enough for a complete cure. If the gonococcal infection is localized in atypical places ( mucous membrane of the anus, pharynx, conjunctiva of the eyes), then along with the systemic use of an antibiotic, a local one will also be required. Then the treatment may be delayed. The most difficult to treat is disseminated gonococcal infection, when the pathogen enters the bloodstream and spreads to various organs.
- Compliance with doctor's orders. With gonorrhea, this factor is of great importance. The fact is that interrupting treatment without laboratory confirmation of a cure can lead to serious consequences. First, the infection can acquire a chronic course. After that, it will be necessary to artificially cause an exacerbation in order to cure it. Secondly, the microbial strain of a given patient may develop resistance to the drug with which treatment was started. Then in the future, for a second course, you will have to select new antibiotic. Finally, thirdly, the patient, who believes that he has recovered, begins to lead an active sexual life. This leads to infection of his sexual partners. As a result, the infection circulates in a vicious circle, and it becomes even more difficult to get rid of it.
- Presence of other infections. Often gonorrhea is combined with urogenital chlamydia or trichomoniasis. This is due to the fact that the first infection weakens the protective resources of the mucous membrane and, as it were, "opens the gate" for the second. For a complete cure, accordingly, a longer course of antibiotics is required.
- Presence of complications. Sometimes gonorrhea does not show acute symptoms, but over time leads to a number of unpleasant complications. In men, this is balanoposthitis, acute and chronic prostatitis, and in women, gonococcal bartholinitis and salpingitis. These complications, as a rule, complicate the treatment process and the patient has to spend more time and effort on it.
- Body condition. In immunocompromised patients, as well as in women during pregnancy, gonococcal infection may be more aggressive. It spreads faster and easier, often accompanied by complications. Because of this, the treatment of such patients, as a rule, lasts longer.
To minimize the duration of treatment for gonorrhea, regardless of its form, you need to follow a few simple rules:
- compliance with the doctor's instructions regarding the use of antibiotics ( terms, doses, frequency of use);
- simultaneous examination and treatment of all sexual partners of the patient;
- abstinence from sexual intercourse until a control bacteriological analysis;
- testing for other infections.
Can I make love while I'm being treated for gonorrhea?
As you know, gonococcal infection, or gonorrhea, most often affects the genitourinary system. In men, it usually causes anterior or posterior urethritis ( inflammation of the urethra), and in women also vulvovaginitis. In addition, gonorrhea is a highly contagious infection that is easily transmitted through sexual contact. It does not leave immunity after curing, so a person can easily get sick again. Based on this, during the treatment of gonorrhea, the patient should refrain from any sexual contact, as this can lead to serious consequences. Sexual contact during treatment is dangerous for the following reasons:
- Spread of infection. Until the end of the course of treatment and the conduct of control tests, the patient poses a threat in terms of the spread of infection. Despite the fact that 1 injection of an antibiotic is often enough for recovery, no doctor can say for sure whether gonorrhea is cured after this. Thus, there is a chance that the patient will simply infect his sexual partner. This is also dangerous because after the end of treatment ( obtaining a negative result of the control analysis) he may come into contact with that partner again and become infected again. Thus, the infection will, as it were, circulate between two people. If they have more than one sexual partner, gonorrhea will begin to spread in society.
- Re-infection. Reinfection is dangerous through sexual contact with a partner who also has gonorrhea. In this case, the patient under treatment receives a new portion of bacteria. Unlike their own, dying under the influence of an antibiotic, these gonococci are stronger. When the course of treatment is over, they will be able to multiply again, and recovery will not occur, although the patient has completed the full course of treatment. In addition, it is possible to become infected with another strain of gonococci. If he is not receptive to the started treatment, then you will have to repeat all the tests and change the drug.
- Chronic infection. Re-infection contributes to chronic infection. If gonococci survive after a course of antibiotics, they will not make themselves felt for a long time. Many patients consider this a sufficient confirmation of recovery and do not conduct a control analysis. Then, after some time, gonorrhea will worsen again, its treatment will be much longer and more difficult, and the risk of complications will also increase.
- The development of antibiotic resistance. antibiotic resistance ( resistance to certain antibacterial drugs ) is one of the major problems in modern medicine. Among gonococci, it is recorded in approximately 5 - 15% of cases. If a patient during the treatment period has infected a sexual partner with gonorrhea, then it is highly likely that in the future his partner will develop a disease that is resistant to the drug that was used in the treatment. After all, the microorganism has already been in contact with this antibiotic, and genetic rearrangements in gonococci occur quite quickly. As a result, after some time, such patients have to spend money on stronger antibiotics in order to still defeat the resistant strain and be cured.
- Development of complications. During sexual intercourse, the spread of gonococcal infection is possible not only to the mucous membrane of the genitourinary tract, but also to other anatomical areas. Both the partner of the patient and the patient himself may in the future give a number of complications or atypical forms of gonorrhea. We are talking about anorectal and pharyngeal gonorrhea. In addition, during unprotected intercourse, microtrauma of the mucous membrane often appears. Through such defects, the infection can enter the bloodstream and spread throughout the body.
- Infection with other infections. In medical practice, patients with several concomitant genitourinary infections are often encountered. Their treatment requires more careful selection of drugs, takes more time and is much more expensive. Sexual contact during treatment for gonorrhea can not only negate the treatment itself, but also lead to an “exchange” of infections. As a result, the patient may become infected with chlamydia, trichomoniasis, or other common diseases.
If sexual contact did take place during the treatment period, this must be reported to the attending physician. In this case, the course of antibiotic treatment may be extended. Additional tests for other urinary tract infections may also be needed. At the same time, a sexual partner is found, examined and preventive treatment is started.
Safe sex becomes only after a special control analysis. It is carried out on the 7th - 10th day after the end of treatment. If bacteriological culture does not give growth of gonococci, and the patient does not have any symptoms of the disease, he is considered healthy.
Is it possible to get pregnant after gonorrhea?
Gonococcal infection in women most often occurs without severe symptoms and is localized in the urethra. Therefore, neither during the illness, nor after the end of treatment, nothing usually prevents the onset of pregnancy. The reproductive organs are usually not affected by the infection. However, in rare cases, a number of serious complications may develop that may affect the reproductive function of a woman. First of all, we are talking about a long-term chronic infection, the treatment of which was not given enough time. Problems with conceiving a child after gonorrhea can occur in the following cases:
- incomplete recovery. Gonococcal infection with improper treatment or premature termination can become chronic. In this case, there are no symptoms of the disease, but the pathogen still remains on the mucous membrane of the urinary tract. The problem is that its presence creates unfavorable conditions inside the vagina and uterus. The chance of getting pregnant is reduced partly due to insufficient lubrication, partly due to low mobility and too rapid death of spermatozoa after ejaculation ( ejaculation). In addition, the chance of attaching chlamydia or trichomoniasis increases, which also reduce the likelihood of successful fertilization. In this case, no structural changes in the genitourinary system may be observed. The detection of such a latent infection and proper treatment usually return reproductive function.
- Gonococcal salpingitis. Salpingitis is called inflammation of the fallopian tubes. It can occur in the acute course of infection with pronounced symptoms. During the period of illness, changes may appear in the mucous membrane lining the fallopian tubes. As a result, after a course of treatment, there is no more gonococcal infection, but the patency of the fallopian tubes for the egg is reduced. The stronger the inflammatory process was, and the longer the disease was ignored, the greater the chance of losing reproductive function. In severe cases, changes at the level of the fallopian tubes are irreversible. In addition to sterility, the risk of ectopic pregnancy increases.
- Gonococcal pelvioperitonitis. It is the most severe local complication of gonococcal infection, in which the inflammatory process spreads to the pelvic peritoneum. Then the treatment can take quite a long time. During this period, the sensitive peritoneum forms adhesions. These are connective tissue bridges that do not disappear after the inflammatory process subsides. They deform the organs to which they are attached, and disrupt their normal operation. Thus, after this complication, a woman will have adhesive disease of the small pelvis, which in some cases can manifest itself as infertility. However, here the problem can usually be solved by surgical dissection of the adhesions.
- Complications of gonorrhea in a sexual partner. Even if a woman is completely cured of gonorrhea, this does not mean that her partner does not have the disease either. Genitourinary infections usually circulate between sexual partners unless treated concomitantly. In men, the disease is usually more severe. Without adequate treatment, it is possible to develop prostatitis, purulent urethritis, lesions of the glands and even testicles ( orchitis). Then the seminal fluid, for various reasons, may simply not contain spermatozoa, or they will be unable to fertilize the egg.
What are the discharges for gonorrhea?
Discharge from the urethra is a kind of "calling card" of acute gonorrhea. This symptom distinguishes it from most other genitourinary infections and is very diagnostic value. In the acute course of the disease, it is the characteristic discharge that helps to suspect the correct diagnosis. Allocations with gonorrhea have the following characteristic features:
- In men, they usually appear 1 to 5 days after unprotected sexual contact with infected person. Sometimes this period is extended up to 30 days ( depending on the state of immunity and the characteristics of the pathogen). In the chronic course of the discharge may not be for months.
- In women, the discharge is usually more meager even in the acute course of the disease.
- Externally, the selections have white-yellow color. Without appropriate treatment, after a few days they become white-green, which indicates impurities of pus.
- Most often, in men, the discharge appears in the form of a “morning drop”. This is a symptom in which a large drop of a mucopurulent mixture is released from the opening on the glans penis in the morning. In women, this symptom is absent due to a different anatomical location of the urethra.
- In an acute course, a lot of pus is formed in the urethra. Therefore, it can be mixed with the morning portion of urine in the form of flakes.
- In a chronic open course, discharge can be observed continuously for several months. At the same time, the daily volume is small - only 1 - 2 small drops.
- Discharge from gonorrhea has an unpleasant pungent odor that appears 2 to 3 days after the onset of the symptom itself. In women, the discharge may not be visible ( e.g. during menstruation). But the menstrual flow itself against the background of gonorrhea becomes more abundant and also acquires bad smell.
- In the acute course of the disease, discharge can be observed at night. This can be detected by small yellowish spots on the underwear.
- Discharge from the urethra urethra) are enhanced under certain conditions. Alcohol, spicy food, excess caffeine, sex, drug provocation can become such a provoking factor ( may be necessary to start treatment in a chronic course of the disease).
- Allocations in men are almost always accompanied by a burning sensation and moderate soreness.
- If left untreated, the discharge may decrease after 12 to 15 days. However, this sometimes only indicates the spread of infection up the urethra. Then in patients at the end of the act of urination, 1 - 2 drops of blood can be released, sometimes with impurities of mucus and pus. This indicates an unfavorable course of the disease, the risk of complications and the need for an urgent start of treatment.
- In rare advanced cases, as a variant of discharge, hemospermia is possible - streaks of blood in the seminal fluid during ejaculation.
With extragenital forms of gonococcal infection ( conjunctivitis, pharyngitis) are not so typical. They may appear as a whitish coating on the tonsils or accumulate around the edges of the eyelids in young children with blenorrhea.
In chronic latent course of the disease ( more characteristic of women) there may be no discharge at all. However, this does not mean that the disease has disappeared or the patient is on the mend. Under the influence of the provoking factors listed above, an exacerbation occurs, and discharge appears ( sometimes for the first time months after the infection itself).
Microscopic examination of secretions in gonorrhea shows the presence of the following components:
- epithelial cells;
- pathogen cells ( Neisseria gonorrhoeae) - diplococci located inside epithelial cells;
- slime;
- erythrocytes ( rarely, outwardly look like streaks of blood).
Can gonorrhea be cured at home?
In principle, the most common form of gonorrhea is gonococcal urethritis ( inflammation of the urethra) may well be cured at home. However, home treatment does not mean self-treatment. In any case, the patient must definitely visit a doctor and pass all the necessary tests. At home, he can directly undergo a course of treatment prescribed by a specialist. To treat gonorrhea at home, you must go through the following steps:
- Consultation of a dermatovenereologist. A symptom specialist may suspect gonorrhea and order appropriate laboratory tests. The patient himself, based only on his own complaints, may confuse gonorrhea with another genitourinary infection.
- Laboratory tests. As a rule, the doctor takes a swab from the mucous membrane of the urethra. Subsequently, the obtained material is inoculated on nutrient media in a microbiological laboratory. Obtaining a culture of gonococcus confirms the diagnosis. If necessary, the doctor also takes a smear from the mucous membrane of the rectum, conjunctiva or pharynx. With severe general symptoms ( temperature, general weakness, etc. The patient's blood is also taken for analysis. This is how it is defined clinical form diseases.
- Home treatment. If the gonococcal infection is localized only in the urethra, the doctor prescribes the necessary antibiotic. Most often, only one dose is needed ( injection or tablet). Less commonly, the course lasts 1 - 2 weeks. The patient independently treats the mucous membrane and skin with disinfectant solutions ( installations in the urethra in men, in the vaginal cavity in women). In this case, hospitalization is not required.
- Control analysis . 7 to 10 days after the end of antibiotic treatment, the patient takes a smear again. If the result is negative, he is considered healthy. Women may need another follow-up smear after their second menstrual cycle.
blindness, and sometimes even a threat to life. In this regard, proper care can only be provided by doctors in a hospital setting.
Self-treatment of gonorrhea at home without contacting a specialist most often ends with a chronic infection. Neither means traditional medicine, nor self-selection of an antibiotic usually does not completely eradicate the infection. They can only remove the symptoms of the disease. Then the patient believes that he is cured, and no longer goes to the doctor. The problem is that in the future such neglected gonorrhea will worsen again and again, its treatment will require more time and effort, and the risk of complications will greatly increase.
Is gonorrhea transmitted through a condom?
Currently, condoms are the easiest and most affordable way to protect against sexually transmitted diseases. There are many studies proving that this remedy is effective against all bacterial and most viral infections. The gonococci that cause gonorrhea are bacteria. They are relatively large ( compared to viruses) and are unable to penetrate the microscopic pores of the latex from which the condom is made. Thus, it can be argued that gonorrhea is not transmitted through a condom. However, there are two important exceptions that the patient needs to be aware of. First, condoms are highly effective in protecting against gonorrhea only when used correctly. In most cases, people who claim to have been infected through a condom simply did not know how to use it correctly.
To achieve maximum protection against infection, the following rules must be observed:
- Compliance with the expiration date. Each condom package has an expiration date. If it is exceeded, then the lubricant inside begins to dry out, and the latex loses its elasticity. Because of this, when used, the risk of rupture increases. Even if the condom does not break, microcracks will appear in it, which are larger than normal pores. Through them, gonococci can already penetrate.
- Use with any sexual contact. Gonococci can affect not only the mucous membrane urinary tract, but also other tissues ( though less likely). Therefore, a condom should also be used for orogenital and anogenital contact. However, in these cases, the risk of its rupture rises to 3-7%.
- Proper opening of the package. The dense-looking condom packaging is actually easy to open with your hands. To do this, it is necessary to tear it from the side of the ribbed surface or in a specially indicated place. Opening with sharp objects ( knives, scissors) or teeth can cause accidental damage to the latex itself.
- Proper donning. When putting on a condom, the penis must be in a state of erection. Otherwise, it will subsequently slip and form folds, and during intercourse the risk of rupture will increase.
- Air release. When putting on a condom, you need to pinch a special cavity at its top with your fingers so that air comes out of it. This cavity is designed to collect semen after ejaculation ( ejaculation). If you do not release air from it in advance, there is a high risk of rupture.
- Use throughout the act. The condom should be put on even at the stage of foreplay, before the first contact of the partner with the infected mucous membrane occurs. After the end of intercourse, the condom is thrown away, and the penis is washed with warm water to remove the remnants of semen.
A condom does not protect against the following forms of gonococcal infections:
- gonococcal conjunctivitis ( inflammation of the mucous membrane of the eye);
- pharyngitis ( damage to the mucous membrane of the pharynx);
- skin lesion.
In general, the correct use of a condom gives almost one hundred percent guarantee of protection against gonorrhea. Nevertheless, doctors recommend that patients with this disease refrain from sexual intercourse until complete recovery.
Is gonorrhea transmitted by kissing?
Gonococcal infection is most often localized in the urethra ( urethra) and on the mucous membrane of the genital organs. In this case, the transmission of the disease through a kiss is impossible, since the pathogen is not in any oral cavity, nor in saliva. However, there are also atypical forms of this disease, in which other organs and systems are also affected. One of these forms is pharyngeal gonorrhea or gonococcal pharyngitis. With this disease, gonococci colonize the mucous membrane of the pharynx and, less often, the oral cavity. Then, with a kiss, it is theoretically possible to transfer the pathogen to a partner. However, the chance of such infection in practice is extremely small.
Transmission of pharyngeal gonorrhea through kissing is unlikely for the following reasons:
- Gonococci in the pharynx are in unusual conditions. The mucous membrane of the urethra, which differs in structure from the mucous membrane of the mouth and pharynx, is best suited for their reproduction. Because of this, the number of gonococci is smaller, they weaken, and the likelihood of infection is reduced.
- Human immunity also plays a significant role in this form of gonorrhea. The likelihood of infection is somewhat higher if the patient's immune system is weakened. In this case, the body does not fight well with the microbe, and the gonococci are activated. But for infection, immunity must be weakened in the second person who kisses the patient. Otherwise, the gonococcus simply will not take root on its mucous membrane.
- For gonococci, the mucous membrane of the pharynx is better suited than the oral cavity. With a kiss, infections localized above are more often transmitted.
How to treat gonococcal conjunctivitis?
Gonococcal conjunctivitis ( gonoblenorrhea) is a specific inflammation of the mucous membrane of the eyes caused by the microbe Neisseria Gonorrhoeae. In adults, gonorrhea is most often localized within genitourinary system. But in newborns, eye damage is more common. Infection occurs when a child passes through the birth canal if the mother has a gonococcal infection. Treatment of such conjunctivitis should begin even before the first symptoms appear. If doctors know the diagnosis of the mother, but it was not possible to completely eradicate the infection before childbirth, it is necessary to carry out special prophylaxis. To do this, immediately after the birth of a child, drugs are dripped into the eyes that destroy the causative agent of the disease.
For the prevention of gonorrhea, the following means are used:
- silver nitrate 1% ( drops);
- tetracycline ointment 1%;
- erythromycin ointment 1%;
- sulfacetamide 20% ( solution).
Antibiotics to treat gonococcal conjunctivitis
| Name of the drug | Recommended dose | special instructions |
| Cefazolin | Solution 133 mg/ml 1 drop every 2-3 hours. | Treatment lasts 3 - 4 weeks. After the symptoms decrease and until the end of the course, the drug is dripped 3-4 times a day. |
| Ceftazidime | Solution 50 mg/ml 1 drop every 2 to 4 hours. | |
| Ofloxacin | Ointment 0.3% is applied every 2 to 4 hours. | |
| Ciprofloxacin | Ointment or solution of 0.3%, applied every 2 to 3 hours. | |
| Ceftriaxone | Intramuscular injection, done once. Adults - 1 year Children weighing up to 45 kg the dose is reduced to 125 mg. newborn - 25 - 50 mg per 1 kg of body weight ( but not more than 125 mg per day), within 2-3 days. | The exact dose for children is determined only by the attending physician. |
In addition to antibiotics, it is necessary to use means for local disinfection. They will reduce the likelihood of other infections and speed up recovery. If the cornea is damaged, other drugs must be added. The most effective - Retinol acetate ( solution 3.44% 3 times a day) or Dexpanthenol ( ointment 5% 3 times a day).
With intense leakage of pus, it must be washed off. To do this, you can use potassium permanganate ( potassium permanganate) 0.2% or nitrofural ( furatsilin) in the form of a 0.02% solution.
In general, the treatment of gonococcal conjunctivitis in both children and adults should be handled by an ophthalmologist. With concomitant other localization of infection ( usually urethritis) consultation of a dermatovenereologist is necessary. Self-treatment can lead to further spread of the process to other structures of the eye, which is fraught with irreversible loss of vision.
ELISA is one of the most widely used diagnostic methods for various STDs. At the same time, it often happens that suspecting a venereal disease in a patient, the doctor may prescribe several tests at once, such as: seeding tank, PCR and ELISA for gonorrhea. Given that the patient's data laboratory methods studies from the outside seem exactly the same, patients have bewilderment about this. But this is not so, the research materials taken in a similar way are analyzed by different methods.
So, ELISA does not detect gonorrhea, this analysis looks for certain markers, which in turn are the waste products of pathogens of various infections. Based on the foregoing, it should be understood that enzyme immunoassay shows a trace of the infection. That is, it is indicative if the gonorrhea pathogen was present in the patient's body and caused an immune response, as a result of which the production of IgG antibodies began. It is the determination of these antibodies that occurs in the process of ELISA analysis.
It happens that enzyme immunoassay indicates the presence of gonorrhea, and PCR and other analyzes of the pathogen are not detected. There may be three reasons for this:
- violation of the research technique;
- the disease was successfully treated, but the trace of the markers in the patient's body was preserved;
- the disease became chronic and other tests did not reveal a small amount of the pathogen.
The second option from the third is easy to recognize by collecting an anamnesis from the patient. After all, gonorrhea does not disappear on its own. There can be no question of any self-healing. This means that if the patient did not pass drug therapy against gonococci, then he is still sick, just gonorrhea has passed into a chronic latent form.
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But it also happens the other way around: PCR can show a positive result for gonococci, and ELISA does not detect the causative agent of gonorrhea. This situation is typical in the case of a protracted course of the disease, when the immune system, weakened by years of fighting gonorrhea, can no longer resist and ceases to produce antibodies.