1, uncomplicated gonorrhea
(1) male uncomplicated gonorrhea
Acute gonorrheal urethritis (acute gonorrhea): the incubation period is 1-14 days, often 2-5 days. At first, it is acute anterior urethritis, urethral urethral erythema, redness, swelling, itching and slight tingling, followed by thin mucus outflow, causing urinary discomfort, about 2 days later, the secretion becomes viscous, the urethral urethral urethra overflows with pus, pus is dark yellow or yellowish-green, accompanied by the aggravation of urethral discomfort, the redness and swelling develops to the whole penis glans and part of the urethra, there are frequent urination, urgency of urination, urinary pain, difficulty in urination, difficulty in mobility, and at night, the penis often has a Painful erection. There may be inguinal lymph node enlargement, redness and pain, may also be pus. Acute symptoms are most severe in the first week, and if left untreated, the symptoms gradually decrease or disappear in about one month. Acute anterior urethritis 2 weeks after the onset of the disease, about 50-70% of patients have gonococcal invasion of the posterior urethra, manifested as urinary distress, urinary frequency, acute urinary retention. Painful urination is characterized by pain or increased pain at the end of urination, with a pins and needles pattern, sometimes perineal cramps, and hematuria at the end of urination may occur. The symptoms gradually disappear after 1-2 weeks. Systemic symptoms are generally mild, a few may have fever up to about 38 ℃, general malaise, loss of appetite and so on.
Chronic gonococcal urethritis (chronic gonorrhea): symptoms lasting more than 2 months is called chronic gonococcal urethritis. Because the treatment is not complete, the gonococcus can be hidden in the urethral body, urethral gland, urethral crypt so that the course of the disease into chronic. If the patient is weak, suffering from anemia, tuberculosis, the condition of the beginning of the chronic process, mostly for the anterior and posterior urethra combined infection, good invasion of the urethral bulb, membrane and prostate. Clinical manifestations of the urethra often itchy, burning sensation or mild tingling during urination, thin urine stream, urinary weakness, dribbling. Most patients have a small amount of plasma crust seal in the urethra in the early morning, if squeezing the pubic area or the root of the penis commonly thin mucus overflow. The urine is basically clear, but there are gonorrhea.
(2) Women without comorbid gonorrhea
The main site of primary gonococcal infection in women is the uterine cervix, where the gonococcus is able to attach to the stratified squamous epithelium, and the site of gonococcal infection is observed by electron microscopy to be the squamous-columnar epithelial junction of the uterine cervix. Patients with gonorrheal cervicitis are often asymptomatic in the early stages, making the incubation period difficult to determine. There is congestion of the cervix, tenderness, an increase in purulent discharge, often a tingling and burning sensation in the vulva, and occasionally lower abdominal pain and lumbago. These atypical symptoms make patients often do not go to the clinic for treatment, thus becoming the main source of infection; gonococcal urethritis often occurs 2-5 days after sexual intercourse, with congestion of the urethral orifice, tenderness and purulent discharge, mild urinary frequency, urgency, urinary pain, burning sensation during urination, and purulent secretion when pressing on the urethra; gonococcal vestibular dacryocystitis is often unilateral, with redness and swelling in the opening of the glands and severe pain, and in severe cases abscesses can be formed. There are systemic symptoms such as fever; gonococcal vaginitis is less common, and those with a long course of the disease have mild symptoms; some patients have abdominal cramps, lumbar and back pain, more leukorrhea, and some patients have lower abdominal pain and excessive menstruation, etc.; gonococcal vulvovaginitis in women is manifested as inflammation of the vulva and vagina. There is more pus discharge from the vagina, sometimes yellow-green discharge from the vagina and urethra, painful urination, and redness and swelling of the vulva. The discharge may flow to the anus, causing irritation. In severe cases, it can infect the rectum and cause gonorrheal proctitis.
2, with comorbid gonorrhea
(1) men with comorbid gonorrhea:
Gonorrheal urethritis has a variety of comorbidities, mainly prostatitis, seminal vesiculitis, epididymitis.
a. Prostatitis: Acute prostatitis is caused by gonococcus entering the excretory ducts and glands of the prostate, with symptoms of urinary tract infection such as fever,
chills, perineal pain and accompanying urinary difficulty. The prostate is swollen and painful on examination. But gonococcus is not a common cause of acute prostatitis. Gonococcus caused by the prostate is mainly manifested as chronic lesions, its symptoms are mild, perineal discomfort, penile pain, the morning urethra has a "paste" phenomenon, see gonorrhea in the urine, prostate massage fluid with pus balls and lecithin reduction, smear or culture to find the gonococcus, anus diagnosis in the prostate can be touched on a small nodule, and there is discomfort or pain. In the drainage tube near the discharge of pus to form a scarring contraction affects ejaculation, resulting in infertility.
b. Epididymitis: usually occurs after acute urethritis, unilateral predominance. There is low-grade fever, painful swelling of the epididymis, reflex cramps in the inguinal and lower abdomen on the same side, initially with a clear boundary with the testicle, gradually unclear, testicular tenderness, swelling, severe tenderness. Urine is often cloudy. At the same time there can be prostatitis and seminal vesiculitis.
c. Seminal vesiculitis: Acute with fever, urinary frequency, urgency, painful urination, and eventually cloudy urine with blood. Rectal examination can touch the enlarged seminal vesicles at the same time there is severe tenderness, chronic seminal vesiculitis is usually no conscious symptoms, rectal examination of the seminal vesicles hard, there is fibrosis.
d. Urethral bulbourethritis: occurs in the perineum or its left and right, the appearance of finger-sized nodules, pain, acute may be pus breakthrough, compression of the urethra and urinary difficulties, there may be fever and other systemic symptoms, the progress is slow.
e. Urethral stenosis: repeated occurrences can cause urethral stenosis, a small number of vas deferens stenosis or obstruction, there is difficulty in urination, thinning of the urinary line, and in severe cases, urinary retention. Secondary to vasal stenosis, seminal vesicle cysts and infertility.
(2) women have comorbid gonorrhea
The main comorbidities of gonorrhea in women are gonorrheal box inflammation, such as acute tubulitis, endometritis, secondary tubo-ovarian abscess and its rupture caused by the pelvic abscess, peritonitis and so on. Most of them have sudden onset after menstruation, with high fever, chills, headache, nausea, vomiting, lower abdominal pain, and increased purulent leukorrhea. Bilateral adnexal thickening and pressure pain.
3, other parts of gonorrhea:
a. Gonorrheal conjunctivitis: newborns more than 2-3 days after birth symptoms, mostly bilateral, eyelid redness, swelling, purulent discharge, adults more than self-inoculation, often unilateral, the performance of the same newborns. Due to pus spillage, want to call "pus leakage eye" once delayed treatment, the cornea is steamy, corneal perforation. This can lead to blindness.
b. Gonococcal pharyngitis: mainly seen in oral sex, the so-called "oral *" Western homosexual or heterosexual people, manifested as acute pharyngitis or acute tonsillitis, occasionally accompanied by fever and cervical lymph node enlargement. There are symptoms such as dry and uncomfortable throat, sore throat, and painful swallowing.
c. Gonococcal anorectitis: mainly seen in male homosexuals. Women are often caused by vaginal self-infection. The manifestations are acute and severe, with pus and blood stool, anal canal mucosal congestion, purulent discharge, positive gonococcal culture.
4, disseminated gonococcal infection
Disseminated gonococcal infection is due to the gonococcus through the bloodstream spread to the whole body, the emergence of more serious systemic infection. The incidence rate is about 1% of gonorrhea patients. The strain that causes disseminated gonococcal infection is mostly AHU-nutritional type, which has stable resistance to normal human serum, in addition, normal human serum has IgM antibodies against gonococcal lipopolysaccharide, with the assistance of complement, most gonococci are bactericidal, and patients lacking complement components such as C5, C6, C7 and C8 are prone to gonococcal sepsis or gonococcal meningitis.
(1) Gonococcal sepsis: patients begin to fever, body temperature can be as high as 40 ℃, but usually is between 38 ℃ -40 ℃, chills but uncommon, there are some patients occurring skin papules, petechiae, pustular, hemorrhagic or necrotic skin lesions, and some of the lesions have painful symptoms. In the skin lesions, gonococci were detected by fluorescent immunostaining or cultured for gonococcal growth, and PCR was positive for gonococcal DNA. The pathologic histology of the skin lesions showed superficial ulceration with pus formation, diffuse inflammation of the dermis and subcutaneous tissues with infiltration of polymorphonuclear leukocytes, and involvement of small blood vessels with thrombosis and limited necrosis.
(2) Gonococcal arthritis: swelling and pain in the joints, one or several septic arthritis. It is usually asymmetric and rarely involves the hip, shoulder and spinal joints. Joint fluid tests have the presence of N. gonorrhoeae, which can lead to bone destruction causing fibrosis and osteoarticular ankylosis.
(3) gonococcal keratosis: may be due to gonococcus or its toxins, the lesions can not be found gonococcus, often with gonococcal arthritis, lesions for the hands and feet, ankle and heel and waist. The lesions are usually flat, keratotic, slightly elevated patches or plaques that are conical, yellow, or copper-red or grayish-white. The lesions on the palms and metatarsals are hyperkeratotic with large areas of keratinization.
(4) Gonococcal endocarditis: gonococcus was the main pathogen of endocarditis in the decades before the use of antibiotics, and now gonococcal endocarditis is almost impossible to see, gonococcal endocarditis and other types of endocarditis have the same clinical manifestations. In endocarditis, the aortic or mitral valve is often involved, and death results from subacute or acute endocarditis caused by rapid destruction of the valve.
(5) Gonococcal meningitis: uncommon, may be accompanied by arthritis and a typical rash to distinguish meningococcal meningitis.
5, gonorrhea on pregnancy and newborn
When female gonorrhea is complicated with salpingitis, it can lead to infertility. The incidence of infertility caused by female gonorrhea is about 20%, and the incidence of infertility increases with the number of infections. For women with more than three gonorrhea infections, the incidence of infertility can be as high as 70%. Gonorrhea of the cervix can lead to early rupture of membranes, infection of the amniotic cavity, intrauterine infection, intrauterine growth retardation, and preterm labor. Newborns have a high incidence of sepsis and mortality due to prematurity and low birth weight. Postpartum gonococcal upstream infection can cause endometritis, puerperal fever, and in severe cases cause postpartum sepsis, neonatal gonorrheal conjunctivitis and gonococcal women's vulvovaginitis.