Provocations for gonorrhea - methods and techniques for examining patients with skin and venereal diseases. Methods for provoking gonorrhea Taking swabs after combined provocation

The modern laboratory service has many options for diagnosing gonorrhea. However, methods of provocation continue to be in demand. In fact, this is a group of different ways to exacerbate the disease, to make gonococci leave the cysts and the accumulations formed by them in the submucous layer of the affected genital organs, to become more noticeable.

It is sometimes necessary to carry out a provocation as at the start of the treatment of gonorrhea for an accurate diagnosis of chronic gonorrhea. So after the completion of the course of therapy, to control the recovery. To whom, when and by what methods - we will consider below.

Biological mechanisms of the procedure

The pathogens, Neisseria gonorrhoeae, thrive on the mucous membranes of the genital tract. They live well in the internal genital organs, they are able to take root on the conjunctiva of the eyes and the lining of the ENT organs. In all these places, microorganisms penetrate into the submucosal layer within 8-10 weeks from the moment of infection. And they form there clusters limited by the fibrous capsule.

Standard research methods, smear and culture, for chronic gonorrhea, are often mistaken due to the fact that gonococci migrate into the submucosal layer. Also, immune cells and drugs to treat infection are poorly penetrated there. Therefore, even if the surface of the mucous membranes can be cleared of gonococci, they remain in such lacunae and cause relapses. In addition, microbes often form cysts, close from external influences "until better times."

To force Neisseria to get out of there, to provoke an exacerbation while the patient is under the control of doctors is the main task of the procedure for gonorrhea. This can be done in two ways. Allow pathogens to exacerbate or vice versa- activate immunity, make it react to foreign agents in the submucosal layer.

Indications for the procedure for provoking gonorrhea

• diagnosis of chronic gonorrhea in the presence of signs of inflammation in the analyzes of smears from the urethra or genital tract (4 leukocytes or more in one field of view at a magnification of 1000 times);
• confirmation of complete recovery from gonorrhea;
• clarification of the diagnosis from a partner, if a person infected with gonococci is found in a pair;
• getting an idea of ​​the prevalence of infection.

Thanks to the provocation, it is possible to achieve an important result: to increase the activity and the number of gonococci on the surface of the mucous membranes. This increases the diagnostic value of smear and culture. The likelihood of false negative tests at the stage of diagnosing chronic gonorrhea and confirming recovery during control studies is reduced.

What approaches are used to provoke gonorrhea

Provocation has to be used by men, women in a "normal" state and during pregnancy, children. Therefore, the approach to the choice of the method of exacerbation of gonorrhea must be done very responsibly.

For this purpose, several groups of techniques are used:

• Chemical... They are applied topically, act due to local irritation of the mucous membranes, as a result of which the submucous foci are exposed, destroyed and gonococci come out to the surface of the mucous membranes.
• Mechanical or physical. They are also applied topically and achieve the same effect: the causative agents of gonorrhea emerge from the buried accumulations, but under the influence of physical, locally applied influence.
• Biological. The introduction of special substances (we will consider below which ones) stimulates the immune system, if possible, specifically against gonococci. The body begins to recognize and find them, there is inflammation, exacerbation.
• Alimentary... They act on the opposite principle - slightly weaken the immune system so that the gonococci are activated, the cysts are shed and chronic gonorrhea worsened.
• Thermal. Similar to physical, but heating is used as a provoking factor.
• Physiological. It is believed that during certain periods of life, the human body is more open to gonorrhea and pathogens are more active, they can be detected.

It is necessary to take into account the prescription of chronic gonorrhea, the estimated prevalence and localization of hidden foci, the age and state of human health.

Chemical methods of provoking gonorrhea

They are used in the examination of patients with suspected gonorrheal urethritis and cervicitis.

The following are used as a working preparation:

• lapis (silver nitrate) in different concentrations;
• Lugol's solution.

In men, with gonorrhea, the urethra is most often affected. Several milliliters of 0.5% silver nitrate solution are poured into the urethra.

For provocation in women, typical foci of gonorrhea are treated - the urethra with instillation of 1-2% lapis, the cervical canal with 2-5% silver nitrate solution.

The procedure is well studied and performed in a chair.

The provocation with Lugol's solution on glycerin is mainly offered to women. Also, taking into account the sexual characteristics of the course of the infection, patients are given 1% silver nitrate (less often) into the anus to a depth of 4-5 cm to provoke rectal gonorrhea.

Mechanical methods of provoking gonorrhea

They are also called physical methods of provocation are used exclusively for urethral localization of infection.

For male patients, a hard metal rod (bougie) of a suitable diameter is inserted into the urethra to a depth of 4-8 cm. There he stays for up to 10 minutes. In the case of long-standing, chronic gonorrhea with pronounced cicatricial changes in the urethra, the doctor combines bougienage with massage. The bougie is put on 4-5 cm and strokes the urethra with light movements from the pubis to the head. Another way of physically provoking gonorrhea is the anterior ureteroscopy procedure.

Physical provocation requires good skills and experience, as there is a risk of injury to the urethra.

Women wear a Kafka neck cap for a day. But this method is rarely used due to the sufficient number of alternative techniques.

It should be noted that sex has nothing to do with provocation. On the contrary, it provokes injury to the mucous membranes and the spread of gonococci to other parts of the reproductive system. Therefore, intimacy should be abandoned until complete recovery from gonorrhea.

Biological methods of provoking gonorrhea

There are three options for the procedure:

• introduction of gonovaccine;
• autohemotherapy;
• the introduction of pyrogenal and other drugs.

Gonovaccine is a gonococcus killed by high fever.

The drug adjusts the immune system to act more aggressively against gonococci. Microbes emerge from cysts and clumps in the submucosal layer. The drug is administered intramuscularly on an outpatient basis (in a dose of 0.5 ml, which corresponds to 500 million microbial bodies). Or in a hospital setting, under the mucous membrane of the urethra and / or cervical canal in a five-fold lower dosage (0.1 ml, about 100 million microbial bodies). As a rule, once. If the gonovaccine was used in the treatment regimen for chronic gonorrhea, the doctor doubles the dose of the last injection. Or he prescribes a double provocation, but not more than 2 ml (2 billion microbial bodies).

Other methods in this category force the immune system to kind of start a big purge of everything foreign. Autohemprovocation is practiced - intramuscular injection of 5 ml of freshly collected venous blood of the patient himself. Sometimes pyrogenal, a drug that stimulates high temperature, is injected at a dose of 25 μg (200 MTD).

Sinestrol, prodigiosan, a mixture of sulfur and peach oil are used for the same purpose. The effect is the same: gonococci enter the mucous membranes, the likelihood of their getting into the diagnostic material with a smear increases significantly.

Alimentary methods provocation of gonorrhea

This includes the alcohol provocation method so popular among men: it is recommended to drink up to 1 liter of beer in the evening. An alternative is the intake of irritating food - salty, smoked, spicy.

Alcohol reduces immunity, plus it and extractives, excreted in the urine, have a slight irritating effect on the mucous membrane of the urethra.

In some cases, this is enough to provoke gonococci to shed cysts.

Thermal provocation of gonorrhea

Also a variant of physical provocation, when several sessions of inductothermal current are applied to the alleged area of ​​the lesion.

Physiological method provocation of gonorrhea

Biological material taken from the genitals of girls and women during menstruation is the most informative in relation to gonorrhea. Recommended be examined on the 2-3 day of menstruation.

The most effective method provocation of gonorrhea

To achieve maximum efficiency from provocation, apply combined approach: combination of two or three methods in one patient at once. For example, immediately after the introduction of the gonovaccine, massage the man's urethra on the buge. And for women - to give an injection on the first day of menstruation. In any case, it is desirable to have a gonovaccine as one of the components.

In response to its management, gonorrhea is exacerbated in all foci of infection. Extragenital lesions can be noticed by the appearance of discharge from the eyes, signs of pharyngitis or proctitis. In parallel, regional lymph nodes increase - inguinal, submandibular, cervical. Such phenomena allow the doctor to better orient himself in the prevalence of the process. And collect diagnostic material from all affected parts: eyes, mouth, anus.

And not only to be limited to the study of a smear from the urethra and sperm analysis in men.

As for women, they recommend doing all the provocations against the background of menstruation. Caution is needed in relation to pregnant women: the gonovaccine is administered to them only in the third trimester and only according to indications. Until this moment, they are limited to the use of chemical techniques in combination with autohemotherapy.

The gonovaccine is not contraindicated for children, only the doctor chooses the dosage suitable for the age. Local methods for boys and men are identical. For girls and girls, silver nitrate is inserted into the vagina with a catheter, the material is taken from the posterior commissure of the vulva, and the lapis is instilled into the urethra with an eye pipette.

Laboratory monitoring of gonorrhea provocation

Control examinations are carried out no earlier than 7-10 days after the last dose of antibiotics. Men first do a smear and urethra, microscopy and culture for gonococcus sperm, prostate juice.

This is followed by a provocation and the examinations are repeated on the second, third and fourth days. If all tests are negative, then the patient is invited to come back in a month for a final examination. After this negative test, the man is considered recovered.

For women, three examinations are performed to confirm recovery from gonorrhea:

• 10 days after the last intake of antibiotics, a gonovaccine is administered or another method is used, the material is taken for microscopy, sowing from the genital tract and anus on the day of provocation, after a day and after 48 hours;
• in the first menstruation after the end of the course, with an interval of 24 hours, a smear is taken from the vagina and rectum three times;
• at the end of menstruation, another provocation is carried out and again the material is taken three times daily.

The first two samples are microscoped, and the sample taken on the third day is also sown.

It must be borne in mind that each method of provocation can lead to complications and the development of side effects. To high fever, burns and mucosal injuries, the spread of infection and others. Therefore, the method of provocation should be selected individually, carried out by a specialist under the control of side effects. It is critically important that this is an experienced dermatovenerologist who is well acquainted with the characteristics of the patient's disease.

If you need to provoke gonorrhea, contact the author of this article - a venereologist in Moscow with many years of experience.

At diagnosis of acute gonorrhea gonorrhea disease is not difficult.

Particular difficulties are latent and chronic forms.

The diagnosis is established on the basis of an anamnesis of objective research, bacterioscopic, bacteriological and serological studies.
Important is anamnesis:

a) casual sexual intercourse, cramps during urination, the appearance of leucorrhoea of ​​a mucopurulent nature, causing irritation in the external genital area, leaving dark green and green spots on the linen, etc.;

b) menstrual irregularities with frequent exacerbations of the inflammatory process in the uterine appendages;

c) the development of a bilateral inflammatory process in the uterine appendages after menstruation, abortion and childbirth, secondary infertility; d) the presence in the past or present of gonorrhea in the husband.
For diagnosing gonorrhea first of all it is necessary to conduct bacterioscopic examination of secretions from all places where the localization of the gonococcus is possible (roundabout urethra, urethra, vagina, cervical canal, rectum).

Of particular importance for the determination of gonococcus is the method of taking a smear. It should be taken not with a loop, but with a blunt spoon or a grooved probe.
If the bacterioscopic examination of smears has not yielded convincing results, you should resort to sowing secretions... In a number of cases, when it was not possible to detect a gonococcus bacterioscopically, cultures on certain media give the growth of a gonococcus.

If gonococcus cannot be detected, it matters the nature of the shaped elements in the strokes... The most characteristic companions of gonococcus are neutrophilic leukocytes. Based on the study of the bacterioscopic and cytological picture of smears from the urethra and the cervical canal in inflammatory diseases of the female genital organs, in particular in gonorrhea, G.A. Baksht suggested the following differential diagnostic scheme.

• Scene 1 (K1) - an abundance of segmental-nuclear leukocytes, a small number of "dying" leukocytes that have lost the membrane and part of the cytoplasm, but retained the nucleus and segmental structure; gonococci in greater or lesser numbers, other flora is absent (typical for acute gonorrhea).
• Picture 2 (K2) - the same cytological picture, but without the presence of gonococci. The picture is suspicious for its purity, that is, the absence of flora, which, obviously, is supplanted by an undetected, but participating in the process, gonococcus. Picture 2 is typical for the latent form of gonorrhea and requires re-examination. Often, under the influence of various aggravating moments, K2 can turn into K1.
• Picture 3 (K3) - characterized by a variety of coccal and rod flora in the presence of single leukocytes. If K1 and K2 are replaced by K3, it can be considered that a turning point has occurred in the course of the disease and recovery begins.

If, with the help of laboratory studies, gonococcus is not detected, but there is a suspicion of latent gonorrhea, it is necessary to draw a series provocations in order to artificially exacerbate inflammation, cause exudation, which would facilitate the release of gonococci to the surface of the mucous membranes.

• Physiological provocation is menstruation. Therefore, smears should be taken on premenstrual days, when hyperemia and loosening of tissues contribute to increased extravasation and leaching of gonococci to the surface of the mucous membrane (take swabs daily).
• Alimentary provocation- the use of acute, irritating to the mucous membrane of food substances (beer, herring, etc.).
• Mechanical provocation- massage of the urethra, imposing a Kafka cap on the cervix for 24 hours, followed by taking smears from the cervix.
• Chemical provocation- lubrication of the cervical canal with 25% Lugol's solution, 5% Protargol's solution or 1% silver nitrate solution.
• Biological provocation- subcutaneous administration of a polyvalent gonococcal vaccine (500 million microbial bodies). In the presence of a gonorrheal focus, after the administration of the gonovaccine, a focal reaction occurs, that is, hyperemia appears, the secretion of glands and inflammation in the lesion focus increase. At gonorrhea of ​​the cervix regional Bucourt vaccination(introduction of gonovaccine into the thickness of the cervix), according to Burlakov(introduction of gonovaccine into the mucous membrane of the cervix) (carried out only in a hospital). In order to provoke hidden gonorrheal foci, it is also recommended to introduce foreign proteins, most often whole milk (lactotherapy), starting from 2 ml, each subsequent dose is increased by 2 ml, gradually brought to 10 ml. Injections are made in 2-3 days. Most often, autohemotherapy is prescribed.
• Thermal provocation - hot douching, baths, diathermy (vaginal), inductothermy, mud tampons, paraffin, ozokerite for three days. In 2 hours after each session, discharge from the cervical canal is taken for bacteriological examination.

In doubtful cases, the provocation method undoubtedly contributes to the identification of gonococci.

Often after provocation with gonovaccine appears triad of symptoms:

• a positive reaction to the introduction of the vaccine (general, local and focal);
• K2 in smears;
• a combination of increased ESR with a normal number of leukocytes.

All this makes it possible to diagnose gonorrhea with a high probability. This triad is so convincing that it can serve as the basis for specific therapy.

In some cases, several methods of provocation are combined. Absence of gonococci after three provocations in patients with clinical signs of gonorrhea indicates the need bacteriological research - sowing of secretions on nutrient media (human serum, ascitic fluid) to obtain pure cultures of gonococcus. The bacteriological diagnostic method is the most accurate and conclusive.

Bordet-Zhangu reaction and reaction to gonococcal antigen (Lisovskaya-Feigel) can be used only as auxiliary methods for diagnosing gonorrhea, since the first of them in patients with acute uncomplicated gonorrhea can be negative and remain positive for a long time (1-2 years) in persons who have had gonorrhea after clinical recovery. The reaction to the gonococcal antigen can also remain positive for 3-4 months after the persistent disappearance of gonococci in the study. Along with this, this reaction can be positive in the absence of gonorrheal infection and negative in the presence of gonococci in the discharge from the cervix.

In the diagnosis of gonorrhea have some value blood changes(eosinophilia - 4.5-12%, lymphocytosis with moderate leukocytosis, a significant increase in ESR).

With gonorrhea, persistent immunity is not formed, and therefore reinfection is possible. Gonococcus gets along well with Trichomonas and a fungus of the Candida species, competes with streptococcus and staphylococcus. Pregnancy does not prevent infection with gonorrhea, especially in the early stages; moreover, it is often a provoking factor for gonorrhea.

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The disease affects the genitourinary system, selectively affects the cylindrical epithelium, and therefore can cause the following diseases: inflammation of the urethra, Bartholin's gland, cervical canal, uterus, uterine appendages and pelvic peritoneum.

Most of the infection occurs through sexual contact.

But a non-sexual route of infection is possible through linen, sponges, towels. Infection of newborns is possible during passage through the birth canal of a mother with gonorrhea. There is no persistent immunity, so you can get sick many times. The incubation period can last 2-7 days.

Classification of gonorrhea

Distinguish gonorrhea:

Acute - disease up to 2 months,
- chronic.

Acute gonorrhea is characterized by an acute onset, a clinic of urethritis, endocervicitis, bartholinitis, etc. A woman is worried about itching in the urethra, pain at the beginning of urination and increased urge to urinate. Sometimes patients complain of vaginal discharge, rarely - pulling pains in the lower abdomen.

Sometimes there are forms of gonorrhea that are not associated with the genitals: gonorrhea of ​​the rectum, gonococcal damage to the oral cavity, pharynx, larynx, eyes, kidneys, gonococcal arthritis, endocarditis, etc. Damage to the mouth, pharynx, larynx is most often the result of oral sex and usually combined with gonorrhea of ​​the genitourinary system.

With gonococcal stomatitis clinical manifestations occur 2 days after infection. Patients begin to be bothered by dry mouth, burning lips and tongue, later - increased saliva secretion, containing mucopurulent impurities, sometimes bad breath. The mucous membrane of the oral cavity is painful; if the pharynx is affected, complaints of painful swallowing appear.

With gonorrhea of ​​the rectum, the infection of which often occurs during anal intercourse, women experience painful bowel movements, pain and itching in the anal region, purulent-bloody discharge from the anus.

Chronic gonorrhea is a sluggish disease lasting more than 2 months. Fresh torpid gonorrhea is a low-symptom disease, its manifestations are insignificant or absent.

With fresh gonorrhea, gonococcus can be detected in smears.

Fresh gonorrhea, in turn, is subdivided into:

Sharp
- subacute,
- torpid.

Features of the course of gonorrhea

Currently, a number of features of the course of gonorrhea are noted, namely, an increase in the frequency of low-symptomatic or asymptomatic gonorrhea. Women with torpid or asymptomatic gonorrhea usually continue their sex life unaware of their illness and spread the infection. In the smears, the presence of gonococci is determined.

Gonorrhea often proceeds as a mixed infection, combined with trichomoniasis, chlamydia, mycoplasmosis, etc.

According to the localization of the process, they are distinguished:

Gonorrhea of ​​the lower part of the genitourinary apparatus: includes gonorrhea of ​​the urethra, paraurethral passages, large glands of the vestibule of the vagina, cervix;
- gonorrhea of ​​the upper genital apparatus - ascending: gonorrhea of ​​the body of the uterus, tubes, ovaries and peritoneum.

Gonorrheal urethritis- This is acute urethritis, one of the most common manifestations of gonorrhea. However, in women, it manifests itself with little symptoms due to the wide and short urethra: minor pain and burning sensation during urination. With chronic urethritis, there are even fewer complaints, sometimes there is frequent urination.

Gonorrheal endocervicitis- in the acute stage, dull pains in the lower abdomen and mucous or purulent discharge from the vagina are worried.

Gonorrheal bartholinitis- less often it becomes infected with gonococcus, when the excretory duct is infected, the outflow from the gland can be disturbed and a false or sometimes true abscess is formed. In this case, the gland increases in size, is sharply painful, and the temperature may rise.

Gonorrheal vulvitis it happens in adult women secondary, which is associated with irritation of the mucous membrane of the vestibule with the resulting discharge and can be manifested by itching, burning in the vulva.

Gonorrheal proctitis most often develops secondarily due to leakage from the vagina or urethra into the rectum, or due to anal sex. Gonococcus affects not only the rectal mucosa, but also the deeper layers of the rectal wall, leading to infiltrates and abscesses. Patients are worried about pain and burning in the anus, painful urge to defecate.

It is necessary to take swabs from the urethra and cervical canal to confirm the diagnosis. The absence of gonococcus in smears does not confirm the absence of the disease; various methods of provocation are used to detect gonorrhea.

Ascending gonorrhea it is customary to call the inflammation of the internal genital organs located above the internal pharynx of the uterus (the body of the uterus, fallopian tubes, ovaries, pelvic peritoneum). The spread of infection is facilitated by menstruation, especially if hygiene rules are not followed (for example, sexual activity during menstruation), postpartum and post-abortion periods, intrauterine manipulations with unrecognized gonorrhea of ​​the lower genitourinary system, as well as weakening of the body's defenses as a result of hypothermia, physical overstrain, etc.

Gonorrheal endometritis occurs as a result of the ingress of gonococci into the uterine cavity; if infection occurs during menstruation, then the gonococci immediately enter the basal layer of the mucous membrane. The disease begins with chills, fever, malaise, sharp pain in the lower abdomen and purulent discharge from the uterus. Symptoms of intoxication are often present - dry tongue, rapid pulse.

After 3-4 months, inflammatory changes in the endometrium disappear, and endometritis becomes chronic with damage to the muscles of the uterus. This is usually manifested by constant pain in the lower abdomen, profuse watery or mucopurulent discharge, painful periods, various menstrual irregularities.

Gonorrheal inflammation of the appendages is obtained as a result of the passage of infection through the tubes to the ovaries. With inflammation of the pipe, purulent contents appear in its lumen, the pipe is sealed, its patency is disturbed, it takes the form of a retort - pyosalpinx, saktosalpinx.

Pathogens, getting into the follicle, contribute to the formation of an abscess, which sometimes spreads to the entire ovary. The outcome may be recovery, but more often the tube and ovary turn into saccular formations, which, under unfavorable conditions, can burst, leading to inflammation of the peritoneum.

Gonorrheal pelveoperitonitis occurs as a result of a gonococcus hitting the peritoneum. It runs very violently: high body temperature, chills, lower abdominal pain, stool retention, flatulence, difficulty urinating.

The acute period lasts about a week, and then becomes chronic, which continues for another 3-6 weeks.

Provocation with gonorrhea

There is an artificial exacerbation of the inflammatory process in order to detect gonococci - a provocation with gonorrhea.

Physiological provocation is the taking of smears for bacteriological examination on the days of menstruation, after childbirth and after abortion. Increased secretion during provocation promotes the "washing out" of gonococci from the depths of the glandular passages and increases the frequency of finding them in smears. Artificial provocation of the inflammatory process is achieved by biological, thermal and chemical provocation.

Biological provocation consists in a single intramuscular injection of a gonovaccine (500 million microbial bodies).

Thermal provocation is carried out using inductothermy with a vaginal electrode or 4-5 mud vaginal tampons.

Chemical provocation consists in treating the mucous membranes of the urethra, rectum with a 1% solution, and the cervical canal with a 5% solution of silver nitrate or Lugol's solution on glycerin.

After applying these methods, smears are taken after 24.48 and 72 hours.

S. Trofimov

Chemical lubrication of the urethra to a depth of 1-2 cm with 1 - 2% silver nitrate solution, the lower rectum to a depth of 4 cm with 1% Lugol's solution in glycerin and the cervical canal to a depth of 1 - 1.5 cm 2-5 % Silver nitrate solution.

Biological provocation - a gonovaccine is administered intramuscularly with 500 million microbial bodies (bw) or a gonovaccine simultaneously with pyrogenal (200 μg). If the gonovaccine was used during treatment, then the last therapeutic dose is prescribed for provocation, but not more than 2 billion MT. In a hospital setting, the gonovaccine can be administered regionally - into the submucous layer of the cervix and urethra (100 million bw).

Thermal provocation - diathermy is carried out daily for 3 days in succession for 30, 40, 50 minutes or inductothermy for 3 days for 15-20 minutes. Detachable for laboratory examination is taken every day 1 hour after warming up.

The physiological provocation is menstruation (on the days of the greatest bleeding, smears are taken).

Combined provocations are the best. Most often, chemical, biological and thermal provocations are carried out in one day. Smears of the discharge from all lesions are taken after 24, 48 and 72 hours, cultures - after 72 hours. The diagnosis of gonorrhea is made only after the detection of gonococci.

Vulvovestibulitis- gonorrhea of ​​the lower parts of the genitourinary system. The vulvovestibular region is rarely involved in the inflammatory process, since it is mainly covered with stratified squamous epithelium. Gonorrheal vulvitis and vestibulitis are diagnosed in pregnant and infantile women, in whom the integumentary epithelium is juicy and loosened or tender, like in girls, as well as in menopause, when the epithelium is also thinned.

Clinically, vulvitis and vestibulitis in the acute stage are manifested by diffuse hyperemia, edema of the mucous membrane and discharge from the crypts of yellowish-whitish pus, which, drying out, forms crusts, under which there may be ulcerations. Small lips swell and stick together.

Urethritis (Urethritis). In patients in 80-96% of cases, the urethra is affected. The female urethra is short (3.5 - 4 cm) and wide (1.5 times wider than the male). The glandular apparatus is located mainly in the anterior section on the anterolateral walls. Urethritis is essentially a disease not so much of the urethra itself as of its glands. The duration of the disease depends on the nature of the branching of the glands and the depth of their occurrence.

In acute gonorrheal urethritis, the most common complaints are pain and burning during urination. However, after a few days, these phenomena become much less. In chronic urethritis, complaints are usually absent. Clinically, there is hyperemia and swelling of the urethral sponges, which rise in the form of a roller, the urethra itself is infiltrated, its palpation is painful. When pressed on it from the side of the vagina, a yellowish discharge containing gonococci flows out.

Paraurethritis (Paraurethritis). Gonorrheal inflammation of the paraurethral passages occurs both initially (simultaneously with urethritis) and secondarily as a result of infection by discharge flowing down from above. According to different authors, the frequency of paraurethritis in patients with gonorrhea ranges from 20 to 55%.

Paraurethritis is usually asymptomatic. Gonococci most often nest and multiply at the bottom of the paraurethral passage, because it is covered with columnar epithelium, and the walls are covered with stratified squamous epithelium. The external opening of the paraurethral tract is located extra- or intraurethral in the form of a point. A hyperemic spot appears around this point. When pressed from the side of the vagina, purulent discharge is shown from the orifice of the duct. When the mouth is closed with purulent discharge and peeling epithelium, a false abscess the size of a cherry is formed. Periodically, it can empty and recur, remaining a constant focus of infection.

Bartholinitis- inflammation of the large vestibular glands, often occurs secondarily, after 2 to 3 weeks from the moment of infection, but it can also be primary. It occurs in 8-50% of patients with gonorrhea. As a rule, only the excretory duct is affected, and the gland itself is involved in the process after the penetration of the secondary bacterial flora into it. There are six forms of gonorrheal lesions of the large vestibular glands.

1. Superficial canaliculitis develops as a result of penetration into the gland of pus flowing from the urethra and cervix to the vulva. With superficial canaliculitis, the peripheral part of the excretory duct of the gland is affected. The inflamed orifices of the excretory ducts of the gland protrude above the surface of the mucous membrane of the vestibule in the form of red spots. 2. Canaliculitis, or canalicular bartholinitis, affects the entire excretory duct of the gland. The duct thickens due to periglandular small-cell infiltration and is felt as an elongated strand or nodule ranging in size from a millet grain to a pea, painful on palpation

3. Bartholinitis nodosa occurs in patients with chronic gonorrhea as a result of partial replacement of the infiltrate with dense connective tissue. At the site of the gland and its duct, a dense, usually painless, bean-sized knot is felt.

4. A pseudo-abscess, or pseudo-abscess, occurs after blockage of the mouth of the excretory duct and the accumulation of purulent secretions behind the mouth. The excretory duct stretches and compresses, but does not destroy the gland. On palpation, a painful, mobile, fluid fluctuating tumor with liquid contents is determined, located in the lower third of the labia majora, protruding from the genital fissure in the form of a round, tight-elastic formation ranging in size from a cherry to a goose egg.

5. A true abscess develops if pyogenic microorganisms join the gonococci, that is, a mixed infection appears. Purulent melting of the gland itself and the surrounding connective tissue occurs. Hyperemia, edema, severe soreness of the labia minora and majora are noted, and the inguinal lymph nodes are enlarged. The general condition worsens: there is a high body temperature, weakness, patients cannot walk. When the abscess softens, the pus erupts outward, just like a pseudo-abscess.

6. The cyst of the excretory duct is formed as a result of obliteration of the outer part of the excretory duct of the Bartholin gland, when the infection has already disappeared. The excretory duct is stretched by the secretion of the gland. Part of the small, and often large, labia protrudes, according to the localization of the affected Bartholin gland. The tumor is round in shape, painless, tight-elastic consistency, fluctuating, in size from a pea to an egg.

Vaginitis (Vaginitis). True gonorrheal vaginitis develops in pregnant women, in women during menopause (with an alkaline reaction of the environment and with thinning of the vaginal epithelium) and in girls in whom the epithelium is very loose and does not contain glycogen, and the reaction of the vaginal contents is slightly alkaline.

Complaints of profuse discharge, itching and burning in the external genital area. When viewed with a speculum, the vaginal walls are hyperemic or cyanotic.

Endocervicitis (Endocervititis). Inflammation of the cervix usually occurs primarily. The incidence of damage to the cervical canal ranges from 85 to 89% in acute gonorrhea and from 94 to 98% in chronic gonorrhea. With a fresh process, the vaginal part of the cervix is ​​edematous, hyperemic. From the external os of the cervix, drainage in the form of a tape of mucopurulent discharge. Around the pharynx, a bright red superficial erosion (false erosion) is observed, which is then covered with a cylindrical epithelium growing from the cervical canal.

Endomyometritis (Endomyomethritis)... When the inflammatory process from the endometrium spreads to the muscular layer of the uterus, endomyometritis occurs. Symptoms of acute endomyometritis are the same as endometritis, but are more pronounced. Violations of the general condition are more severe: chills, nausea, vomiting, rapid pulse, high body temperature. Menses irregular and profuse. The uterus is evenly enlarged and painful. In chronic endomyometritis, there is a feeling of heaviness in the lower abdomen, soreness in the lumbar region and sacrum. As a result of the proliferation of connective tissue, the uterus is strongly compacted.

Salpingoophoritis (Salpingoophoritis). For ascending gonorrhea, a characteristic feature is the rapid spread of infection from the uterus to the fallopian tubes, ovaries, and peritoneum. Signs of inflammation of these organs closely merge with each other, so it is difficult to distinguish a picture of salpingitis and oophoritis. Gonorrheal oophoritis (inflammation of the ovaries) occurs after salpingitis (inflammation of the fallopian tubes), so salpingo-oophoritis is usually observed in clinical practice.

In the acute stage of the disease, usually with purulent salpingo-oophoritis, the general condition worsens: there is a high body temperature, rapid pulse, loss of appetite, nausea, vomiting. Tongue dry, coated. In the blood, the number of leukocytes increases, the ESR rises (up to 40-60 mm / h).

Peritonitis (Peritonitis). Spreading along the mucous membrane, gonococci, along with purulent contents through the ampullar end, enter the pelvic peritoneum. Distinguish between pelvioperitonitis, which is one of the forms of local peritonitis, and inflammation of the peritoneum outside the small pelvis - the lower and upper floors of the abdominal cavity, corresponding to widespread peritonitis.

The diagnosis of the presence of any infectious STD is always preceded by a number of medical procedures, the most important of which is laboratory tests. They allow not only to identify the pathogen and determine its type, but also to choose the optimal course of treatment and drugs to which the pathogen has no resistance.

Types of analyzes

Depending on the data of the initial examination, a dermatovenerologist may prescribe one of several options for laboratory tests:

• Bacteriological inoculation - carried out when a number of diseases are suspected, the causative agent of which is bacteria and fungi. It has high accuracy, but it takes a lot of time (about 14 days), therefore it often serves only to confirm the established diagnosis. In venereological practice, the sampling of tests for the tank culture is taken from the vagina, cervical canal, urethra, ejaculate.
• Serological analysis - the detection of specific antibodies in the blood for a specific pathogen. Such an analysis for latent infections of the genital organs accurately and quickly identifies pathogens, in some cases, determines the degree of development of the disease (chronic or acute).
• PCR - identification of DNA fragments of the pathogen, even if it has not yet had time to lead to the development of severe symptoms.

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Patient preparation

The test results largely depend on the correct preparation of the patient before the examination. To reduce the likelihood of distortion of the obtained data and increase the accuracy of the study, the specialists of the EUROMEDPRESTIG clinic recommend adhering to the following rules:

• When analyzing for genital infections with a blood test, you should refrain from eating 8 hours before taking a biomaterial. It is best to undergo the procedure in the morning.
• When serological analysis with suspected syphilis, it is not recommended to eat fatty foods 24 hours before sampling. Violation of this recommendation can lead to a false positive result and the appointment of incorrect treatment.
• Urogenital swabs are taken only after 3-4 hours of abstaining from urination. This will ensure the presence of a sufficient amount of biomaterial on the tissues of the urethra, which would otherwise be washed off by urine.
• Bacteriological studies exclude the possibility of taking antibiotics in any form. Even taking the drugs a week before the analysis will affect the accuracy.
• Rashes of the genitals and adjacent tissues are indications for additional examination of scrapings from the affected parts. In this case, the patient is advised to stop taking local and systemic drugs that reduce itching and inflammation several days before the test.
• The sampling of tests for genital infections in women is as informative as possible in the first days after menstruation. It is also recommended to refrain from sexual intercourse for at least three days before submitting the biomaterial.

Provocation of pathology and its necessity in modern venereology

In some cases, when the disease is at the initial stage and the doctor has doubts about the diagnosis, a "provocation" may be required - a temporary decrease in the body's defenses, which increases the activity of the pathogen. Due to the accuracy of modern laboratory tests for genital infections, provocation is rarely used, most often if there is a suspicion of a latent form of the disease.

The simplest option is alimentary provocation through the use of certain foods and dishes: spicy, salty, smoked, alcohol. For example, in the absence of other contraindications, the doctor may recommend drinking one or two glasses of beer with the usual snacks (smoked or salted fish, bacon, etc.) 1-3 days before taking tests for latent infections. This will help the pathogen to manifest itself, and it will be detected during laboratory tests. For some pathogens of STDs, there are specially designed agents provocateurs. They can only be used in a hospital setting, when the doctor can constantly monitor the patient and monitor his condition.

If you suspect any STDs, we recommend that you seek the advice of a dermatovenerologist at the EUROMEDPRESTIZH clinic. Here you will find modern diagnostic methods, accurate equipment and highly qualified personnel who can quickly determine the cause of the problem and eliminate it.