Treatment of gonorrhea during pregnancy. Gonorrhea during pregnancy: how to avoid dire consequences? In the treatment of gonorrheal infection in pregnant women, it is used

Gonorrhea during pregnancy has serious consequences for both the mother and the baby. Only 30% of pregnant women with gonorrhea complain of leucorrhoea, dysuric disorders, and pain in the lower abdomen. However, in the vast majority of women, these symptoms disappear quickly and they do not go to the doctor.

In acute endometritis, as a result of focal development of the gonorrheal process, conception may occur, but later, as a result of decidual endometritis, a miscarriage occurs in the early stages of pregnancy. When infected with gonorrhea, which occurs after four months of pregnancy, gonococci that penetrate into the uterus encounter an obstacle and abortion does not occur. However, timely unrecognized gonorrhea is fraught with serious postpartum complications - infection of the uterus and its appendages occurs.

A single examination for gonorrhea in pregnant women is ineffective. With repeated examinations, the percentage of detection of the disease increases. The frequency of detection of gonorrhea in pregnant women also increases with the use of two laboratory diagnostic methods - bacterioscopic and cultural. Particularly good results are obtained by the culture method in the chronic stage of the disease, and as the gestational age increases, sowing becomes more and more diagnostic.

In our country, a pregnant woman is examined for gonorrhea 2 times (in the first and second half of pregnancy). If there are indications (inflammation in the genitourinary organs, leucorrhoea, urinary disorder, urological diseases of the husband), then the pregnant woman must be examined many times. In cases where gonococcus cannot be detected, and clinical or anamnestic data suggest gonorrhea, prophylactic antibiotic treatment is necessary. The use of the whole complex for gonorrhea during pregnancy is limited.

For pregnant women with suspected chronic gonorrhea, the following provocation is carried out: the urethra is lubricated with a 1% solution of silver nitrate or 2.5% solution of protorgol, the cervix is outside, and the rectum is 3-4 cm above the sphincter - with 1% nitrate solution silver or Lugol's solution. Intramuscularly injected 5 ml of autoblood and gonovaccine with 200 million mt or only gonovaccine. When examining a pregnant woman, it is necessary to take into account the course of this pregnancy and the outcomes of previous ones. With a burdened history and any deviations during this pregnancy, provocations are contraindicated.

The course of gonorrhea largely depends on when the infection occurred - before or during pregnancy. If the infection occurred before pregnancy, then in the vast majority of patients the disease proceeds chronically, erased, accompanied by small mucopurulent discharge from the cervix. In a quarter of patients, there is an exacerbation of the pathological process during pregnancy. If the infection occurred during pregnancy, then in most cases there are pronounced inflammatory phenomena from the affected foci. Gonorrhea is especially acute when infected in the second half of pregnancy. Mucopurulent discharge becomes very profuse.

With gonorrhea in pregnant women, the lower part of the reproductive apparatus is affected. The ascending process is extremely rare and only in the first 3 months of pregnancy, when not the entire uterine cavity is filled with the ovum. Starting from the 4th month, the advancement of the gonococcus into the internal genital organs is impossible. This is due to the fact that the decidual parietal membrane merges with the capsular and the ovum closes the internal pharynx. During pregnancy, fresh gonorrhea mainly occurs as a multifocal disease. An isolated lesion of any focus is extremely rare, and these are patients with a chronic process or with an erased, torpid form of the disease. Most often, the cervix and urethra are affected.

Gonorrhea in 6.5-10% of pregnant women leads to spontaneous miscarriages (Plintovie et al., 1978), and in 6.3-12% is the cause of premature birth (Edwards et al., 1978). According to R.D. Ovsyanikova (1975), the symptoms of threatened miscarriage and miscarriage are more common with fresh gonorrhea, and miscarriages and premature birth are more common with chronic gonorrhea. In the fresh stage of the disease, the cause of an unfavorable course of pregnancy is an acute inflammatory process in the lower part of the genitourinary organs and gonointoxication. Timely specific therapy helps to eliminate the symptoms of termination of pregnancy. In chronic gonorrhea, specific endometritis is observed and the implantation process is disrupted, therefore, even with full treatment, it is not always possible to maintain a pregnancy.

Gonorrhea in postpartum women is much easier to diagnose than in pregnant women, since lochia is a favorable environment for gonococcus. Gonococcus enters the uterine cavity earlier than other microorganisms, therefore, already on the 3-4th day after childbirth, a pure culture of gonococcus can be found in lochia. When examining postpartum women in the first days after childbirth, the discharge should be taken from the urethra, rectum and vagina (lochia). After 5-7 days, in addition to these foci, the cervix should also be examined.

The clinical manifestations of gonorrhea in the postpartum period are very diverse. In some patients, in the first days of the postpartum period, gonorrhea manifests itself only by a one-, two-fold increase in body temperature within 38 degrees C. Many women in childbirth develop endometritis with clinical manifestations of varying degrees.

Generalization of gonorrheal infection in the postpartum period is extremely rare. The erased course and the absence of severe complications after childbirth is explained by the fact that gonococci are removed from the uterine cavity along with abundant lochia. With an erased, torpid course, gonorrhea in puerperas may remain unrecognized. Such a dormant infection enters the fallopian tubes after a long time, for example, during the first menstruation.

More severe complications in the postpartum period develop in women who were infected with gonorrhea in the second half of pregnancy. For the timely diagnosis of gonorrhea and the prevention of complications, even minor deviations during the puerperal period should alert the doctor.

In maternity hospitals, the following contingents of puerperas are subject to mandatory examination for gonorrhea: with inflammatory processes in the genitals; with brown-purulent lochia; with an increase in body temperature of unclear etiology; single and unmarried women.

Gonorrhea is a human infectious disease caused by Neisseria gonorrhoeae, which is primarily sexually transmitted.

ICD-10 code
A54 Gonococcal infection.
A54.0 Gonococcal infection of the lower genitourinary tract without abscess formation of the periurethral and accessory glands.
A54.1 Gonococcal infection of the lower genitourinary tract with abscess formation of the periurethral and accessory glands.
A54.2 Gonococcal pelvioperitonitis and other gonococcal infection of the genitourinary organs.
A54.3 Gonococcal eye infection
A54.4 Gonococcal infection of the musculoskeletal system.
A54.5 Gonococcal pharyngitis.
A54.6 Gonococcal infection of the anorectal region.
A54.8 Other gonococcal infections.
A54.9 Unspecified gonococcal infection

EPIDEMIOLOGY

Gonorrhea is one of the most common STIs. The disease is subject to mandatory registration when detected on the territory of the Russian Federation. The prevalence of gonorrhea is significantly influenced by social, demographic and behavioral factors. In recent years, a relatively low incidence of gonorrhea has been noted, which, apparently, is due to incomplete registration of patients due to the appeal of some patients to commercial medical institutions, insufficient examination, wide and uncontrolled use of antibiotics, limited use of cultural diagnostic methods.

ETIOLOGY (CAUSES) GONORRHEA

The causative agent of gonorrhea is the gram-negative diplococcus Neisseria gonorrhoeae, which is a member of the Neisseriaceae family of the genus Neisseria. This is a bean-shaped coccus, the cells of which are arranged in pairs, with concave sides to each other. The size of the cocci is 1.25–1.60 µm in length and 0.7–0.8 µm in diameter.

PATHOGENESIS

Infection with gonococci causes an inflammatory process, which leads to degenerative and infiltrative changes in the organs of the genitourinary tract, rectum, oropharynx, conjunctiva. In women, it is primarily affected by the spread of the inflammatory process to the uterus, fallopian tubes, and ovaries. In the affected organ, a cellular infiltrate is initially formed, which is subsequently replaced by connective tissue.

Pathogenesis of complications of gestation

Untreated infection can spread intracanalicularly ascending with the development of amnionitis or chorioamnionitis, leading to fetal death, premature discharge of OS, premature birth. The transplacental route of transmission of gonococci has not been proven. Fetal infection is possible both antenatally (with gonococcal chorioamnionitis) and intrapartum (with the mother).

CLINICAL PICTURE (SYMPTOMS) OF GONORRHEA IN PREGNANT WOMEN

The incubation period for gonorrhea is 3 to 14 days (average 5–6 days). Chronic recurrent course is often noted. The most common diseases are urethritis, cervicitis, proctitis, salpingo-oophoritis is not excluded, which is rare. The clinical picture of gonorrhea in pregnant women has no features.

Main clinical symptoms

Among women:
Vaginal discharge;
Dysuria;
· Acyclic bleeding;
· Pain in the lower abdomen;
Dyspareunia;
Pain in the rectal area and discharge from it in the presence of proctitis.

In newborns:
Conjunctivitis;
Sepsis.

The main manifestations of the disease

Among women:
· Cervicitis;
· PID;
Urethritis;
Perihepatitis;
Bartholinitis;
Pharyngitis;
Conjunctivitis;
· Proctitis;
Disseminated gonococcal infection: arthritis, dermatitis, endocarditis, meningitis.

In newborns and infants:
Ophthalmia of newborns;
· AF infection syndrome;
· Dissemination of gonococcal infection.

Possible complications in women:
PID (endometritis, salpingitis, salpingo-oophoritis, etc.);
· Infertility;
· Ectopic pregnancy;
· Reiter's syndrome.

DIAGNOSTICS OF GORRHEA DURING PREGNANCY

Diagnostics is based on the following criteria:
· Data of anamnesis (indication of sexual contact with a sick or possibly infected partner with gonorrhea);
· Assessment of subjective and objective symptoms of the disease;
· Detection of gonococci in laboratory studies.

ANAMNESIS

Anamnesis in adults indicates an indication of sexual intercourse. When questioning, the patient reveals a possible
source of infection.

It is important to clarify:
The time elapsed from the moment of the last sexual contact with the alleged source of infection until the onset of symptoms of the disease;
· Results of examination of the sexual partner for gonorrhea.

PHYSICAL STUDY

It is necessary to examine the patient completely to exclude manifestations of other STIs, to assess the condition of all groups of lymph nodes. All parts of the abdomen, large vestibular and periurethral glands, urethra are palpated, bimanual vaginal examination is performed.

LABORATORY RESEARCH

Laboratory diagnostics of gonorrhea includes (table 48-8):

· Microscopy of smears stained with methylene blue and Gram;
· Cultural method. It is used to diagnose gonorrhea in pregnant women, minors, in the presence of cervicitis and PID in women. When it is carried out, the antibiotic sensitivity of the isolated gonococci is required;
· Non-cultural methods (molecular biological - PCR).

If indicated, a culture study is performed. Given the high sensitivity of gonococci to drying and temperature, inoculation is recommended to be done immediately on chocolate agar or other nutrient medium for the isolation of gonococci. If it is impossible to inoculate the clinical material on a nutrient medium for gonococci, it is necessary to use special transport media.

A combination of microscopic and cultural methods is used as a criterion for cure.

Additional use of non-cultural methods (PCR) in this case is possible no earlier than 3 weeks after the end of treatment.

Serological methods are not used to diagnose gonorrhea.

The following main areas for taking material are distinguished:
· The cervical canal of the cervix and urethra;
· Rectum when indicating anogenital contact;
· Pharynx if orogenital contact is indicated.

It is possible to take material for the detection of gonococcus and from other areas:
· Rectum and urethra, if the cervix is removed;
· Pelvic organs during laparoscopy in women with PID;
· Blood and other fluids (pus) during dissemination of the infection;
· Synovial fluid;
· Conjunctiva of the lower eyelid;
· The first portion of freely released urine (10-15 ml) for the PCR method (rarely).

SCREENING

The following are subject to examination for gonorrhea:
Women with clinical manifestations of mucopurulent cervicitis, symptoms of adnexitis;
· Persons who have had sexual contact with a patient with gonorrhea;
· Persons undergoing examination for other STIs;
· Pregnant women when registering for pregnancy;
· Pregnant women aimed at termination of pregnancy;
· Newborns with purulent conjunctivitis (if the gonorrheal etiology of the process is confirmed, parental examination is necessary).

DIFFERENTIAL DIAGNOSTICS

Differential diagnosis of gonorrhea is carried out with cervicitis caused by other microorganisms, primarily chlamydia.
With skin lesions - with keratoderma with Reiter's disease.
With joint damage - with reactive arthritis, Reiter's disease, arthritis of a different etiology.
In the presence of symptoms of conjunctivitis - with conjunctivitis of chlamydial, viral etiology.
With meningitis in children - with meningitis of meningococcal etiology, viral lesions of the tissue and membranes of the brain.

EXAMPLE FORMULATING A DIAGNOSIS

Uncomplicated gonococcal infection of the lower urinary tract (urethritis, cervicitis).

Table 48-8. Laboratory methods for the diagnosis of gonorrhea and their features

Sampling area	Diagnostic method	Comments (1)
Endocervix / urethra (in adult women)	Microscopic with Gram stain for the detection of intracellular diplococci	The sensitivity of the method is lower than when using material from the urethra in men
	Cultural	To confirm the diagnosis (isolation and identification of Neisseria) and to conduct an antibiotic susceptibility test
	Non-cultural (PCR)	Only as a screening, followed by confirmation by other methods
Pharynx / conjunctiva / rectum	Cultural only (microscopic with Gram stain not applicable)	Confirmation of the diagnosis (isolation and identification of Neisseria) and an antibiotic susceptibility test
Pharynx / conjunctiva / rectum	Non-cultural (PCR)
Urine	Non-cultural (PCR)	Only as a screening followed by examination of material from the urethra and cervical canal and detection of Neisseria by other methods
Sepsis	Microscopic method with Gram stain for clinical materials from the urethra and cervical canal, skin rashes	Screening method. It is obligatory to study material from other localizations by the cultural method.
	The culture method for clinical materials from the urethra and cervical canal, skin rashes, rectum, nasopharynx, cerebrospinal fluid, synovial fluid, blood	The main diagnostic method, confirmation of the diagnosis (isolation and identification of Neisseria) and an antibiotic susceptibility test
	Non-cultural (PCR)	As screening only followed by culture confirmation

TREATMENT OF GORRHEA DURING PREGNANCY

OBJECTIVES OF TREATMENT

Eradication of gonococci, resolution of the inflammatory process, prevention of complications.

INDICATIONS FOR HOSPITALIZATION

Gonorrhea in pregnant women; complicated course of gonococcal infection (conjunctivitis, damage to the cardiovascular, nervous system, musculoskeletal system, etc.) require inpatient treatment.

The duration of inpatient treatment is determined by the nature of clinical manifestations and the severity of the inflammatory process and is 2–4 weeks.

NON-MEDICINAL TREATMENT

In the presence of complications, physiotherapeutic treatment methods can be used after consulting a physiotherapist, depending on the severity of the disease and the patient's condition.

MEDICINAL TREATMENT OF GONORRHEA IN PREGNANT WOMEN

Treatment of pregnant women is carried out at any gestational age in a hospital setting with antibacterial agents that do not have a pathological effect on the fetus. The choice of drug for treatment depends on the manifestations of the disease (Table 48-9).

In the absence of results from treatment, it is recommended to consider the following possible causes:
· False positive test result;
• non-compliance with the treatment regimen, inadequate therapy;
· Repeated contact with an untreated partner;
· Infection from a new partner;
· Infection with other microorganisms.

Table 48-9. Medicines used to treat and prevent gonorrhea

Indications for use	Medicines of choice	Alternative medicines
Gonorrhea in pregnant and lactating mothers	Ceftriaxone * intramuscularly 250 mg once or	Erythromycin inside the first 2 days 400 thousand units 6 times a day, then 400 thousand units 5 times a day (course dose 8.8 million units) or
	Spectinomycin intramuscularly 2.0 g single dose or	Azithromycin inside 1.0 g once
	Cefixime * 400 mg orally once
Conjunctivitis	Ceftriaxone * intramuscularly 1.0 g single dose
Ophthalmia of newborns	Ceftriaxone * intramuscularly 25-50 mg / kg body weight (no more than 125 mg) once or intravenously 1 time per day for 2-3 days or
Ophthalmia of newborns	Cefotaxime * intramuscularly 100 mg / kg body weight once plus abundant lavage of the conjunctiva with isotonic sodium chloride solution
Prevention of ophthalmia in newborns	Silver nitrate topically 1% aqueous solution once 2-3 drops in each eye or
	Erythromycin external ophthalmic ointment 0.5% single dose or
	Tetracycline topical ophthalmic ointment 1% single dose
Pharyngitis	Ceftriaxone * intramuscularly 250 mg once
Anorectal infection	Ceftriaxone * intramuscularly 250 mg once	Cefuroxime intramuscularly 1.5 g once or
		Cefodizim intramuscularly 500 mg once or
		Azithromycin inside 1.0 g single dose
Complications of neonatal gonococcal infection (meningitis)	Ceftriaxone * intramuscularly or intravenously at the rate of 25-50 mg / kg body weight 1 time per day for 7 days (with meningitis - at least 10-14 days) or
Complications of neonatal gonococcal infection (meningitis)	Cefotaxime * intramuscularly or intravenously at the rate of 25 mg / kg body weight 2 times a day for 7 days (with meningitis - at least 10-14 days)
Prevention of gonorrhea in newborns born to mothers with this infection	Ceftriaxone * intramuscularly at the rate of 25-50 mg / kg body weight (no more than 125 mg) once or
	Spectinomycin intramuscularly 40 mg / kg body weight (no more than 2.0 g) once

Note: * Cefixime, cefotaxime, and ceftriaxone are not indicated for patients with a history of cephalosporin or penicillin allergy.

If necessary, you can use another treatment option. Therapy with the main or one of the alternative drugs is continued for at least 24–48 hours.

In order to prevent a possible concomitant chlamydial infection, treatment is simultaneously prescribed using the scheme, as in the case of chlamydial infection.

ASSESSMENT OF TREATMENT EFFICIENCY

Evaluation of the effectiveness of treatment is carried out on the basis of clinical laboratory and instrumental studies confirming the eradication of the gonococcus and the resolution of the inflammatory process.

Maintaining contact persons

The examination of patients is carried out depending on the history of sexual intercourse, the severity of clinical symptoms and the estimated duration of infection (in the acute course of gonorrhea - from 3 days to 3 months; with torpid and low-symptom course - 6 months).

A newborn born of a mother with gonorrhea is taken from the vulva and conjunctiva of both eyes for microscopy and culture. If gonorrhea is detected in a newborn, his parents are examined.

FURTHER INTRODUCTION

· Sexual identification is mandatory and important.
· Treatment of the sexual partner is mandatory.
· Registration: send an emergency notification to the KVD in the form 089 / ukv.

PREVENTION OF GORRHEA IN PREGNANCY

Prevention of gonorrhea includes activities common to all STIs, and is divided into primary and secondary.

Primary prevention aims to change behavior in high-risk groups in order to avoid infection. It is necessary to promote a healthy lifestyle, safe forms of sexual relations through the media, as well as in educational and medical institutions. It is necessary to talk about the clinical manifestations of genital infections, ways of infection, methods of prevention, taking into account the educational level of the audience. It is important to explain the harm of self-medication and treatment to lay people.

Secondary prevention is aimed at:

· Examination and treatment of patients with diagnosed STIs to reduce the likelihood of transmission of infection to their sexual partners;
· Reducing the risk of re-infection among sick or previously infected people;
· Effective diagnosis and, if necessary, treatment of contact persons.

All sexual partners of patients with symptoms of gonorrhea are subject to compulsory examination and treatment if they have had sexual intercourse in the last 14 days.

In the absence of symptoms of the disease in a patient with gonorrhea, all sexual partners who have had sexual contact with her in the last 60 days are subject to examination.

Specific preventive measures in newborns consist in laying erythromycin eye ointment behind the lower eyelid in the first minutes after birth.

Conducting epidemiological measures among contact persons (remediation of the epidemic focus) is carried out
together with the district epidemiologist:
· Examination and examination of contact persons;
· Assessment of laboratory data;
· Deciding on the need for treatment, its volume and timing of observation.

In case of residence of contact persons in other territories, an attire is sent to the territorial KVU.

PATIENT INFORMATION

It is necessary to exclude sexual intercourse until complete recovery, strictly observe the regimen of taking medications and visit a doctor in a timely manner to determine the criteria for cure.

FORECAST

The prognosis with timely treatment started is favorable.

One of the venereal diseases - gonorrhea is manifested by inflammatory processes in the urinary tract. Gonorrhea during pregnancy in the first trimester manifests itself in the form of damage to the inner layer of the uterus, fallopian tube and ovaries. In some cases, the disease can be asymptomatic, which greatly complicates the treatment of pregnant women and can provoke serious complications.

Causes

The cause of the onset of the disease is most often intercourse, not protected by contraceptives.

When a gonococcus pathogen enters the mucous membrane of a microorganism on the genitals.

Also, infection can occur during the birth of a child, through the infected genital tract of the mother. The disease proceeds at a rapid pace and is accompanied by pronounced ones.

Symptoms of the disease:

when urinating, sharp pain occurs;
discharge of pus from the genital tract;
the onset of fever.

Untimely treatment of the disease or the complete absence of therapy, threatens damage to many internal organs of the mother and fetus

The causative agent of gonococcus in gonorrhea in pregnant women affects:

uterus;
bladder;
kidneys.

In men, in addition to the kidneys and bladder, the testes, their appendages and the vas deferens are affected.

Often the result of gonorrhea is infertility in both women and men. The causative agent of gonorrhea - gonococcus can provoke inflammation of other organs.

Gonococcus provokes inflammation:

tissues with glandular or columnar epithelium;
rectum;
the appearance of conjunctivitis;
inflammation of the pharynx.

In women in position, the microorganism affects the cervix in the first place, then spreads to the fallopian tubes.

Ultimately, the ovaries are damaged. In newly born babies, gonorrhea can cause conjunctivitis.

The causes of gonorrhea can be:

not using condoms;
promiscuous sex;
violation of personal hygiene.

Based on the causes of gonorrhea, it can be avoided by following simple rules of personal hygiene with control of sexual intercourse.

Symptoms

Conditionally, gonorrhea is divided into 3 stages. They differ depending on the clinical manifestations.

Stages of gonorrhea in pregnant women:

Fresh form of gonorrhea- the infection has an acute, subacute or sluggish form. The form is diagnosed within 2 months from the date of infection.
Latent form or latent infection- extremely rare during pregnancy. Basically, it provokes infertility. An infection is formed in the area of the fallopian tubes in the form of adhesions, which subsequently prevents the meeting of the sperm with the egg. A woman suffering from this form of the disease poses a constant threat to infect her partner.
Tropid shape- in case of an untimely visit to a doctor, the form becomes chronic. Treatment of gonorrhea in pregnant women in this form is more difficult and longer to treat than the acute form. It is almost asymptomatic.

Symptoms of gonorrhea during pregnancy are not uncommon for several days after infection. This period can vary from 3 days to 14 days.

Gonorrhea during pregnancy symptoms:

general malaise and a;
sharp headaches;
intoxication with local symptoms;
sharp pain when urinating;
discharge of pus from the genital tract.

During pregnancy, signs of any of the symptoms should prompt a woman to see a doctor.

It is desirable that the treatment was at the initial stage of the disease, until the gonorrhea acquired a chronic form.

Consequences of the disease for pregnant women

First of all, you need to understand how gonorrhea affects pregnancy. It is a fact that pathology can be dangerous for both the mother and the fetus.

The work of a woman's reproductive system and the development of a child inside the womb depends directly on the period of development of the disease.

After giving birth, women infected with gonorrhea may suffer from severe inflammation of the uterus.

Consequences for the child

During pregnancy, gonorrhea can negatively affect the development of the fetus. Infection and the development of the disease in the initial period of pregnancy, as a rule, is accompanied by an inflammatory process of the walls of the uterus. Therefore, a miscarriage is not excluded at this time.

Pregnancy at 8-10 weeks is critical.

Infection in the 2nd and 3rd trimesters of pregnancy, the child is at risk of intrauterine gonococcal sepsis. What provokes tachycardia and fever in the mother. At the same time, the child does not receive enough oxygen and nutrients. The baby is gaining weight slowly.

Most often, a baby is infected at birth. The consequences of gonorrhea during pregnancy for a child can be very serious.

Consequence of gonorrhea in a newborn:

inflammation of the mucous membrane of the eyes;
conjunctiva of the mucous membrane and eyeball;
gonorrhea of the genitals in girls.

Purulent inflammation of the gonococcal flora can lead to complete blindness of the child.

Complications in a child begin to appear after childbirth for 2-3 days. The baby's eyelids swell, and after 24-72 hours there is a discharge of pus from the eyes. In severe cases, this can lead to an eyesore.

Pregnancy after gonorrhea is not an indication for. It is carried out only if the child is severely intoxicated.

Diagnostics

When a diagnosis is made, it is enough to hand over gonorrhea during pregnancy. The analysis is completely safe for mom and fetus. After a mucosal smear is submitted, it is examined under a microscope and sown to determine special nutrient media.

Another method for diagnosing gonorrhea is the polymerase chain reaction method. The method allows detecting infection of gonococci, but does not determine their number. Although in the diagnosis of gonorrhea, their presence in the microflora is sufficient.

In addition, doctors may prescribe certain groups of people for tests to identify gonorrhea.

For a study to identify gonorrhea, the following are sent:

newborn babies, after birth, that have signs of conjunctivitis;
women planning to terminate their pregnancy;
with pregnant women;
with complex diagnostics;
persons who have confirmed sexual contact with partners infected with gonorrhea;
women suffering from pathologies of the genitourinary system.

A pregnant woman is sent by a doctor for research after a conversation based on her complaints and after a gynecological examination.

It is impossible to confirm the diagnosis of gonorrhea only by 1 study:

cultural method or bacteriology - in 95% of cases, the diagnosis is confirmed, but it takes a long time. The analyzes will be ready only in a week;
ELISA test - not performed in all laboratories;
PCR - requires additional verification of the results, as it can give false ones;
microscopy of the urethra, smear and cervical canal is a quick and simple test, but it directly depends on the qualifications of the laboratory assistant. Its efficiency is 65-70%.

Antibacterial therapy

During pregnancy with gonorrhea, a woman is prescribed antibiotic therapy. It can be prescribed at any stage of pregnancy.

The procedure consists in the introduction of drugs of the group of cephalosporins, intramuscularly once.

Re-administration of the drug may be required with rare exceptions.

Multiple clinical trials have proven that drugs in this group are safe for the health of the mother and baby in her womb.

Refusal of therapy with antibacterial drugs leads to irreversible consequences, where termination of pregnancy is not excluded.

Other treatments

When several diseases of the genitourinary system are combined, other drugs of a wider effective spectrum of action are prescribed.

On the 2nd half of the term, antibacterial suppositories can be prescribed. They eliminate the symptoms of the disease and relieve inflammation of the genital tract.

For a period of 16 weeks, immunomodulatory drugs are prescribed. If there is a threat of miscarriage, conservative therapy is prescribed. It aims to reduce.

It is very important that not only the woman, but also her partner should undergo the full course of treatment for gonorrhea in pregnant women. Otherwise, it can be re-infected.

Useful video: how gonorrhea is treated in children and pregnant women

Gonorrhea, at least as the name of one of the most common sexually transmitted diseases, is known to everyone. The people call this disease "French runny nose" or "gonorrhea" (translated from a foreign "tourist"). The latter name was invented by the romantic Dutch, linking gonorrhea with travel and casual romantic relationships. Even the Bible mentions gonorrhea as a source of ritual impurity. Many people do not know how dangerous this disease is and whether it can be treated at all. We will discuss these topics and learn some basic information about gonorrhea, its symptoms and treatment.

Characteristics of gonorrhea

Gonococcal infection, or gonorrhea, is an infectious disease caused by gonococci of the species Neisseria gonorrhoeae. They are gram-negative diplococci, do not move, are bean-shaped and do not form spores.

Epidemiology

Tripper is a very common sexually transmitted infection. About 60 million cases of gonorrhea are reported worldwide each year. In Russia, since the beginning of the 2000s, a decrease in the incidence rate has been noted compared to previous years. In the adult population, this is 24 cases per 100 thousand souls.

It seems that the situation is not critical, especially since gonorrhea is easy to cure. However, there is one big "but". In 2018, a new strain of gonorrhea was discovered in Britain that does not respond to treatment. If such gonorrhea begins to spread everywhere, then the whole world is threatened with a real epidemic.

Infection routes

The main route of transmission of infection is sexual intercourse of all types. Gonorrhea can affect not only the genitals, but also the rectum, as well as the oral cavity. Women have an increased risk of infection due to the structure of their genitals.

Despite the fact that gonorrhea quickly dies in the external environment, the transmission of the disease is carried out not only sexually, but also by contact-household means. In swimming pools, in the subway and in cafes, it is almost impossible to get infected, since outside the carrier, gonococci die very quickly. Infection can occur upon contact with fresh biomaterials of an infected person: sperm, vaginal secretions, saliva. For example, if a family member suffers from oral gonorrhea and shares a towel or toothbrush with his relatives.

Another way to get gonorrhea is to infect a baby during childbirth. For a baby, this is very dangerous, since a fragile body practically does not resist infection.

Stages of the disease

There are several stages of gonorrhea:

Incubation period. Gonococci have just entered the human body and have not yet had time to cause a response. However, an infected person can already infect others. The incubation period for gonorrhea lasts from 12 hours to 10 days (in rare cases, up to 3 months). During this time, the causative agent of the infection spreads through the body through the lymph and can cause inflammation of the more distant organs of the genitourinary system (testicles, prostate, fallopian tubes, etc.).
Fresh gonorrhea. It manifests itself within two months after the incubation period. The fresh form is divided into acute (at this stage, the first clinical signs of gonorrhea appear), subacute (symptoms are present, but not pronounced) and torpid (without clinical manifestations).
Chronic gonorrhea. It is characterized by a latent course of the disease and blurred symptoms. During this time, chronic gonorrhea can invade the urethra and lead to a blockage.

Clinic of the disease

The symptoms of gonorrhea have a characteristic clinical picture. As a rule, with gonorrhea, patients have an increased body temperature and general weakness. The mucous membranes at the site of penetration of the pathogen are very vulnerable and are greatly affected by the gonococcus, which causes a variety of discomfort. It is also worth noting that in the overwhelming majority of cases with gonorrhea there is purulent discharge.

Consider how gonorrhea manifests itself depending on the location of the infection.

Gonorrhea of the lower urinary tract

The infection can cause abscess formation (purulent inflammation) of the urethra (paraurethral) and sperm-producing glands, or pass without it.

Visually, representatives of the stronger sex note the swelling of the opening of the urethra. Otherwise, the gonococcal infection of the lower urinary tract in men goes away with the following symptoms:

purulent discharge from the urethra;
itching and burning in this area both during urination and at rest, as well as pain radiating to the rectum;
frequent urge to urinate;
soreness during intercourse.

Women often do not experience any discomfort at all when infected with gonorrhea, but in 50% of cases they have to suffer from the following symptoms of the disease:

purulent discharge from the urethra and genital tract;
itching and burning in the genital area and discomfort during intercourse;
soreness in the lower abdomen;
swelling of the mucous membranes of the urethra, vagina, cervix, as well as erosion of these surfaces.

With abscess formation of the paraurethral and accessory glands in both women and men, the symptoms are similar to the previous case, but are less pronounced. In addition, hard painful formations the size of a grain can be felt near the glands.

Gonococcal anorectal infection

Due to anal intercourse with an infected partner, gonococcal proctitis may occur. Signs of gonorrhea in the anorectal region in men and women are the same:

itching and burning in the anus with a slight amount of yellowish discharge, there may be an admixture of blood;
hyperemia (overflow of blood vessels) of the anus and skin folds;
pain during bowel movements, constipation.

Gonococcal pharyngitis

Gonorrhea can take a liking to the throat of a person infected after oral intercourse, and then gonococcal pharyngitis occurs. Very often it goes away completely asymptomatic. If gonorrhea in the mouth still makes itself felt, then representatives of both sexes will feel such clinical manifestations of it:

feeling of dry mouth;
pain when swallowing;
hoarseness of voice;
the tonsils are enlarged and covered with a film.

Gonococcal eye infection

Gonococcal conjunctivitis is rare in adults and can be caused by an infection in the eyes with dirty hands with particles of genital secretions. Gonococcal eye infection affects newborns whose mother had gonorrhea during childbirth. Both men and women note the following symptoms with this type of disease:

swelling and hyperemia of the eyelids;
sore eyes;
profuse purulent discharge;
lacrimation and photophobia.

Possible complications

Gonorrhea is a rather serious disease that without treatment can end very unfavorably. Tripper is cunning and loves to metastasize to other organs, which causes complications of the infection:

gonococcal arthritis with unilateral involvement of 1–2 joints with fever, pain and stiffness;
gonorrheal perihepatitis - inflammation of the fibrous membrane of the liver, causing acute pain, and subsequently adhesions in the peritoneum;
myositis - muscle inflammation with the risk of its future atrophy;
gonorrheal meningitis with damage to the nervous system and mental disorders.

Skin lesions

If it enters the bloodstream, gonococci can cause sepsis with concomitant damage to internal organs. This condition can cause a hemorrhagic rash - a hematogenous skin lesion. At first, it is characterized by small spots (up to 2 cm in diameter), then these spots turn into pustules with hemorrhagic contents.

But most often, a rash with gonorrhea after a while forms ulcers with a necrotic center, surrounded by a purple corolla. These spots disappear within 4-5 days, leaving behind scars and pigmentation.

The very lesion of the skin with gonococci is not as scary as the reason for its appearance - gonococcal sepsis. Infection of blood with gonorrhea pathogens can cause diseases of the heart, kidneys and other internal organs, and in severe cases, death.

Diagnostics

If you suspect gonorrhea in the pelvic area, you should consult a urologist or gynecologist. Gonorrhea of the mouth, anus, gonococcal conjunctivitis is a reason to contact specialized specialists: an ENT specialist, a proctologist and an ophthalmologist. Doctors must confirm the diagnosis in order to refer the infected person to a dermatovenerologist for consultation.

Biomaterial serving as a subject for research is:

scraping from the urethra, rectum;
discharge from the oropharynx, eyes;
the first portion of urine collected no earlier than three hours after the last urination;
for women - a smear from the vagina, cervical canal;
for men - the secret of the prostate gland.

All test materials for gonorrhea should be sent to the laboratory as soon as possible in compliance with the transportation rules. If more than three hours have passed from the date of the analysis to laboratory research, then the result may be doubtful.

Laboratory diagnosis of gonorrhea is reduced to the following research methods:

microscopic examination with staining the biomaterial with a 1% solution of methylene blue - gonococci become clearly visible under a microscope;
culture research using selective nutrient media - identifies the pathogen and determines its sensitivity to certain antibiotics;
molecular biological tests (PCR) - allow you to find the smallest particles of bacteria in the blood and establish a diagnosis.

Additional methods that clarify the stage of gonorrhea, as well as allow to determine concomitant diseases, include instrumental diagnostics. These are ureteroscopy, colposcopy, anoscopy, ultrasound and diagnostic laparoscopy.

Treatment of various forms of gonorrhea

The question of how to treat gonorrhea can be answered unequivocally - with antibiotics. Most often, treatment is prescribed after determining the sensitivity of the pathogen to antibiotics, but it will take a long time to wait for the result - about two weeks. Therefore, sometimes, in the case of a neglected process and obvious suffering of the patient, antibiotics for gonorrhea are prescribed immediately.

Treatment for different forms of gonorrhea involves different regimens. Infection of the genitourinary system without abscess formation of the paraurethral and accessory glands will respond to drugs such as ceftriaxone 500 mg intramuscularly as a single dose or cefixime 400 mg orally as a single dose. Abscess formation significantly complicates treatment. Complicated gonorrhea lends itself to the following scheme: ceftriaxone 1 g intramuscularly or intravenously every two days for two weeks; cefixime 400 mg orally 2 times a day for the next two weeks. Anorectal gonorrhea and other forms of gonorrhea other than ocular gonorrhea are recommended to be treated in the same way.

An eye infection can be defeated fairly quickly. Ceftriaxone 500 mg intramuscularly once a day for three days will help to cure gonococcal conjunctivitis.

If the infection does not respond well to treatment, then it is recommended to undergo physiotherapy courses, as well as observe the daily regimen and a moderate diet.

Gonorrhea and pregnancy

Each pregnant woman takes an analysis for gonorrhea at least three times: upon registration, at 27–30 weeks and at 37–40 weeks of pregnancy. Such close monitoring is done for a reason. Gonorrhea is dangerous for the baby and requires special treatment during pregnancy.

Features of the disease

If a pregnant woman contracted gonorrhea before conception, then in most cases the symptoms of the disease will be very scarce, since the infection quickly becomes chronic. Therefore, it is so important to recognize the disease in time and carry out appropriate treatment, despite the absence of complaints.

Infection during pregnancy manifests itself quite clearly against the background of an unstable hormonal status. The discharge is profuse, itching and hyperemia are obvious. In this case, it is also important to confirm the diagnosis and quickly select a drug in order to prevent the influence of gonococci on the fetus.

Diagnostics and treatment

To diagnose such a dangerous disease during pregnancy as gonorrhea, two methods are most often used: bacterioscopic and cultural. The second method is great for identifying chronic, sluggish gonorrhea.

If there is a suspicion of gonorrhea, but there are no gonococci in the smear, a so-called provocation can be prescribed for a pregnant woman: chemical or biological. In the first case, the urethra, cervical canal and rectum are lubricated with a solution of Lugol with glycerin or silver nitrate. After that, after 24 hours, a smear is taken, in which gonococci should appear if the woman is infected. With the biological method of provocation, a gonovaccine is injected intramuscularly with a certain number of gonococci. It will provoke an infection already present in the body to come out of the hidden corners to be detected in a smear. If a woman is healthy, then she will not be able to get infected from such a meager dose of pathogens.

If gonorrhea is found in a pregnant woman, treatment should be carried out immediately, regardless of the period. The drugs are prescribed with the participation of obstetricians and gynecologists. Typical treatment regimen: ceftriaxone 500 mg intramuscularly as a single dose or cefixime 400 mg orally as a single dose.

Consequences for the fetus

Gonorrhea of the genitourinary tract is especially dangerous in the first three months of pregnancy, since the entrance to the uterus is not yet blocked by the fetal bladder and is the gateway for infection. Therefore, in the first trimester, gonorrhea can cause miscarriage or future premature birth.

If gonorrhea is not cured before childbirth, then the danger of infection is already in the newborn baby. Potential consequences: gonococcal conjunctivitis, gonococcal arthritis, and even sepsis.

Disease prevention

It is important to understand the symptoms of gonorrhea and how the infection is treated. But it is even more important to know how to prevent illness.

Prevention of gonorrhea consists in using a barrier method of contraception during sex with a casual partner. Only a condom can prevent gonococci from entering the body. The use of local antiseptics after intercourse will not save you from gonorrhea.

In order to prevent gonococcal conjunctivitis, all newborns are lubricated with an antiseptic ointment, for example, tetracycline.

EPIDEMIOLOGY

ETIOLOGY (CAUSES) GONORRHEA

PATHOGENESIS

Pathogenesis of complications of gestation

CLINICAL PICTURE (SYMPTOMS) OF GONORRHEA IN PREGNANT WOMEN

DIAGNOSTICS OF GORRHEA DURING PREGNANCY

ANAMNESIS

PHYSICAL STUDY

LABORATORY RESEARCH

SCREENING

DIFFERENTIAL DIAGNOSTICS

EXAMPLE FORMULATING A DIAGNOSIS

TREATMENT OF GORRHEA DURING PREGNANCY

OBJECTIVES OF TREATMENT

INDICATIONS FOR HOSPITALIZATION

NON-MEDICINAL TREATMENT

MEDICINAL TREATMENT OF GONORRHEA IN PREGNANT WOMEN

ASSESSMENT OF TREATMENT EFFICIENCY

FURTHER INTRODUCTION

PREVENTION OF GORRHEA IN PREGNANCY

PATIENT INFORMATION

FORECAST

Causes

Symptoms

Consequences of the disease for pregnant women

Consequences for the child

Diagnostics

Antibacterial therapy

Other treatments

Useful video: how gonorrhea is treated in children and pregnant women

Characteristics of gonorrhea

Epidemiology

Infection routes

Stages of the disease

Clinic of the disease

Possible complications

Skin lesions

Diagnostics

Treatment of various forms of gonorrhea

Gonorrhea and pregnancy

Features of the disease

Diagnostics and treatment

Consequences for the fetus

Disease prevention

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