淋病

　　淋病的发病原因有哪些？它主要是通过以下两种方式进行传染：

　　1、通过性接触传染：主要是通过性交或其他性行为传染。男性淋病几乎都是由性交接触引起的；女性淋病也可由性交直接感染，也可由其他方式感染。淋病患者是传染源，接触是淋病主要传播方式，传播速度快而且感染率很高，感染后3-5天即可发病。

　　2. Non-sexual contact transmission (indirect transmission):This situation is rare, mainly due to contact with the secretions containing Neisseria gonorrhoeae from patients or contaminated articles, such as towels, foot coverings, foot basins, bedding, and even the toilet bowl rings, etc., which can be transmitted. Especially women (including young girls) are more prone to infection due to the short urethra and reproductive tract.

　　Patients with gonorrhea should actively seek treatment during the illness to prevent the occurrence of complications. The following briefly describes common complications:

　　I. Common Complications of Gonorrhea in Men

　　1. Gonococcal balanoposthitis: Caused by the purulent secretion of gonorrhea irritating the glans and inner prepuce. Initially, there is local burning, itching, slight pain, prepuce edema, and erosion of the inner prepuce. The glans becomes red and slightly eroded, and in severe cases, the prepuce becomes significantly swollen, cannot be flipped up, the glans swells, and secondary inflammatory phimosis may occur.

　　2. Gonococcal paraurethritis: The paraurethra usually opens around the urethral orifice, or at the frenulum, or along the midline skin on the dorsal side of the penis. If a patient with gonorrhea has such a paraurethra, it is easy to be involved and develop a marked inflammation. Gonococci can be found in purulent secretion, making it one of the sources of gonorrhea transmission.

　　3. Gonococcal urethral stricture: Chronic gonorrhea may cause urethral stricture after several months or years, initially with no sensation, gradually leading to poor urination, frequent urination, thin and weak urine stream, unable to be射 directly, and eventually unable to urinate or only dribble. Progressive urethral stricture, if not treated early, can have extremely poor consequences, sometimes even life-threatening.

　　4. Gonococcal prostatitis: It is divided into acute and chronic types. Acute prostatitis is one of the complications of gonococcal posterior urethritis. It often occurs in the third week of gonorrhea, with frequent urination, dysuria, especially severe pain after urination, dull pain around the perineum and near the anus, and pain during defecation. Digital rectal examination shows prostatic swelling, uneven surface, pain upon palpation, and purulent secretion often flowing from the urethra. Chronic prostatitis, if the acute prostatitis is not treated thoroughly, is prone to transform into chronic prostatitis. It is characterized by a sense of坠胀, tenderness, frequent urination, and often lower back pain. Digital rectal examination shows prostatic enlargement, multiple hard nodules, tenderness upon palpation, sticky secretion during palpation, and leukocytes in the examination.

　　5. Gonococcal epididymitis: This condition is caused by Neisseria gonorrhoeae entering the epididymis through the ejaculatory duct. It is one of the most common complications of acute posterior urethral gonorrhea. It is characterized by epididymal swelling, firm nodules on the surface, often with radiating pain, and the body temperature rising to about 39 degrees Celsius during the acute stage.

　　6. Gonococcal seminal vesiculitis: Neisseria gonorrhoeae invades through the ejaculatory duct, vas deferens, or lymphatic duct. There is a feeling of坠胀 in the perineum, which worsens during urination and defecation, with a hernial pain radiating to the vas deferens and testicles, and clear urine.

　　7. In female infants and pre-adolescent girls, there may be vulvar irritation, erythema, edema accompanied by purulent vaginal discharge and proctitis. The child may complain of dysuria or difficulty in urination, and the parent may find that the child's underwear is soiled.

　　II. Common Complications of Gonorrhea in Women

　　Gonorrhea in women, especially when the cervix is infected with Neisseria gonorrhoeae, can lead to infections of the upper reproductive system, causing severe gonorrhea, such as pelvic inflammatory disease, including endometritis, salpingitis, ovarian cysts, pelvic abscess, peritonitis, and so on.

　　1、子宫内膜炎：一般发生在有淋病而经过生产或早产的妇女，患者有白带增多、腹痛、子宫肿大疼痛，急性者体温升高。

　　2、输卵管炎：常在月经后2～3大发病，患者有发热、畏寒、全身不适、呕吐、下腹部和腰部有阵痛，可放射到会阴部。白带多而带脓血，触诊时下腹两侧有触痛，可摸到有压痛的小肿块，子宫也有压痛。若治疗不及时、不彻底成为慢性输卵管炎，可引起宫外孕，输卵管因发炎后可致粘连，积水或积脓，两侧均发生者可导致不孕。

　　男性淋病患者潜伏期为2~14日，通常以尿道轻度不适起病，数小时后出现尿痛和脓性分泌物。当病变扩展至后尿道时，可出现尿频、尿急。检查可见脓性黄绿色尿道分泌物，尿道口红肿。

　　女性淋病患者通常在感染后7~12日开始出现症状，虽然症状一般开始轻微，但有时开始就很严重，有尿痛、尿频和脓性阴道分泌物。子宫颈和较深部位的生殖器官是最常被感染的部位，其次依次为尿道、直肠、尿道旁腺管和前庭大腺。子宫颈可发红变脆，伴有粘液脓性或脓性分泌物。压迫耻骨联合时，可从尿道、尿道旁腺管或前庭大腺挤出脓液。输卵管炎是常见的并发症。

　　同性恋者，直肠淋病常见。女性常无症状，但可有肛周症状和直肠分泌物。男性同性恋者，严重直肠感染较常见。患者可以发现粪便包有粘液脓性分泌物，并诉排便或直肠交媾时疼痛。口-生殖器接触所致的淋菌性咽炎通常无症状，但有些患者可诉喉痛和吞咽不适；咽和扁桃体发红，偶有水肿。

　　女性婴儿和青春前期少女淋病患者，可有外阴部刺激、红斑、水肿伴脓性阴道分泌物及直肠炎。患儿可诉尿痛或排尿困难，家长可发现其内裤有污染。

　　淋病是危害较大的性病之一，但是淋病的传染有它独特的途径，大可不必谈虎色变、危言耸听。以下措施可以有效预防淋病：

　　1、宣传性传播疾病知识，提倡高尚的道德情操，严禁嫖娼卖淫。

　　2、使用安全套，可降低淋球菌感染发病率。

　　3、预防性使用抗生素，可减少感染的危险。可在性交前后各服用氟哌酸或阿莫西林，可有效的预防性病的感染。

　　4、性伴同时治疗。

　　5、患者注意个人卫生与隔离，不与家人、小孩尤其女孩同床、同浴。

　　6、执行新生儿硝酸银溶液或其他抗生素液滴眼的制度，防止发生淋菌性眼炎。

　　Laboratory examination of Neisseria gonorrhoeae includes smear examination, culture examination of Neisseria gonorrhoeae, antigen detection, drug sensitivity test, and determination of penicillinase-producing Neisseria gonorrhoeae (PPNG), and gene diagnosis.

　　1. Smear examination

　　Obtain the patient's urethral discharge or cervical secretion, perform Gram staining, and Gram-negative diplococci can be found in polymorphonuclear leukocytes. For patients with simple urethritis with a large amount of purulent secretion, the positive rate of this method is about 90%, and a preliminary diagnosis can be made.

　　2. Culture examination

　　Culturing Neisseria gonorrhoeae is an important ancillary method for diagnosis. The culture method is a sensitive method for male and female patients with mild symptoms or without symptoms. A positive culture can be diagnosed. Before the advent of gene diagnosis, culture was the only method recommended by the World Health Organization for screening gonorrhea.

　　3. Antigen detection

　　1. Solid-phase enzyme immunoassay (EIA): Can be used to detect Neisseria gonorrhoeae antigens in clinical specimens. It is used in areas with a high prevalence of gonorrhea where culture cannot be performed or specimens need to be transported long distances. It can be used to diagnose Neisseria gonorrhoeae infection in women.

　　2. Direct immunofluorescence test: Direct immunofluorescence test is performed by detecting the monoclonal antibody to the outer membrane protein I of Neisseria gonorrhoeae. However, at present, the sensitivity is not high and the specificity is poor in both male and female specimens, and due to the judgment level of the experimenters, this test cannot be recommended for the diagnosis of Neisseria gonorrhoeae infection.

　　4. Gene diagnosis

　　1. Gene probe diagnosis of Neisseria gonorrhoeae. The probes used in this diagnosis include plasmid DNA probes, chromosome gene probes, and RNA gene probes.

　　2. Gene amplification detection of Neisseria gonorrhoeae.Polymerase chain reaction (PCR). The emergence of PCR technology and ligase chain reaction has further improved the sensitivity of detecting Neisseria gonorrhoeae, which has the advantages of rapidity, sensitivity, specificity, and simplicity, and can directly detect extremely low concentrations of pathogens in clinical specimens.

　　The main symptoms of gonorrhea are purulent infection of the urinary system. Patients with gonorrhea should actively seek treatment and pay attention to dietary taboos during the treatment period:

　　1. Foods to be eaten

　　1. Patients with gonorrhea should eat light foods. During the acute attack, they should eat congee, noodles, silver ear soup, mung bean soup, and cooling and detoxifying fruits and vegetables, etc.

　　5. Patients with gonorrhea should eat foods rich in protein and vitamins. After the condition stabilizes, they should eat cakes, wontons, dumplings, milk, soy milk, eggs, lean pork, shrimp, fresh vegetables, and fruits, etc. Sweet and salty flavors can be mixed, with small amounts taken multiple times. They should also drink plenty of water to promote the excretion of toxins.

　　3. Food therapy methods

　　(1) Take 60 grams of lotus seeds (with the core removed), 10 grams of licorice root, boil them together until the lotus seeds are soft, add an appropriate amount of rock sugar. Eat the lotus seeds and drink the soup.

　　(2) Grind 3 grams of rhubarb into powder, take one egg, make a small hole in it, put the medicine powder in, seal the hole with wet paper, and steam until cooked, once a day.

　　(3) Radish 1500 grams, washed, peeled, sliced, soaked in an appropriate amount of honey for 10 minutes, dried on a tile, soaked and dried again (do not burn), for a total of 3 times. Chew several slices each time, taken with salt water, 4-5 times a day.

　　Second, Foods to Avoid

　　Patients with gonorrhea should avoid spicy and irritating foods such as chili, pepper, ginger, scallion, mustard, alcohol, strong tea, etc.; eat less dry and hot foods that can cause fire, such as leek, sauerkraut, rapeseed, coriander, mutton, etc.

　　Gonorrhea is a highly contagious and recurrent sexually transmitted disease, often accompanied by chlamydia and other infections. Neisseria gonorrhoeae is prone to drug resistance, and complications and sequelae are easy to occur.

　　First, Treatment Principles

　　1. Early diagnosis and early treatment.

　　2. Take timely, adequate, and regular medication.

　　3. Adopt different treatment methods according to different conditions.

　　4. Trace the sexual partners and treat them at the same time.

　　5. Follow-up examination after treatment.

　　6. Pay attention to the presence of chlamydia, mycoplasma infection, and other STDs infection at the same time.

　　Second, Treatment Plan

　　1. Gonococcal urethritis and cervicitis: procaine penicillin G, 4.8 million units added to 100 ml normal saline intravenously; or ampicillin 4.0g orally once; or can also be used by injection intravenously; or cefametin 4.0g taken all at once.

　　2. Gonococcal pharyngitis: ceftriaxone sodium 3.0g intravenously; or ofloxacin 250mg orally three times a day, or Bactrim 1g per dose, twice a day for a total of 7 days.

　　3. Gonococcal proctitis: ceftriaxone sodium 3.0g intravenously; or Leflunomide 3.0g intravenously; or Cefoperazone 3.0g intravenously.

　　4. Gonococcal conjunctivitis: 10 million units of penicillin G in solution intravenously once a day for a total of 5 days.

　　5. Children weighing more than 45kg should be treated with adult dosage. Children weighing less than 45kg should be treated as follows: ceftriaxone sodium 125mg, once intramuscular injection; or Leflunomide 25mg/kg, once intramuscular injection; or Spectinomycin 40mg/kg, once intramuscular injection.

　　6. Gonorrhea with complications:

　　(1) Gonorrhea complicated with salpingitis and epididymitis, 4.8 million units of procaine penicillin G in solution intravenously twice a day for a total of 7 days.

　　(2) Disseminated gonorrhea: 10 million units of penicillin G in solution intravenously once a day for a total of 7 days; or ceftriaxone sodium 3.0g intravenously once a day for a total of 7 days.