Clinical manifestations. Gonorrhea of the lower urogenital system is often asymptomatic. The manifestations of the disease include symptoms of dysuria, itching and burning in the vagina, and pussy, creamy discharge from the cervical canal. On examination, detect hyperemia and swelling of the mouth of the urethra and the cervical canal.
Gonorrhea of the upper part (ascending) usually causes a violation of the general condition, complaints of lower abdominal pain, fever up to 39 ° C, nausea, sometimes vomiting, chills, loose stools, frequent and painful urination, menstrual disorders. Artificial interventions — abortions, curettage of the uterine mucosa, sensing of the uterus, taking endometrial aspirate, cervical biopsy, administration of the IUD — contribute to the spread of infection beyond the internal os. Acute ascending inflammatory process is often preceded by menstruation, childbirth. An objective examination marked purulent or sumicular purulent discharge from the cervical canal, enlarged, painful, mild consistency of the uterus (with endomyometritis), swollen painful appendages (with salpingoophoritis), pain on abdominal palpation, symptoms of peritoneal irritation (with peritonitis). Acute inflammatory process in the uterine appendages is complicated by the development of tubo-ovarian inflammatory formations up to the occurrence of abscesses (especially in women using the IUD).
At present, the gonorrheal process has no typical clinical signs, since in almost all cases a mixed infection is detected. Mixed infection prolongs the incubation period, contributes to more frequent recurrence, complicates diagnosis and treatment.
Chronization of the inflammatory process leads to a violation of the menstrual cycle, the development of adhesions in the pelvis, which can lead to infertility, ectopic pregnancy, miscarriage, chronic pelvic pain syndrome.
The main methods of laboratory diagnosis of gonorrhea are bacterioscopic and bacteriological, aimed at identifying the pathogen. Bacterioscopic examination of gonococcus is identified by pairing, intracellular location and gram negativeness (Fig. 12.20). Due to the high variability under the influence of the environment, gonococcus cannot always be detected by microscopy. Bacteriological method is more suitable for identifying erased and asymptomatic forms of gonorrhea, as well as infection in children and pregnant women. Sowing material produced on artificial nutrient medium. When the material is contaminated with extraneous accompanying flora, the release of gonococcus becomes difficult, therefore, selective media with the addition of antibiotics are used. If it is impossible to sow, the material for research shall immediately be placed in the transport medium. Cultures grown on a nutrient medium are subjected to microscopy, determine their properties and sensitivity to antibiotics. Material for microscopy and seeding is taken from the cervical canal, vagina, urethra.