What Are the Causes of Gonorrhea?

Gonorrhea is a sexually transmitted disease mainly caused by purulent infection of the urogenital system caused by Neisseria gonorrhoeae (referred to as gonococcus). Its incidence rate ranks second in China for sexually transmitted diseases. Neisseria gonorrhoeae is Gram-negative diplococcus, which is difficult to survive without the human body, and it is generally easy to kill it with disinfectants. Gonorrhea occurs mostly in sexually active young men and women.

Basic Information

English name: gonorrhea
Visiting department: Dermatology
Multiple groups: young people
Common causes: Neisseria gonorrhoeae

Common symptoms: Frequent urination, urgency, dysuria, purulent discharge from the cervix or vagina of women, etc.
Contagious: Have
way for spreading: Sexual contact

Gonorrhea

The pathogen of gonorrhea, Neisseria gonorrhoeae, was first isolated by Neisseria in 1879. Is a Neisseria, Neisseria. Neisseria gonorrhoeae is kidney-shaped, with two concave surfaces facing each other, the same size, about 0.7 microns long and 0.5 microns wide. It is a carbon dioxide-aerobic bacterium that is Gram-negative and is most suitable for growth in a humid, 35 ° C, 5% carbon dioxide environment. Polymorphonuclear leukocytes often exist, oval or spherical, often in double arrangement, no flagella, no capsules, no spores, poor resistance to external physical and chemical conditions, the most afraid of drying, 1 to 2 hours in a dry environment Can die. Easily fatal under high or low temperature conditions. Resistance to various chemical disinfectants is also weak.

Clinical manifestations of gonorrhea

Gonorrhea without comorbidities

(1) Male gonorrhea Male acute gonorrhea The incubation period is generally 2 to 10 days, with an average of 3 to 5 days. It started with itching, redness, and eversion. Burning pain during urination, with frequent urination, and a small amount of mucus secretion at the urethral opening. After 3 to 4 days, most of the urethral mucosal epithelium occurred focal necrosis, producing a large amount of purulent secretions, tingling during urination, and the glans and foreskin were significantly red and swollen. There may be drips or blood in the urethra, and pus may form in the mouth of the urethra in the morning. With systemic symptoms of varying severity. Chronic gonorrhea in men generally has no obvious symptoms. When the body's resistance is reduced, such as excessive fatigue, drinking, and sexual intercourse, symptoms of urethral inflammation can occur.

(2) Female gonorrhea Females have mild or asymptomatic symptoms after acute gonorrhea infection. Generally, after a 3-5 day incubation period, urethritis, cervicitis, paraurethral glanditis, vestibular glandular inflammation, and proctitis occur. Among them, cervicitis is the most common. Urinary tract infections occur in 70% of women with gonorrhea. Gonococcal cervicitis is common, and often occurs simultaneously with urethritis. Chronic gonorrhea in women Acute gonorrhea can be turned into chronic if it is not adequately treated. Manifestations include lower abdomen swelling, backache, back pain, and more leucorrhea. Pregnancy with gonorrhea is mostly without clinical symptoms. Pregnant women with gonorrhea can infect the fetus through the birth canal when giving birth, especially when the fetal position is exposed first, but the fetus is particularly vulnerable to infection, such as premature rupture of the membrane, infection of the amniotic cavity, premature delivery, postpartum sepsis, and endometritis. Gonococcal vulvovaginitis in young girls The vulva, perineum, and perianal are swollen, and the vaginal purulent secretions are more, which can cause dysuria, local irritation and ulceration.

2. Gonorrhea with comorbidities

(1) Complications of male gonorrhea Prostatitis and seminal vesiculitis If the seminal vesicles are involved, semen may be mixed with blood. With prostatitis, perineal pain, digital rectal prostate enlargement and pain, seminal vesicle gland enlargement. Epididymitis and urethritis. Epididymis pain, swelling and tenderness. When complicated with urethritis, the perineum can touch the enlarged glands, and the patient feels discomfort or dull pain. When complicated with epididymitis, the scrotum is swollen and painful, the epididymis is painful, and the spermatic cord is thickened. Gonorrhea foreskin balanitis Stimulation of purulent secretions can cause balanus and foreskin inflammation. Glandular urethritis , retention cysts, lymphangitis, lymphadenitis, and foreskin gland abscesses The crypts and glands of the anterior urethra can be invaded, known as glandular urethritis. If these glands are blocked, they can form retention cysts, which can form cysts around the urethra when the cysts are ruptured. Inflammation of the paraurethral glands or urethra can extend to the cavernous body of the penis, often accompanied by lymphangitis, unilateral or bilateral inguinal lymphadenitis. Foreskin glands on both sides of the penis can also be involved to form an abscess.

(2) Complications of female gonorrhea Gonococcal vestibular glanditis. The opening of the vestibular large gland is red and swollen, protruding outwards, with obvious tenderness and purulent secretions. In severe cases, the glandular duct is blocked by purulent secretions and cannot be excreted. A vestibular gland abscess is formed, with obvious pain, difficulty in acting, and may be accompanied by fever, general discomfort and other symptoms. Gonorrhea paraurethral adenitis Squeeze the urethral glands and purulent discharge from the urethral orifice. Gonococcal perianal inflammation When vaginal discharge is large, it can be drained to the perianum and perineum to cause inflammation. Gonorrhea pelvic inflammatory diseases include acute salpingitis, endometritis, secondary fallopian tube ovarian abscess, pelvic peritonitis, and pelvic abscess. A small number of gonococcal endometritis can be infected with gonococcal pelvic inflammatory disease, salpingitis, ovarian inflammation, appendicitis, and hysteritis. Can cause tubal obstruction, stasis, and infertility. If it adheres to the ovary, it can lead to a fallopian tube ovarian abscess. Once the abscess ruptures, it can cause purulent peritonitis. Most pelvic inflammatory disease occurs after menstruation, mainly in young women of childbearing age. Typical symptoms are severe pain in both sides of the lower abdomen, one side being heavier, fever, and general discomfort. There may be chills before fever, often accompanied by loss of appetite, nausea, and vomiting. Patients often have prolonged or irregular vaginal bleeding and increased purulent leucorrhea.

3. Gonorrhea outside the genitourinary organ

(1) Gonorrhea conjunctivitis This disease is rare. Can occur in newborns and adults, conjunctival congestion, edema, purulent discharge, severe cases can cause corneal ulcers and blindness.

(2) gonococcal pharyngitis is usually asymptomatic, and those with symptoms can show swelling and purulent discharge in the throat.

(3) Gonococcal proctitis is mostly itching and burning in the anus, painful defecation, discharge of mucus and purulent discharge, rectal congestion, edema, purulent discharge, erosion, small ulcers and fissure

4. Disseminated gonorrhea

Disseminated gonococcal infection is rare. Low and moderate fever occurs, and the body temperature is mostly below 39 ° C, which can be accompanied by other symptoms such as fatigue and decreased appetite. Cardiovascular and nervous system involvement may occur.

Gonorrhea diagnosis

Contact history

The patient has a history of extramarital sex or sexual intercourse, a spouse has a history of infection, a history of sharing items with gonorrhea patients (especially gonorrhea patients at home), and a newborn mother has a history of gonorrhea.

2. Clinical manifestations

The main symptoms of gonorrhea include frequent urination, urgency, urinary tract discharge, or purulent discharge from the cervix and vagina. Or there are symptoms of gonococcal conjunctivitis, proctitis, pharyngitis, or symptoms of disseminated gonorrhea.

3. Laboratory inspection

Acute gonococcal urethritis smear is diagnostic in men, but gonococcus culture should be performed in women. Where conditions permit, genetic diagnosis (polymerase chain reaction) can be used to confirm the diagnosis.

Differential diagnosis of gonorrhea

Gonorrhea urethritis should be distinguished from Chlamydia trachomatis urethritis. Gonococcal cervicitis in women should be distinguished from Chlamydia trachomatis cervicitis. Because gonococcal cervicitis can have symptoms such as abnormal vaginal discharge, it should also be distinguished from vaginal trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.

Gonorrhea complications

1. Male gonorrhea complications

(1) Gonorrhea balanitis is caused by the purulent secretion of gonorrhea and the inner leaf of the foreskin. Local burns, itching, slight pain, foreskin edema, and erosion started. The glans are flushed and mildly erosive, and the foreskin is severely edema and cannot be turned up. The glans is red and swollen, which can be followed by inflammatory phimosis.

(2) Gonorrheic urethral stricture If gonorrhea does not heal for a long time, after several months or years, it can cause urethral stricture. At first, the patient has no feeling, gradually urinates poorly, frequent urination, weak and weak urethra. No or only dripping.

(3) Gonorrhea prostatitis is divided into acute and chronic. Acute prostatitis, with a more rapid onset, frequent urination and pain, especially pain after urination, dull pain around the perineum and anus, and pain during stool. In the anal diagnosis, the prostate is swollen, the surface is uneven, and the pressure is painful. The purulent secretion of the urethra is often discharged. Chronic prostatitis and acute prostatitis are not completely treated and can easily be converted to chronic prostatitis. Presented as perineal sensation of falling, tenderness, frequent urination, and often low back pain. Anal diagnosis of prostate hypertrophy, induration in many places, tenderness to touch, abnormal secretions during massage, check for increased white blood cell count.

(4) Gonorrhea epididymitis caused by gonorrhea invading epididymis through ejaculation tube. Presented as epididymal swelling, hard nodules touching the surface, often with radial pain, accompanied by fever, general discomfort.

(5) Gonorrhea seminal cystitis, gonococcal invasion through the ejaculation tube, vas deferens or lymphatic tract. Perineal bulging sensation, intensified during urination and defecation, pain radiated to the vas deferens and testes, and urine cleared.

2. Female gonorrhea complications

Female gonorrhea, especially when there is a gonococcal infection of the cervix, can be combined with infections of the reproductive system, causing more serious consequences, such as gonorrhea pelvic inflammatory disease, including endometritis, salpingitis, tubal ovarian cysts, pelvic abscess, peritonitis Wait.

(1) Endometritis Patients have increased vaginal discharge, lower abdominal pain, uterine body enlargement and pain, and the temperature of acute patients increases.

(2) Salpingitis Patients have fever, chills, general malaise, vomiting, and pain in the lower abdomen and waist, which can be radiated to the perineum. There are many leucorrhea with pus and blood, and there is tenderness on both sides of the lower abdomen when palpation, small tender masses can be felt, and tenderness in the uterus. If the treatment is not timely and incomplete, it can cause chronic salpingitis, which can cause ectopic pregnancy (ectopic pregnancy). The inflammation of the fallopian tube can cause adhesions, hydrops or pus, which can lead to infertility.

Gonorrhea Treatment

Treatment principle

(1) Early diagnosis and timely treatment First of all, the diagnosis should be established as soon as possible after the illness, and the treatment should not be random before the diagnosis is confirmed. Secondly, treatment should be performed immediately after diagnosis.

(2) Defining clinical types and judging whether there are comorbidities. Defining clinical classification is extremely important to properly guide treatment.

(3) To determine whether there is drug resistance. To determine whether it is resistant to penicillin, tetracycline, etc. can help guide the treatment correctly.

(4) Determine whether there is a chlamydia or mycoplasma infection. If a chlamydia or mycoplasma infection is combined, a combined drug treatment plan should be formulated.

(5) Correct, sufficient, regular and comprehensive treatment The drug most sensitive to N. gonorrhoeae should be selected for treatment. The dose should be sufficient, the treatment course should be regular, and the medication method should be correct.

(6) Strict assessment of efficacy and follow-up observation It is necessary to strictly grasp the cure standards and adhere to the efficacy assessment. Only when the cure standard is reached can it be judged to be cured to prevent recurrence. Healers should insist on regular review.

(7) Simultaneous examination and treatment of their sexual partners The husband and wife or both of the patients should receive examination and treatment at the same time.

2. General considerations

Prohibition of sexual activity without cure. Pay attention to rest. Those with comorbidities must maintain a balance of water, electrolytes and carbohydrates. Pay attention to the local hygiene of the genitals.

3. Systemic therapy

For uncomplicated gonorrhea, such as gonococcal urethritis, cervicitis, and proctitis, give ceftriaxone by intramuscular injection, single administration; or intramuscular injection of spectinomycin, single administration; or intramuscular injection of cefotaxime, Single administration. The secondary selection scheme is other third-generation cephalosporins, and if it has proven to be effective, it can also be used as an alternative medicine. If Chlamydia trachomatis infection cannot be ruled out, add anti-Chlamydia trachomatis medication.

For gonorrhea with complications, such as gonorrhea epididymitis, seminal vesiculitis, and prostatitis, use ceftriaxone, intramuscularly, once a day for 10 days; or spectinomycin, intramuscularly, once a day for 10 days. Or cefotaxime, intramuscularly, once a day for 10 days.

Prognosis of gonorrhea

Patients with uncomplicated gonorrhea generally do not need to be re-examined for a trial of healing after a recommended treatment. After treatment, those who have persistent symptoms should undergo N. gonorrhoeae culture. If N. gonorrhoeae is isolated, a drug sensitivity test should be performed to select effective drug treatment. Patients who relapse after treatment with the recommended regimen are usually caused by reinfection, suggesting that the education of patients and the diagnosis and treatment of sexual partners should be strengthened. Persistent urethritis, cervicitis, or proctitis can also be caused by Chlamydia trachomatis and other microorganisms, and targeted inspections should be made to make judgments and treat them. After regular treatment of some gonococcal urethritis, there are still urethral discomforts. No gonorrhoeae and other microorganisms can be found, which may be due to the incomplete repair of urethral infection.

Children with gonorrhea ophthalmia should be hospitalized and checked for disseminated infection. After the treatment of gonococcal epididymitis, if the symptoms do not improve significantly within 3 days, the diagnosis and treatment should be re-evaluated. After treatment according to the recommended regimen, if testicular swelling and tenderness persist, a comprehensive examination should be performed to rule out other diseases. If there are complications of gonococcal meningitis and endocarditis, the relevant specialist consultation should be consulted.

Within 2 weeks after the end of treatment, in the absence of a history of sexual contact, the following criteria were met for cure: all symptoms and signs disappeared; samples were taken from the affected area within 4 to 7 days after the end of treatment and negative for N. gonorrhoeae.

Gonorrhea prevention

1. Provide health education to avoid non-marital sex.

2. Promote safe sex and promote the use of condoms.

3. Pay attention to isolation and disinfection to prevent cross infection.

4. Carefully follow up the patient's sexual partners, and conduct timely inspection and treatment.

5. Carry out STD examinations for pregnant women and preventive eye drops for newborns to prevent neonatal gonorrhea ophthalmitis.

6. Regular inspection of high-risk groups to find infected persons and patients and eliminate hidden sources of infection.

Management of gonorrhea partners

Adult gonorrhea patients should be asked to check and treat their sexual partners when they visit the clinic. All sexual partners who have had sexual contact with the patient during the onset of symptoms or within 2 months before the diagnosis should be examined and treated for gonococcal and chlamydia trachomatis infections. If the patient's most recent single exposure was before the onset of symptoms or 2 months before the diagnosis, then her most recent sexual partner should be treated. Patients should be educated to avoid sexual intercourse before treatment is completed, or if they and their partner still have symptoms.

Mothers of neonates infected with gonococcus and their sexual partners should be diagnosed according to relevant requirements and treated according to the recommended protocol for adult gonorrhea treatment. Men with gonococcal pelvic inflammatory disease should be examined and treated with their male partners who have had sexual contact with them within 2 months before the onset of symptoms, even if their male partners have no symptoms.