Obstetrics and gynecology. Specific infections. Gonorrhea (most important)

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Obstetrics and gynecology. Specific infections. Gonorrhea (most important)

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45. Specific infections. Gonorrhea

Gonorrhea is a specific infectious disease caused by Neisser's gonococcus. Infection occurs through sexual contact with the patient. The incubation period is from 3 to 20 days. Gonococcus infects mucous membranes covered with cylindrical epithelium. The pathological process in the area of primary lesions is usually called gonorrhea of the lower part of the female genital organs. The spread of infection in gonorrhea occurs ascending through the mucous membranes, or intracanalicularly. This affects the endometrium, fallopian tubes, ovaries and pelvic peritoneum. Often formed abscesses fallopian tubes (pyosalpinx) and ovaries (pyovarium).

The association of gonococcus with Trichomonas vaginalis is found in 96% of patients with acute ascending gonorrhea. Recognition of gonorrhea is facilitated by the study of anamnestic data: the appearance of the disease 3-4 days after the onset of sexual activity, casual sexual intercourse, the appearance of discharge from the genitals, pain in the lower abdomen after menstruation, fever, the appearance of acyclic bleeding.

The examination of the patient begins with examination and palpation of the abdominal wall, examination of the integument of the vulva and the mucous membrane of the vestibule. The condition of the inguinal lymph nodes and their painlessness are determined. When examining the urethra, its swelling and hyperemia of the sponges are noted. Smears are taken after wiping the urethral sponges with sterile cotton wool using a blunt ear spoon or loop inserted to a depth of 0,5-1 cm. The vestibular glands are palpated using the index finger. Pay attention also to hyperemia of the mouth of the gland duct, its compaction, and pain. The vagina is examined in the mirrors. Hyperemia of the mucous membranes, the presence or absence of erosions, and discharge are noted. The discharge from the area of the posterior fornix is taken with a spoon, and to collect material for fungi of the genus Candida, a light scraping is made from the walls of the vagina. Then the cervix is examined, the presence of erosions, their location, and the nature of the discharge are determined.

Bimanual examination determines the state of the body of the uterus, its position, size, texture, pain. Next, the uterine appendages are palpated, their size, shape, consistency, soreness and the presence of adhesions are determined. Then, on palpation of the parametrium, the presence of infiltrates and their location are noted.

When examining the rectum, attention is paid to the presence of swelling of the folds of the external sphincter, hyperemia, and the nature of the discharge. The diagnosis of gonorrheal infection is made after the detection of gonococci.

Treatment of gonorrhea of the lower genital organs is carried out on an outpatient basis, patients with ascending gonorrhea, as a rule, are treated in a gynecological hospital. The principles of treatment of patients with gonorrhea do not differ from the treatment of patients with inflammatory processes of septic etiology. General therapy (antibacterial, desensitizing, detoxifying, etc.) in the subacute and chronic stages is combined with local treatment of lesions.

Author: Ivanov A.I.

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