What are the symptoms of acute non-gonorrhea?

Gonorrhea-related knowledge and precautions

Gonorrhea is an infectious disease that is transmitted by Diplococcus gonorrhoeae through sexual intercourse and mainly affects the urogenital organs

, is the oldest, most prevalent and currently most prevalent sexually transmitted disease in the world. According to reports, there are 150 million new gonorrhea patients in the world every year. Among infectious diseases, the occurrence of gonorrhea ranks second after influenza.

Gonorrhea should be cured by medication under the guidance of a professional doctor. At the same time, patients should cooperate to < /p>

: As long as the medication is taken on time and in sufficient amounts, it can generally be cured. Also note:

1. Bed rest, strenuous activities and excessive excitement are prohibited.

2. Sexual life is prohibited.

3. Underwear should be changed, disinfected and cleaned every day. Keep your vagina clean.

4. Spouses and sexual contacts should be investigated and treated together.

5. Follow the doctor’s instructions, take medication on time and in sufficient amount, and do not seek medical treatment or self-medication.

The prevalence and transmission routes of gonorrhea

1. Epidemic characteristics

(1) Humans are the only natural host of gonorrhea. It is not pathogenic to other animals. The main route of infection is sexual behavior, with the exception of vulvovaginitis and gonococcal conjunctivitis.

(2) It has a high incidence rate and wide prevalence among classic STDs.

(3) Spread quickly. The incubation period of gonorrhea is short, usually 3 to 5 days, and the disease develops quickly after infection.

(4) In terms of occupational distribution, sales and purchasing personnel have a higher prevalence in my country, followed by taxi drivers, self-employed individuals, workers and other personnel. In the United States, soldiers, immigrants, homosexuals and prostitutes have higher incidence rates. For example, at least 30% of prostitutes have gonorrhea.

(5) Women are more susceptible to gonorrhea infection than men. Statistical reports show that when men have sexual relations with women who already have typical gonococcal infection, about 20% to 25% of them will be infected. On the contrary, the chance of infection for women is as high as 80% to 90%. Chronic asymptomatic carriers of gonorrhea are of great significance in the epidemiology of this disease, but they are difficult to manifest and rarely treated. 80% of women with gonorrhea will be asymptomatic or have only mild symptoms.

2. Transmission route

(1) Male gonorrhea is almost always transmitted through sexual contact.

(2) Women are mainly infected through sexual intercourse, with non-sexual intercourse accounting for a small proportion, such as using unsterilized clothes, sheets, bathtubs, toilets and fingers that contain secretions from gonorrhea patients. Contact etc.

(3) Neonates may also be infected with gonorrhea through the birth canal of mothers, causing gonorrhea conjunctivitis, which can quickly lead to blindness if not treated in time.

Young girls are often infected with gonorrhea through indirect contact with their mothers, causing acute vulvar and perianal inflammation.

Clinical manifestations of gonorrhea

Due to different physiological and anatomical structures, men and women have different symptoms and complications. The details are as follows.

Male gonorrhea

(1) Acute gonorrhea: primary urethritis

1. Incubation period: The incubation period of acute gonorrhea is very short, usually after sexual contact 2 to 5 days, and the incubation period in a few patients can be as long as 10 days. Gonococcus goes through three stages after it invades the male urethra. ① Invasion stage: It takes 36 hours after gonococcus invades to penetrate into the superficial layer of the mucosa and start to reproduce and grow. ②Development stage: Completes a life cycle in about 36 hours. ③ Detoxification stage: After the life cycle, some gonococci die and excrete endotoxin-like substances, which causes the body tissue to react to toxins, and clinical symptoms only appear at this time.

Factors that affect the length of the incubation period include: extensive effects of antibiotics; physical weakness, reduced resistance, alcoholism, excessive sexual life, etc. The incubation period can be shortened for those who are alcoholics and those who use antibiotics can extend the incubation period.

2. Conscious symptoms

(1) Dysuria is often an early symptom of the disease. There is a burning, stinging or hot pain in the front of the urethra. The pain is significantly worse during urination and may even radiate to the lower abdomen or spine. When experiencing pain at night, patients may experience "painful erection" of the penis.

(2) After 12 to 24 hours, the pain of the urethral orifice is red, swollen and purulent, and the pain is slightly relieved, and thin mucus-like secretions begin to be discharged in large amounts. After another 12 to 24 hours, a large amount of purulent secretions are discharged. Secretion, 20~50ml of pus can be discharged in 24 hours. After 2 to 3 days, the amount of pus decreases and becomes thicker, and the color changes from white to yellow-white or yellow-brown. After another 3 to 4 days, the pus becomes less and thicker. In the morning, pus accumulates in the urethra orifice, forming a pus film. , called "living", the pain increases, the urethral orifice is red and swollen, appears eversion-shaped, the inner leaf of the foreskin is also red and swollen, and can develop into balanitis, incarcerated phimosis, etc.

(3) Frequent urination and urgent urination are similar to general urinary tract infections. The inflammation causes contraction of the urethral sphincter. Frequent urination and urgent urination are worse at night. In addition, because inflammation affects the small blood vessels of the mucosa, "terminal hematuria" often occurs. Sometimes there may be blood.

(4) Perineal swelling and pain. Clinically, perineal swelling and pain appear, which indicates that the disease has ascended and invaded the posterior urethra, prostate and seminal vesicles.

(5) Systemic symptoms: Some patients may also have systemic symptoms, such as fever (body temperature around 38°C), general fatigue, discomfort, loss of appetite, and even nausea and vomiting.

3. Physical examination: The urethral opening and entry fossa are red, swollen, congested, and edematous, and sometimes there are small, superficial abscesses, erosions, or small ulcers. In severe cases, the urethral mucosa is everted, and the redness and swelling spread to the entire glans penis. The glans and foreskin are everted, and the foreskin cannot be turned up. The urethra may be compressed and pus may flow out. The inguinal lymph nodes on both sides can also be affected, causing redness, swelling, spasm, suppuration, and obvious tenderness, which will decrease with the reduction of urethral inflammation. 2 to 3 days after the inflammation disappears, the inflammation in the lymph nodes will also disappear.

4. Evolution of the course of the disease: The symptoms are the most severe in the first week. If no treatment is given or the treatment is not timely and thorough, the symptoms will gradually decrease after about 2 to 3 weeks, the secretions from the urethra will decrease, and the tissue swelling will decrease. subsided, and the symptoms completely disappeared after one month. However, gonorrhea has invaded the deep glands at this time, and even lurks in the scar tissue and slowly grows, developing into chronic gonorrhea, and urethral stricture may occur in the later stage.

(2) Chronic gonorrhea: late urethritis

1. Cause of onset: Most are transformed from acute gonorrhea, and a few can directly transform into chronic persistent lesions after infection. Gonorrhoeae lurks in the urethral mucosal folds and scar tissue of patients with chronic gonorrhea. Acute symptoms may reappear when the patient's systemic resistance decreases, their sexual life is uncontrolled, they are combined with other wasting diseases (such as tuberculosis, diabetes), or they drink alcohol for a long time. attack.

2. Symptoms: In chronic gonorrhea, gonococci often invade the anterior and posterior urethra (such as the bulb and mucosa of the urethra), prostate and epididymis at the same time, and the symptoms are more complicated than acute gonorrhea.

Mainly include:

(1) Dysuria. Similar to the acute phase, but milder, terminal hematuria may also be seen.

(2) The "living" phenomenon of urethral secretions in the morning can still be seen. The pus flowing out of the urethra is thinner than in the acute stage, and only a small amount of secretions can be seen when squeezing the root of the penis.

(3) It is easy to be combined with prostatitis, seminal vesiculitis and epididymitis, and hematuria or hematospermia may appear clinically.

(4) They often have low back pain and perineal swelling and pain, and are prone to sexual weakness, insomnia, spermatorrhea or premature ejaculation.

(5) Urine contains "drench". It is a cotton fiber-like substance floating in the urine, and is composed of smegma, epithelial cells and pus balls.

(6) Urethral stricture causes the urine stream to become thin or bifurcated.

Chronic gonorrhea often causes acute attacks after overwork, alcohol or sexual intercourse.

3. Comorbid gonorrhea

(1) Gonorrheal prostatitis: a common complication of post-gonorrheal urethritis. In addition to clinical manifestations such as heat, dysuria, frequent urination, urgency, swelling of the anus and perineum, pressure, pain radiating to the waist, and aggravation after urination, sexual dysfunction such as impotence and premature ejaculation may also occur. During physical examination, there is obvious tenderness and enlargement of the prostate during anal examination, and in severe cases, the middle groove disappears. Laboratory examination shows a large number of pus cells and reduced lecithin in the prostate secretions, and gonococci can be detected by microscopy and culture.

(2) Gonococcal epididymitis: This complication has an acute onset. At the beginning, there is traction pain in the scrotum or testicles, which progressively worsens and spreads to the groin. There are systemic symptoms, and the body temperature can rise to 39~40℃. Physical examination shows enlargement and tenderness of the epididymis, flushing and burning of the scrotal skin. In severe cases, the enlarged spermatic cord and inguinal lymph nodes can be palpated. The patient walked with his legs crossed due to pain from the testicular lesion. The advanced stage of the disease can cause epididymal connective tissue hyperplasia, fibrosis, vas deferens atresia, and loss of fertility.

(3) Other complications: Men can also be complicated by parafrenulum and paraurethritis, periurethral abscess, cellulitis, cavernitis, gonococcal balanitis or balanoposthitis.

Female gonorrhea

(1) Acute gonococcal urethritis

Usually onset within 10 days after sexual intercourse. The subjective symptoms include inflammatory symptoms such as painful urination, urgency, frequent urination, and burning sensation in the urethra, but they may be mild or absent. Physical examination shows that the external urethral orifice and vaginal introitus are red, swollen, congested, and have purulent secretions. The Bartholin glands can also be red, swollen, and tender, and gonococci can be detected in laboratory tests. This disease often coexists with primary cervicitis.

(2) Gonococcal cervicitis

The incidence rate is higher than that of urethritis. The subjective symptoms are increased leucorrhea, itching of the vulva, and slight pain and burning sensation in the vagina. A small number of patients are accompanied by systemic symptoms, such as fever and abdominal pain. Because they are often seen together with urethritis, they may also have urinary symptoms such as frequent urination and urgency. Physical examination shows congestion and edema at the vaginal orifice and navicular fossa. There is a large amount of purulent secretion at the vaginal orifice with a foul smell. Congestion, erosion or edema at the cervix orifice and tenderness can also be seen when the urethra is pressed upward from the front wall of the vagina with fingers. There is purulent secretion overflowing from the opening of the paraurethral gland.

(3) Comorbid gonorrhea

1. Gonococcal Bartholinitis (also known as Bartholinitis): The Bartholin gland opens outside the vagina and is easily infected . Symptoms include redness, swelling, heat and pain of the Bartholin gland, a small amount of pus overflowing from the opening of the gland, or even an abscess forming in the gland, and a fluctuating sensation when pressed. The lower 1/2 of the labia majora is obviously swollen. It may also be accompanied by systemic symptoms and inguinal lymphadenopathy. big.

2. Gonococcal pelvic inflammatory disease (complicated gonorrhea): If gonococcal cervicitis is left untreated or irregularly treated for a short period of time, about 20% of patients will become infected and transform into gonococcal pelvic inflammatory disease, including acute gonococcal disease. Sexual salpingitis, endometritis, fallopian tube and ovarian abscess, peritonitis, etc. It occurs more frequently in young and childbearing women. Most patients with gonococcal pelvic inflammatory disease develop the disease after menstruation. Those who develop it before menstruation may experience increased menstrual bleeding and prolonged menstrual periods. There is a lot of leucorrhea, which is purulent or bloody. The systemic symptoms are obvious, such as chills, fever, headache, anorexia, nausea and vomiting, and bilateral lower abdominal pain, with one side being the most severe. The pain intensifies when the abdominal pressure increases. Physical examination revealed lower abdominal tenderness and muscle tension, mainly on one side, and decreased bowel sounds. There was purulent secretion in the urethra, paraurethral glands, Bartholin glands, cervix, etc., and there was also thickening and tenderness in the bilateral appendages. This disease may also develop into a fallopian tube-ovarian abscess or pelvic abscess. At this time, the tumor can be touched in the adnexa and in the recessed area behind the uterus, with obvious tenderness and a fluctuating sensation when pressed. If the abscess ruptures, symptoms such as peritonitis or even toxic shock may occur. . Over time, it can also cause fallopian tube adhesion and obstruction, leading to infertility or ectopic pregnancy.

Treatment of gonorrhea

Most Western medicines are more effective in the acute phase, such as penicillins, tetracyclines, cephalosporins, erythromycin, etc., which can be selectively used in combination, After the clinical symptoms disappear, the test will be repeated until the gonorrhea turns negative. (Couples are treated at the same time).

Non-gonococcal urethritis

Non-gonococcal urethritis is the most common sexually transmitted disease in clinical practice. Seriously endanger human health. Nongonococcal urethritis is a type of disease in which urethritis exists, but gonococci cannot be found in urethral secretions. It is mainly caused by chlamydia and mycoplasma, which are transmitted through sexual intercourse and invade the urogenital tract organs. So far, the incidence of this disease has surpassed gonorrhea in Western countries, ranking first among sexually transmitted diseases.

40% to 50% of non-gonococcal urethritis is caused by Chlamydia trachomatis biovar trachomatis, and 20% to 30% is caused by Ureaplasma urealyticum. Then the mycoplasmas related to humans include Mycoplasma pneumoniae, Mycoplasma hominis, and Mycoplasma genitalium. Mycoplasma and chlamydia can exist in healthy carriers. Ureaplasma urealyticum has the ability to decompose urea into ammonia, which is toxic to cells. Since mycoplasma has no cell wall, it is resistant to antibiotics that disrupt the cell wall, such as penicillin.

Clinical manifestations

The incubation period of non-gonococcal urethritis is generally 7-21 days.

1． Male non-gonococcal urethritis

(1) Symptoms include itching, burning sensation and painful urination in the urethra. A few have frequent urination and slight redness of the urethral opening. In the morning, there is a small amount of mucus secretion at the urethral opening or only a scab opening, or the crotch is dirty, and the urine stream bifurcates during urination. Some patients need to squeeze hard with their hands to get secretions to overflow from the urethral opening. Symptoms are similar to gonococcal urethritis but are milder. Some patients are asymptomatic. The patient developed double infection with gonorrhea at the same time.

(2) Comorbidities ① Epididymitis: The infection extends along the vas deferens to the epididymis. The typical symptom is the coexistence of urethritis and epididymitis. The most common case is acute epididymitis, which is mostly unilateral and often caused by trachomatous biological variants. ②Prostatitis: Subacute prostatitis is more common, while chronic prostatitis may be asymptomatic or may cause dull perineal pain or penile pain. ③Reoter syndrome: occurs in 0.8%--3% of NGU patients, more common in men than women. Including urethritis, polyarthritis and conjunctivitis, etc.

2. Female urogenital infections often spread to other parts of the body centered on the cervix.

(1) Mucopurulent cervicitis manifests as increased leucorrhea and no swelling or erosion of the cervix, but the clinical symptoms are not obvious.

(2) Urethritis: burning of the urethra or frequent urination. Check that the urethral opening is congested, reddish or normal, and secretions overflow when squeezing the urethra. Many patients do not have any symptoms.

(3) Pelvic inflammatory disease, including salpingitis and endometritis. This disease can lead to ectopic pregnancy or infertility.

3. Neonatal conjunctivitis, pneumonia through birth canal infection, and mothers with trachomatous biovar cervicitis, 40%---50% of their newborns will suffer from conjunctivitis, mostly 5-5 years after birth. Neonatal pneumonia appears within 14 days and occurs 2-3 weeks after birth, but is mostly diagnosed at 6 weeks. D---K trachomatous biological variants can be isolated from conjunctiva, nasopharynx, and tracheal secretions.

How can patients detect non-gonococcal urethritis early?

Since the clinical symptoms of non-gonococcal urethritis are not as obvious as gonorrhea, when a patient develops some of the following symptoms, he or she must be infected with non-gonococcal urethritis.

(1) Have had a history of extramarital sexual intercourse within 1 month, or have a spouse who has had similar sexual intercourse, and have recently gradually developed urethral itching and discomfort, or varying degrees of urgency and pain during urination. and poor urination.

(2) After a long period of not urinating or before urinating for the first time in the morning, a small amount of watery mucus will flow out of the external orifice of the urethra. Sometimes only a small amount of scab will be seen sealing the urethral orifice or a small amount of pus will be stained on the crotch of underwear. scab. Since the urethral opening is sealed by a scab, there may be a feeling of obstruction or scattered urine flow at the beginning of urination.

(3) Women’s symptoms are not obvious. Sometimes they only show increased leucorrhea, mucopurulent leucorrhea, and vulvar itching.

Another situation is that after a patient is infected with gonorrhea, after regular treatment and using drugs such as penicillin, spectinomycin, or cephalosporins, the clinical symptoms are significantly relieved, and the laboratory test shows negative for gonorrhea, but the gonorrhea test results in negative results. A small amount of mucus-purulent secretions still flow out of the urethral opening every day, and the urethra is mildly itchy and painful. This situation is likely to be infected with gonorrhea and non-gonococcal urethritis. The reason is that the symptoms of gonorrhea are obvious and cover up the symptoms of non-gonococcal urethritis. After the gonorrhea is cured, the symptoms of non-gonococcal urethritis will be obvious. .

Therefore, if both men and women have the above symptoms, they should go to a regular hospital for examination in time and receive prompt treatment after diagnosis.

What should I do if I still have symptoms after treatment for non-gonococcal urethritis?

One week after the end of the course of treatment for "Fei Lin", if the patient still has symptoms, further examination is required to see if there are inflammatory infections in other parts of the body other than "Fei Lin". If all are negative, then The treatment can be repeated one more time. If the symptoms do not disappear after re-treatment, the spouse’s infection status and abnormal sexual habits should be investigated. Recurrent attacks and persistent symptoms are mostly related to sexual contact with infectious sexual partners. Therefore, simultaneous treatment of the spouse and termination of abnormal extramarital sexual relationships are the keys to successful treatment.

What are the cure criteria for non-gonococcal urethritis?

The cure criteria for non-gonococcal urethritis are: the disappearance of subjective symptoms and the absence of white blood cells in urethral secretions and urine sediment smears.

Can you have sex before non-gonococcal urethritis is cured?

Due to the long treatment period for non-gonococcal urethritis, the condition recurs. Although the patient hopes to have sex during this period, we have to tell the patient not to have sex until the disease is cured. Because during sexual life, the urogenital tract is congested, which can accelerate the reproduction of pathogens and even further infect the internal genitals. Therefore, sexual life will cause the treatment to be wasted.

How to treat non-gonococcal urethritis?

Although the symptoms of non-gonococcal urethritis are not very obvious, if not treated in time, there will be a risk of complications over time. Therefore, you should go to a qualified hospital for diagnosis and treatment in time. Don't hide your medical history from your doctor, and don't overuse antibiotics yourself to avoid delaying treatment. As long as you cooperate with your doctor's treatment and strictly follow your doctor's instructions, non-gonococcal urethritis can be cured. Due to the long growth cycle of chlamydia, long-term medication should be used, and because non-gonococcal urethritis is easy to be mixed with other pathogens, broad-spectrum antibiotic therapy is used, and it is emphasized that it must be continuous and uninterrupted, and the medication must be regular and sufficient for complete treatment. The following are several commonly used antibiotic therapies:

(1) Tetracycline 500 mg 4 times a day, orally for 14 days.

(2) Erythromycin 4 times a day, 500 mg each time, for 7 days.

(3) Doxycycline 100 mg twice a day for 7 days.

(4) Minocycline is administered twice a day, 200 mg each time, and from the second day onwards, it is changed to 100 mg each time, twice a day, for 8 days.

(5) Norfloxacin has a certain effect on chlamydia, 400 mg per day, for 7 to 10 consecutive days.

If you have gonorrhea at the same time, you should first treat the gonorrhea with penicillin, and then use tetracycline or erythromycin. Since tetracycline is more effective against Chlamydia trachomatis but less effective against Ureaplasma urealyticum, erythromycin may be considered.

One week after the end of the treatment, if the patient still has symptoms, various laboratory tests should be rechecked. If inflammation still exists, further examination is required to see if there is any pathogenic infection such as Trichomonas vaginalis, Candida or herpes virus. If it is still positive, it can be treated again. If the symptoms do not disappear after re-treatment, the spouse’s infection status and abnormal sexual habits should be investigated, because patients with repeated attacks and persistent symptoms are mostly related to sexual contact with infectious partners. , so it is necessary to simultaneously treat the spouse and terminate the abnormal extramarital sexual relationship. This is the key to successful treatment.

If non-gonococcal urethritis is left untreated, about 70% of patients will have symptoms that completely disappear within 6 months. However, the disappearance of symptoms does not mean that the disease has been cured and needs to be confirmed by secretion culture.

The cure indicators for non-gonococcal urethritis are: disappearance of subjective symptoms, no urethral secretions, no white blood cells in the urine sediment smear, and no chlamydial inclusions in the iodine-stained smear. Only the test results from a regular hospital are the basis for measuring whether a patient is cured or not. You cannot interrupt treatment at will just based on your own feelings.

Prevention and expert advice

Nongonococcal urethritis is mainly caused by sexual contact with people infected with chlamydia and mycoplasma. To prevent nongonococcal urethritis and prevent its resurgence, the following preventive measures can be taken:

(1). Avoid extramarital intercourse and curb sexual promiscuity.

(2). Adhering to regular treatment and avoiding giving up halfway is beneficial to eliminating the source of infectious diseases and preventing complications. Avoid sexual intercourse before and for at least 2 weeks after treatment to help complete recovery from the disease.

(3). A re-examination is required after completion of treatment to assess whether the condition is truly cured.

(4). Patients and sexual partners should be examined at the same time and receive regular treatment.

(5). Avoid sexual contact until the partner is completely healed.

(6). If symptoms persist or recur, you should go to the relevant specialist in a regular hospital for examination.

(7). Encourage the use of barrier tools such as condoms.

(8). Eliminate anxiety and actively cooperate with the doctor for treatment.

(9). Drink more water during treatment to reduce the concentration of urine and reduce irritation to the urethra.

(10). Do not drink alcohol, as drinking alcohol can increase congestion in the urethra and make inflammation more severe.

(11). Pay attention to the hygiene of normal sexual life and establish good personal hygiene habits.