gonococcal urethritis
Introduction
Introduction to gonococcal urethritis Gonococcal urethritis (GC), also known as specific urethritis, is a purulent infection of the genitourinary system caused by gonorrhea, and can also infect the eyes, pharynx, rectum, pelvis, and gonococcus into the bloodstream, leading to disseminated gonococcal infection. . Gonorrhea is the abbreviation of gonococcal urethritis. Among the sexually transmitted diseases in China, gonorrhea is the first, with a short incubation period and strong infectivity. Often caused by migration or chronic infection of acute infection of the upper urinary tract, often a purulent infection of the genitourinary system caused by Neisseria gonorrhoeae (also known as Neisseria gonorrhoeae), with the main feature of discharge of purulent secretions. The main symptoms are frequent urination, urgency, dysuria, urinary tract irritation, burning pain during urination, pus discharge in the urethra or purulent discharge in the cervix of the cervix. Or gonococcal conjunctivitis, enteritis pharyngitis and other manifestations, or disseminated gonorrhea symptoms. Gonorrhea is mainly through sexual intercourse. Gonococcal urethritis is a sexually transmitted disease, and the focus of prevention is to avoid unclean sexual intercourse and promiscuity. basic knowledge The proportion of illness: 0.012% Susceptible people: no special people Mode of transmission: sexual contact spread Complications: endometritis Prostatitis Seminal vesiculitis Epididymitis
Cause
Cause of gonococcal urethritis
Infection (70%):
Often caused by migration or chronic infection of acute infection of the upper urinary tract, often a purulent infection of the genitourinary system caused by Neisseria gonorrhoeae (also known as Neisseria gonorrhoeae), with the main feature of discharge of purulent secretions. Gonorrhea is mainly through sexual intercourse.
Lower urinary tract lesions (15%):
Such as benign prostatic hyperplasia, chronic prostatitis, urethral stricture, bladder stones or foreign bodies, urethra hymen fusion, hymen umbrella, paraurethral gland inflammation.
Prevention
Gonococcal urethritis prevention
1. Gonococcal urethritis is a sexually transmitted disease, and the focus of prevention is to avoid unclean sexual intercourse and promiscuity.
2. If you notice symptoms such as yellow thick pus and dysuria in the urethra, you should see a doctor promptly.
3. Find Gram-negative negative diplococcus in the secretions to confirm the diagnosis.
4. Treatment should be sufficient for a full course of treatment to avoid recurrence and prolonged chronic.
5. Both men and women are governed by one another.
Complication
Complications of gonococcal urethritis Complications endometritis prostatitis seminal vesiculitis epididymitis
1, when women gonorrhea with salpingitis, can lead to infertility. The incidence of infertility caused by female gonorrhea is about 20%, and the incidence of infertility increases with the increase in the number of infections. For women infected with gonorrhea more than three times, the incidence of infertility can reach 70%. Cervical gonococcal inflammation can lead to early rupture of membranes, intra-amniotic infection, intrauterine infection, intrauterine growth retardation, and premature delivery. Newborns have high morbidity and mortality due to premature birth, low body weight and sepsis.
2, postpartum gonococcal infection, can cause endometritis, puerperal fever, severe postpartum sepsis, neonatal gonorrhea conjunctivitis and vaginal women vulvovaginitis.
3, the main complication of female gonorrhea is gonococcal box inflammation, such as acute salpingitis, endometritis, secondary fallopian tube ovarian abscess and pelvic abscess caused by rupture, peritonitis. Sudden onset after menstruation, there are high fever, chills, headache, nausea, vomiting, lower abdominal pain, increased purulent leucorrhea. Both sides of the attachment are thickened and tender.
4, male patients with gonorrhea urethritis have various comorbidities, mainly prostatitis, seminal vesiculitis, epididymitis.
(1) Prostatitis: Acute prostatitis is caused by the discharge tube and gland of Neisseria gonorrhoeae entering the prostate. There are fever, chills, perineal pain and urinary tract infections accompanied by dysuria. The prostate is swollen and tender when examined. However, Neisseria gonorrhoeae is not a common cause of acute prostatitis. The prostate caused by Neisseria gonorrhoeae is mainly characterized by chronic lesions. The symptoms are mild, there is perineal discomfort, penile pain, there is a "mouth" phenomenon in the morning urethral opening, and the lymph in the urine is seen. The prostate massage fluid has pus and lecithin. , smear or culture to find gonococcus, anal examination can touch small nodules on the prostate, and there is discomfort or pain, drainage of pus near the drainage tube to form scar contraction affects ejaculation, resulting in infertility.
(2) Epididymitis: generally occurs after acute urethritis, mostly unilateral. There is low fever, epididymis swelling pain, ipsilateral groin and lower abdomen have reflex pain, the beginning and testicular boundaries are clear, gradually unclear, testicular tenderness, swelling, severe tenderness. The urine is often cloudy. There can be prostate and seminal vesiculitis at the same time.
(3) seminal vesiculitis: acute fever, frequent urination, urgency, dysuria, no urine turbidity and blood. Rectal examination can touch the swollen seminal vesicle and have severe tenderness. Chronic seminal vesiculitis generally has no symptoms. Rectal examination shows that the seminal vesicle is hard and fibrotic.
(4) urethral ball gland inflammation: occurs in the perineum or around, there are finger size nodules, pain, acute suppurative ulceration, compression of the urethra and dysuria, may have fever and other systemic symptoms, slow progress.
(5) urethral stricture: repeated authors can cause urethral stricture, a small number of vas deferens or obstruction can occur, dysuria, thinning of the urinary tract, severe urinary retention. Secondary vas deferens, seminal vesicle cysts and infertility.
Symptom
Symptoms of gonococcal urethritis Common symptoms Urinary urinary urinary urinary pain Pain urinary tract urinary tract urinary tract burning sensation
Frequent urination, urgency, dysuria, urinary tract irritation, burning pain during urination, pus discharge in the urethra or purulent discharge in the cervix of the cervix. Or gonococcal conjunctivitis, enteritis pharyngitis and other manifestations, or disseminated gonorrhea symptoms.
Male gonorrhea:
1 male acute gonorrhea: the incubation period is generally 2 to 10 days, an average of 2 to 5 days. Start urinary tract irritation, redness and valgus. Burning pain during urination, frequent urination, a small amount of mucous secretions in the urethra. After 3 to 4 days, most of the focal necrosis of the urethral mucosa epithelium occurred, resulting in a large amount of purulent secretions, tingling during urination, and significant swelling of the glans and foreskin. The urinary tract can be seen in the urinary tract or blood. In the morning, the urethra can be connected with purulent sputum. With systemic symptoms ranging from mild to severe.
2 male chronic gonorrhea: generally no obvious symptoms, when the body's resistance is reduced, such as excessive fatigue, drinking, sexual intercourse, that is, there is urinary tract symptoms, but the inflammation is lighter than the acute phase, the urethral secretion is less and thin, only in the morning There is a purulent adhesion in the urethral opening, which is the phenomenon of "digestion".
Due to the long-term inflammation of the urethra, the urethral wall fibrous tissue proliferates and forms scars. When the anterior urethra forms multiple scars, the secretions cannot be discharged smoothly. The inflammation is easy to extend to the posterior urethra, prostate and seminal vesicles, and prostatitis, seminal vesiculitis, and even Retrograde spread to the epididymis, causing epididymitis. At the end of urination, gonococcus from the posterior urethra is often mixed in the urethra. Therefore, posterior urethritis and prostatitis are the source of infection of anterior urethritis. Because the secretions of the prostate and seminal vesicles are discharged into the posterior urethra and continue to stimulate the posterior urethra, it is continuously thickened, which in turn affects the poor drainage of the gland. This interaction affects the progression of gonorrhea, is difficult to cure, and becomes an important source of infection.
Female gonorrhea:
1 female acute gonorrhea: mild or asymptomatic symptoms after infection, usually after 2 to 3 days of incubation period, the genital area first inflamed, consciously itching, pain during walking, urethritis, cervicitis, paraurethralitis, vestibule Large gland inflammation and proctitis, among which cervicitis is the most common. 70% of female gonorrhea patients have urinary tract infections. Gonococcal cervicitis is common, and more often with urethritis.
2 female chronic gonorrhea: acute gonorrhea can be converted to chronic if not fully treated. It is characterized by lower abdominal bulge, back pain, and more leucorrhea.
3 pregnancy combined with gonorrhea: more no clinical symptoms. Pregnant women with gonorrhea can pass the birth canal to infect the fetus, especially when the fetus is exposed to the breech, especially premature rupture of membranes, amniocentesis, premature delivery, postpartum sepsis and endometritis.
4 young girls gonococcal vulvovaginitis: vulva, perineum and perianal redness, vaginal purulent secretions, can cause dysuria, local irritation and ulceration.
(3) gonococcal conjunctivitis: more common in newborns and adults, conjunctival congestion, edema, purulent secretions, severe cases can cause corneal ulcers and blindness. Newborns cause gonorrhea conjunctivitis when they pass through the birth canal. They occur 1 to 14 days after birth. They appear to be red and swollen with both eyes. There is a purulent discharge. If not treated, it may involve the cornea and form corneal ulcer and cornea. White spots, leading to blindness.
(4) gonococcal pharyngitis: more asymptomatic, symptomatic can be expressed as throat redness, blisters, pustules and purulent secretions.
(5) gonococcal proctitis: mostly anal itching and burning sensation, painful bowel movements, discharge mucus and purulent secretions, rectal congestion, edema, purulent secretions, erosion, small ulcers and fissures.
(6) gonococcal peritonitis: unilateral or bilateral lower abdominal pain, a small amount of metastatic lower abdominal pain, but lighter than other peritonitis. Frequent urination, urgency, dysuria, urinary tract burning, and similar symptoms in the past six months. Have a history of unclean sexual contact.
(7) Gonorrhea arthritis: more involved knee, ankle, elbow, wrist and shoulder joints. 2/3 showed migratory asymmetrical arthritis, and about 1/4 showed single joint pain. Arthritis, redness, swelling, effusion or empyema can cause bone destruction and joint stiffness. Often accompanied by synovitis and tenosynovitis.
Examine
Examination of gonococcal urethritis
1, male should be a digital rectal examination to understand whether the prostate has lesions, and for the scrotum, penis, urethra percussion, exclude genital inflammation, urethra inflammation or stones. Women should know whether there is any abnormality in the external urethra, hymen, cervicitis, vaginitis or vestibular gland inflammation. Pay attention to diseases such as diabetes and low immune function.
2, laboratory tests, a small amount of white blood cells in the urine, may have red blood cells. Urine culture can be positive. If multiple mid-stage urinary bacterial cultures are negative, differentiation with urinary tuberculosis should be considered.
3, B-mode ultrasound, excretory urography, etc. can help to understand the presence or absence of urinary tract malformations, stones or tumors.
4, cystoscopy can be seen pyuria, pus moss, bladder mucosal congestion, edema or small hernia, pay attention to the presence or absence of diverticulum, stones, foreign bodies or tumors.
Diagnosis
Diagnosis and diagnosis of gonococcal urethritis
diagnosis
1. History of unclean sexual contact.
2. Symptoms and signs.
3. Laboratory examination 1 secretion smear, Gram stain, can find Gram-negative diplococcus in polymorphonuclear leukocytes. The positive rate of acute male patients is over 95%, and the positive rate of female patients is below 60%. 2 gonococcus culture. 3 Chronic gonorrhea is mainly cultured, males should take prostatic fluid, women take cervical scrapings for culture and drug sensitivity test.
Differential diagnosis
1. Non-gonococcal urethritis.
2. Chronic prostatitis.
