Слайд 1Medical Academy Named after S. I. Georgievsky of Crimea Federal
University
Department of Dermatovenerology and Cosmetology
PhD. in Medical Sciences, Department of
Dermatovenerology and Cosmetology
Maraqa Мarwan Y.N
Мараках Марван Якин Нажи
Слайд 2Lection
Gonorrhea
Gonorrhoea is an old bacterial disease that is almost
exclusively acquired through sexual intercourse. It is among the most
common and widely recognised STDs throughout the world.
Dr. K.H. Lau
Слайд 3Gonorrhea
Neisseria gonorrhoea, a gram-negative intracellular diplococcus arranged in pairs with
their apposing surfaces slightly flattened to produce the characteristic reniform
shape. It primarily affects columnar epithelium in genital mucosal surfaces of the urethra, accessory ducts and gland, as well as endocervix.
Слайд 4Course of gonorrhea
In virtually all cases transmission is the result
of sexual contact.
Incubation period in men is usually 2
to 5 days. Extreme cases can vary from 1-14 days. Incubation period in women is difficult to estimate as many cases are symptomless.
Слайд 5Pathogenesis
Neither congenital, no acquired immunity to gonococcus develops in humans.
The formed antibodies do not have defensive activity. Phagocytosis is
complete, if gonococci were weakened by the use of drugs. The distribution of infection in the organism takes place through lymphatic and blood vessels. The pathogen cannot live in the blood as it has bacteriocidal properties.
Слайд 6Classification
Present classification of gonorrhoea:
1) Fresh:
a) acute,
b) subacute,
c)
torpid
2) Chronic
3) Latency
Слайд 7Clinical features of gonorrhoea
Clinical features of gonorrhoea:
a) fresh acute gonorrhoeal
urethritis (anterior, total) Incubation period, clinical manifestation. What contributes to
the development of posterior urethritis and most acute forms of the process. Period of acute gonorrhoea;
b) fresh subacute gonorrhoea. Period of the disease (from 2 weeks to 2 months). Decrease in the intensity of the process;
c) fresh torpid gonorrhoea is characterized by sluggish progress, with less subjective feelings. Period of the disease is till 2 months.
d) chronic gonorrhoea is characterized by sparse clinical features. Period of the disease is more than 2 months;
Слайд 8Varieties of gonorrhoea
Gonorrhoea in small girls (for pediatricians). As a
result of anatomical and physiological peculiarities of the genitals of
small girls the inflammation of vulva, vagina, urethra, rectum may occur. In elder girls gonorrhoea is same as in women. Acute vulvovaginitis progresses with intense clinical signs.
Gonorrhoeal pharyngitis (for dentists). In sexual perversion there may be a development of gonorrhoeal pharyngitis and tonsillitis. Clinically resembles catarrhal and banal inflammation, almost without any subjective feelings. Can lead to gonococcal sepsis.
Слайд 9Complications of gonorrhea
Balanoposthitis,
Phimosis,
Paraphimosis,
Thysonitis,
Periurethral abscess,
Littritis,
Cowperitis,
Prostatitis,
Vesiculitis,
Epididymitis,
Urethral
stricture,
Cystitis.
Слайд 10Complications. Balanoposthitis.
Balanoposthitis The swelling of the prepuce in phimosis looks
as an enlarged penis, which is red and painful. The
hard chancre localized in such cases in the corona glandis or on the inner surface of the prepuce cannot be examined for T. pallidum. The diagnosis of syphilis is made easier by the characteristic regional lymph nodes whose aspirate is examined for the causative agent.
Слайд 11Complications. Phimosis.
Balanoposthitis may lead to constriction of the prepuce so
that the foreskin cannot be retracted. This condition is called
phimosis. The swelling of the prepuce in phimosis looks as an enlarged penis, which is red and painful.
Слайд 12Complications. Paraphimosis.
An attempt to retract the prepuce in phimosis with
force may lead to another complication called paraphimosis, in which
the edematous and infiltrated preputial ring strangulates the glans. As a result of mechanical disorders of blood and lymph circulation, the swelling increases. Necrosis of the tissues of the glans penis and prepuce may occur if appropriate measures are not applied in time. In the initial stages of paraphimosis the physician removes the serous fluid from the swollen prepuce (by puncturing the thin skin with a sterile needle repeatedly) and attempts to 'reduce' the glans. If the manipulation proves ineffective, the prepuce must be cut.
Слайд 13Complications. Cowperitis
Cowperitis presents as fever, malaise and severe pain in
the perineum with frequency, urgency, painful defecation, and sometime acute
urinary retention. Rectal examination is agonizingly painful.
Слайд 14Thysonitis, periurethral abscess, littritis
Thysonitis is an inflammation of thysonic glands.
Periuretral
abscess - presents as painful local swelling in the bulb
or the fossa navicularis in the penis.
Littritis – is an inflammation of littrius glands,
Vesiculitis –is an inflammation of the seminal vesicle .
Слайд 15Complications. Epididimitis
Epididymitis - inflammation of the epididymis, was formerly encountered
in gonorrhoea much more frequently than now. Gonococci evidently penetrate
into the epididymis from the posterior urethra through the deferent duct, though it is quite possible that the infectious agent is brought here with the blood or lymph.
Слайд 16Urethral stricture
Urethral stricture could lead to obstructive symptoms and damages
as well as recurrent urinary infection, leading to renal failure.
Stricture may occur anywhere in the urethra but most commonly in the bulb. It is diagnosed by anterior urethroscopy or by urethrogram.
Слайд 17Prostatitis
Prostatitis is uncommon as attacks are cut short by the
use of antibiotics. Symptoms include fever, perineal discomfort, pain on
defecation and variable urinary complaints. Rectal examination may show a large, tense and fluctuant mass bulging into the rectum.
Слайд 18Prostatitis
Catarrhal prostatitis - when the inflammatory process is restricted to
the excretory ducts there are no subjective disturbances and the
disease takes an asymptomatic course.
Follicular prostatitis - Spread of the affection to the lobules of the gland and the development of pseudoabscesses in them
Parenchymatous prostatitis - involvement of the interstitial tissue into the process in an acute disease leads to more or less pronounced systemic disorders combined with symptoms of acute posterior urethritis
Слайд 19Treatment of gonorrhoea
Gonorrhoea is managed by means of antigonococcal agents
(antibiotics and sulphanilamides), methods for stimulating specific and non-specific immunity,
as well as by different methods of local therapy the character of which is determined by the localization and type of focal changes in the tissues and involved organs. In acute fresh uncomplicated gonorrhoea, antibiotic therapy only is applied. A complex of measures is needed in protracted, complicated and chronic forms.
Слайд 20Treatment of chronic gonorrhoea
Specific and non-specific immunotherapy (provocation) are used
for treatment of chronic, complicated and torpid forms of gonorrhea.
Specific immunotherapy includes polyvalent gonococcal vaccine (gonovaccine).
Non-specific immunotherapy consists of:
lacto- and autohaemo- therapy
pyrogenal therapy
Chemical agents AgNO3
Alimentary provocation (using alcohol, sharp food, etc.)
Mechanical (introduction of metal bougies and tamponades)
Physiological (women’s month cycle)
Combined immunotherapy includes polyvalent gonococcal vaccine plus one of non-specific methods.
Слайд 21Criteria of recovery from gonorrhoea
The disappearance of the external signs
of the disease after treatment does not serve as evidence
that the causative agents have perished, because they may persist for a long time in some of the enclosed foci (latent gonorrhoea).
Full cure is determined in 7 to 10 days after completion of treatment. For this purpose combined provocation is carried out and then, 24, 48 and 72 hours later, smears are taken for bacteriological examination from the urethra and urine and the prostate secretion in males, and smears from the urethra, cervical canal and other involved organs in females. Whenever possible cultures are made simultaneously.
Слайд 22Criteria of recovery from gonorrhoea
In addition to bacteriological tests,
urological (or gynaecological) examination is carried out to reveal inflammatory
foci in the urogenital organs. The provocation and clinical examination are repeated in a month (females are examined during the next menstrual period). Individuals who have suffered from gonorrhoea are followed-up for two months (females for at least two menstrual periods).
Individuals who have suffered from gonorrhoea are considered healthy and therefore taken off the record in stable absence of gonococci in the smears and cultures, absence of inflammatory changes in the urethra and accessory sexual glands (prostate, seminal vesicles, Cowper's glands) in males, absence of pain or disturbances in the menstrual cycle and obvious changes on palpation in the internal sexual organs in females.