Gonorrhea is an infectious disease caused by gonococcus (Neisseria gonorrhoeae), with a predominant lesion of the urinary organs. Every year the disease is registered in 200 million people. A postponed gonorrhea often causes both female and male infertility.
Etiology and pathogenesis. Gonococcus is a pairwise cocci (diplococcus) bean-shaped, not Gram-stained; necessarily located intracellularly (in the cytoplasm of leukocytes). Gonococci are highly sensitive to environmental factors: they die at temperatures above 55 ° C, when dried, treated with antiseptic solutions, under the influence of direct sunlight. Gonococcus maintains vitality in fresh pus until dry. In this regard, infection occurs mainly through sexual contact (from an infected partner). Contagiousness of the infection for women is 50–70%, for men – 25–50%. Much less common is a household infection (through dirty laundry, towels, washcloths), mostly in girls. The possibility of intrauterine infection remains controversial. The gonococcus is immobile, does not form a spore, is fixed by means of thin tubular filaments (pili) on the surface of epithelial cells, spermatozoa, and erythrocytes. Outside, the gonococci are covered with capsule-like substance that makes them difficult to digest. The pathogen can survive inside leukocytes, trichomonads, epithelial cells (incomplete phagocytosis), which complicates the treatment. With inadequate treatment, L-forms may be formed, which are insensitive to the drugs that caused their formation, antibodies, and complement as a result of the loss of some antigenic properties. The persistence of the L-forms makes it difficult to diagnose and treat, and does not contribute to the survival of the infection in the body. In connection with the widespread use of antibiotics, many strains of gonococcus appeared that produce the β-lactamase enzyme and, accordingly, resistant to the action of antibiotics containing a β-lactam ring.
Gonococci infect mainly the urogenital system lined by a cylindrical epithelium — the mucous membrane of the cervical canal, fallopian tubes, urethra, paraurethral and large vestibular glands. Gonorrheal pharyngitis, tonsillitis and stomatitis can develop in genital-oral contacts, and gonorrheal proctitis in genital-anal ones. When an infection gets on the mucous membrane of the eyes, including when the fetus passes through an infected birth canal, signs of gonorrheal conjunctivitis appear.
The vaginal wall, covered with stratified squamous epithelium, is resistant to gonococcal infection. However, if the epithelium becomes thinner or becomes loose, gonorrheal vaginitis may develop (in pregnancy, in girls, in postmenopausal women).
Gonococci are quickly fixed on the surface of epithelial cells with the help of pili, and then penetrate deep into the cells, the intercellular cracks and the subepithelial space, causing destruction of the epithelium and an inflammatory reaction.
Gonorrheal infection spreads more frequently (canalicular) from the lower urogenital tract to the upper. Adhesion of gonococcus to the surface of spermatozoa and enterobiosis inside Trichomonas, which are active carriers of infection, often contribute to the advancement.
Sometimes gonococci enter the bloodstream (they usually die due to the bactericidal properties of serum), leading to the generalization of infection and the appearance of extragenital lesions, primarily joints. Less frequently, gonorrheal endocarditis and meningitis develop.
In response to the introduction of gonorrheal infection in the body, antibodies are produced, but immunity does not develop. A person can become infected and suffer from gonorrhea many times; This is due to the antigenic variability of gonococcus. The incubation period of gonorrhea ranges from 3 to 15 days, less often – up to 1 month.
The following types of gonorrheal infection are distinguished: gonorrhea of the lower urogenital system, upper urogenital system and pelvic organs, and gonorrhea of other organs. The gonorrhea of the lower parts of the urogenital system includes damage to the urethra, paraurethral glands, glands of the vestibule of the vagina, the mucous membrane of the cervical canal, vagina, and gonorrhea of the upper parts of the urogenital system (ascending) – damage to the uterus, appendages and peritoneum.
Fresh gonorrhea (up to 2 months) is also distinguished, which is subdivided into acute, subacute, torpid (low symptom or asymptomatic, with scanty exudate, in which gonococci are detected) and chronic (lasting more than 2 months or not set). Chronic gonorrhea can occur with exacerbations. Perhaps gonokokosultaty, when the pathogen does not cause the appearance of exudate and there are no subjective disorders.