2. • Gonorrhea - infectious venereal sexually transmitted disease, caused
by gonococci.
• Primarily affects the genitals bodies with cylindrical and glandular
epithelium, mucous membranes shells covered with multi-layer
squamous epithelium
3. Etiology
• • Gonococci (Neisseria gonorrhoeae) - gram-negative diplococci,
bean-shaped, located in pairs, adjacent to each other the concave
side of a small size.
• Have a delicate capsule and pily. In a purulent discharge characteristic
location gonococcus inside and outside phagocytic cells – leukocytes
(incomplete phagocytosis).
4. • Unfavorable conditions:
• 1) antiseptics
• 2) t> 56 and t <18,
• drying, direct sunlight
• Favorable conditions:
• 1) pus
• 2) inside a person
• 3) cylindrical epithelium
5. Risk Factors for GC Infection
• Adolescents > age 20-25 years > older
• Multiple sex partners
• Inconsistent use of barrier methods
• High prevalence in sexual network
• Previously transferred gonorrhea and other genital infections;
6. Classification
• 1.Gonorrhea fresh (up to 2 months old):
• • acute
• • subacute
• • torpid (oligosymptomatic)
• 2.Chronic (more than 2 months old),
• • torpid current, aggravation under the influence of provoking factors
• 3. Latent gonorrhea (no inflammatory reaction on the mucosa)
• Also available: disseminated, extragenital and gonorrhea of pregnant
women.
7. Gonorrhea in men: "gonorrheal urethritis"
• ❑ Clinic for acute gonorrheal urethritis:
• ▪ cutting pains at the beginning of urination
• ▪ copious purulent discharge, yellowish or
brownish color
• ▪ hyperemia and edema of the urethral sponges
• ▪ soreness of the hanging section urethra
• ▪ cloudy urine from pus.
• ❑ Clinic ̆Subacute urethritis (after 3-10 days):
• ▪ moderate itching and cramps when urinating
• ▪ scanty, mainly morning serous discharge
• ▪ less pronounced hyperemia and edema of the
sponges urethra
• ❑ Clinic for Torpid Urethritis:
• ▪ Allocations are scarce
• ▪ No pain or itching
• ▪ No edema of the urethral sponges
• ▪ 2nd portion of urine may be clear
8. • Acute total gonorrheal urethritis
• • more frequent urge to urinate
• • pain and pain appear at the end of the act urination
• • terminal hematuria
• • frequent painful erections and emissions
• • hemospermia
• • urine becomes cloudy from pus in both portions.
9. • Chronic gonorrheal urethritis
• Characteristic:
• • Inflammation of the mucous membrane, lacunae and glands
• • flows torpidly or asymptomatically
• • Is there soft or hard infiltrate
• • granulation and desquamation of urethra
• • endourethral complications
• • bonding of the urethral lips in the morning
10. Complications
• • - littreite
• • - colliculitis
• • - skin lesions in the form of erosion and ulceration
• • - lymphangitis
• • - inguinal lymphadenitis
• • - morganitis (inflammation of the lacunae Morgagni)
• • - paraurethritis
• • –periurethritis
• • - cooperite
• • - acute prostatitis
• • - vesiculitis
• • –epididymitis acute
11. Gonorrhea in women
Based on the features the structure of the
genitourinary organs in women secrete
• ❖ Lower gonorrhea:
• • - urethritis
• • - vaginitis
• • –endocervicitis
• • - bartholinitis
• ❖ Ascending gonorrhea:
• • - endometritis
• • - pelvioperitonitis
12. • Extragenital gonorrhea
• • - gonorrheal proctitis (defeat of the lower third of the straight bow)
• • - oropharyngeal gonorrhea(tonsils and pharynx)
• • - eye gonorrhea
13. • Microbiological diagnostics.
• • Bacterioscopic (microscopic) method - coloring of two strokes:
• 1.According to Gram;2.1% methylene blue aqueous solution and 1%
alcoholic solution of eosin.
• • Bacteriological method Allows to assess sensitivity of gonococci to
antimicrobial drugs.
• • Serological method: CFT(complement fixation test, BordeJangu's
reaction) or indirect hemagglutination test with patient's blood serum.
• • Molecular biological method
• • The final conclusion is possible only on the basis of Gram coloring, and at
detection of typical gram-negative diplococci inside neutrophils.
14. • Diagnosis
• • Anamnesis data
• • Laboratory research
• • Clinic
• • Two-glass sample
15. treatment
• 1.Etiological:
• • drugs of the penicillin group: benzylpenicillin
• injected intramuscularly with 600,000 units, then 300,000 units
• after 3 hours, with fresh build and subacute gonorrhea course
• dose 3.4 million units, with fresh torpid, uncomplicated
• acute, subacutely complicated or chronic gonorrhea -
• 4.2-6.8 million units depending on the severity of the disease.
16. • 2.Immunotherapy
• • (specific-gonococcal vaccine intramuscularly with
• 300-400 million microbial bodies with an interval of 1-2 days; in
• depending on the reaction, the dose is increased by 150-300 million
• microbial bodies, non-specific-pyrogenal, methyluracil,
• prodigiosan ..)
17. • 3.Local:
• • with fresh torpid and chronic gonorrheal urethritis in
• men are carried out by daily washing of the urethra
• solutions of potassium permanganate (1: 6000-1: 10,000),
• chlorhexidine (1: 5000). As well as the treatment of all complications.
18. • Cure criteria
• • 1) persistent absence gonococcus in discharge urethra, scraping,
urine
• • 2) palpation of the prostate and seminal vesicles without changes,
normal the content of leukocytes in their secret
• • 3) lack of inflammation
20. Epidemiology
• There are 3 types of Trichomonas that are encountered man:
• oral (tenax, elongata);
• intestinal (hominis or abdominalis);
• vaginal (vaginalis).
21. The greatest pathogenicity is Trichomonas
vaginalis, living exclusively in the urogenital tract.
• It has been established that T. tenax lives on teeth affected by caries,
and T. hominis is a commensal of the colon flora, and sometimes leads
to the appearance of dyspeptic disorders.
• The non-protein shell contributes resistance to antibiotics, but is
destroyed by the appointment of antiprotozoal drugs.
After chlamydial and gonococcal infections, trichomoniasis takes 3rd
place among all STIs.
• Trichomonas vaginalis has 5 flagella, their location provides
translational undulating movements. Way transmission of infection -
sexual. The causative agent is extremely rare found in postmenopausal
women and virgins.
22. Properties of Trichomonas vaginalis
1.Has a pear-shaped body
2.Size 18 - 40 microns
3.Movable (organelle movement tourniquet and undulating
membrane)
4.Capable of forming pseudopodia
5.Loses mobility under unfavorable conditions
6. Reproduces by longitudinal action
7. Unstable in the external environment
8. The optimal pH value is 5.2 - 6.2.
23. Signs of Trichomonas infection
• There is no specific clinical signs of Trichomonas infection.
• In the acute process, there are abundant, irritating skin, discharge,
severe itching of the genitals, after a month the clinic becomes less
pronounced, until complete absence of symptoms and their periodic
appearance under the influence of provoking factors.
24. • Some patients have completely no symptoms of Trichomonas
infection, asymptomatic carriage, according to different data, ranges
from 10 to 30% in men, in 90% of cases pathology is diagnosed
already in a chronic form.
• Based on some clinical manifestations, the diagnosis is considered
unverified, a similar picture may be for many diseases: candidiasis,
nonspecific inflammation, venereal diseases, etc.
• When examining a patient, age is taken into account, since at a more
mature age, the immune system weakens, which means clinical
manifestations may be obliterated.
25. Forms of urogenital trichomoniasis:
• sharp;
• subacute;
• torpid (sluggish).
• For the infection to become chronic, need only 4 weeks to postpone
specific therapy
• Urogenital trichomoniasis can occur in the form of a single infections,
mixed or combined form, this must be taken into account when carrying
out complex diagnostics.
• Recently, there has been a tendency to decrease morbidity in some
regions, but the situation is not ubiquitous
26. Complications of trichomoniasis
• Trichomonas often provoke inflammation in the prostate gland, which in some cases
leads to impaired fertility. Trichomoniasis more often occurs in men than women in the
form of carriage. In this case, the person feels healthy, but can infect a partner.
• The diagnosis is confirmed by laboratory tests.
• According to the study, in patients with chronic inflammatory process in the prostate was
diagnosed in 30% of case concomitant trichomoniasis.
• In women, these pathogens affect poor pregnancy outcomes, development of infertility
and chronic inflammatory processes of organs small pelvis.
• During childbirth, in 5% of cases, the baby becomes infected, but due to features of the
epithelium, self-healing can occur.
• Intrauterine infection of the fetus with trichomoniasis can lead to fatal consequences.
• Even girls can face the infection, in whom the consequence can be a chronic salpingo-
oophoritis, which in upon reaching fertile age is complicated by pathologies in the
reproductive system.
27. Diagnostics of the urogenital trichomoniasis:
Material for research - pathological discharge, washings, urine
• Diagnostic methods:
• 1. Microscopy (native and stained preparations)
• 2. Bacteriological (cultural) method
• 3.Serological methods
• 4.DNA methods
28. Treatment of urogenital trichomoniasis:
Recommended schemes:
• Ornidazole 1.5 g orally once
before bedtime,
• or Metronidazole 2.0 g orally
once.
Alternative schemes:
• Ornidazole 500 mg orally every
12 hours 5days,
• or Metronidazole 500 mg orally
every 12 hours 7 days
30. • Bacterial vaginosis (BV) is a disease with characteristic abundant and
prolonged vaginal discharge, often with an unpleasant odor. They do
not contain gonococci, Trichomonas and fungi.
31. Etiology
• Bacterial vaginosis results from overgrowth of one of several bacteria
naturally found in vagina. Usually, "good" bacteria (lactobacilli)
outnumber "bad" bacteria (anaerobes). But if there are too many
anaerobic bacteria, they upset the natural balance of microorganisms
in vagina and cause bacterial vaginosis.
• The use of the term "bacterial" is due to the fact that the disease is
caused by polymicrobial microflora:
• Microaerophilic (Gardnerella vaginalis)
• Obligate-anaerobic (Bacteroides spp, Prevotella spp., Mobiluncus
spp., Leptotpichia spp., Etc .;
• vaginosis - since, unlike vaginitis, there are no signs of an
inflammatory reaction of the vaginal mucosa
32.
33. Risk factors
• Having multiple sex partners or a new sex partner - the condition
occurs more often in women who have multiple sex partners or a new
sex partner.
• Douching. The practice of rinsing out vagina with water or a cleansing
agent (douching) upsets the natural balance of the vagina. This can
lead to an overgrowth of anaerobic bacteria, and cause bacterial
vaginosis. Since the vagina is self-cleaning, douching isn't necessary.
• Natural lack of lactobacilli bacteria. If natural vaginal environment
doesn't produce enough good lactobacilli bacteria more likely to
develop bacterial vaginosis.
34. Symptoms
• Thin, gray, white or green vaginal discharge
• Foul-smelling "fishy" vaginal odor
• Vaginal itching
• Burning during urination
• Many women with bacterial vaginosis have no signs or symptoms.
35. Complications
• Bacterial vaginosis doesn't generally cause complications. Sometimes, having
bacterial vaginosis may lead to:
• Preterm birth. In pregnant women, bacterial vaginosis is linked to premature
deliveries and low birth weight babies.
• Sexually transmitted infections. Having bacterial vaginosis makes women more
susceptible to sexually transmitted infections, such as HIV, herpes simplex virus,
chlamydia or gonorrhea.
• Infection risk after gynecologic surgery. Having bacterial vaginosis may increase
the risk of developing a post-surgical infection after procedures such as
hysterectomy or dilation and curettage (D&C).
• Pelvic inflammatory disease (PID). Bacterial vaginosis can sometimes cause PID,
an infection of the uterus and the fallopian tubes that can increase the risk of
infertility.
36.
37.
38.
39. Treatment
• Recommended Regimens
• Metronidazole 500 mg orally twice a day for 7 days
• OR
• Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once
a day for 5 days
• OR
• Clindamycin cream 2%, one full applicator (5 g) intravaginally at
bedtime for 7 days
40. • Alternative Regimens
• Tinidazole 2 g orally once daily for 2 days
• OR
• Tinidazole 1 g orally once daily for 5 days
• OR
• Clindamycin 300 mg orally twice daily for 7 days
• OR
• Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days*
• *Clindamycin ovules use an oleaginous base that might weaken latex or rubber
products (e.g., condoms and vaginal contraceptive diaphragms). Use of such
products within 72 hours following treatment with clindamycin ovules is not
recommended.
