Gonorrhea: the disease of "semen expiration" becomes a threat to children

This disease was called "gonorrhea" thanks to the ancient Greek physician Galen, who considered purulent discharge from the male penis "the expiration of the seed." Today, gonorrhea has not only become one of the most common infections in the world, but has also rapidly become younger - this diagnosis is increasingly being made to very young people and even children. How did children end up at risk for a disease that is traditionally considered a sexually transmitted disease?

According to the WHO, gonococci affect 150 to 180 million people worldwide every year, and due to the increase in the incidence among adults, cases of gonorrhea in children have become significantly more frequent. The reason for this infection is that gonorrhea is easily transmitted not only through sexual intercourse, but also through everyday contact, as well as from a sick mother to a fetus or a newborn who has passed through an infected birth canal.

About 95% of children become infected with gonorrhea in the domestic way, which is associated with the peculiarities of the structure of their genital organs, and girls are infected 10-15 times more often than boys. According to some studies, in 75% of cases, the source of gonococcal infection becomes an infected mother of a child, who can bring gonococci into her daughter's genital tract during intimate hygiene procedures; less often, the closest relatives and attendants of hospitals, maternity hospitals, and children's institutions become the cause of infection.

The spread of gonococcal infection among children in childcare facilities occurs when sharing chamber pots, shared intimate toilet items, as well as in the case of games using the genitals. Outbreaks of infection in children's groups are facilitated by overcrowding, which occurs in kindergartens, holiday camps, and children's sanatoriums.

Increasingly, gonorrhea is diagnosed in children between 5 and 12 years of age. According to experts, the incidence of gonorrhea at this age is highly dependent on fluctuations in immunity and hormonal status. Thus, in the neonatal period, this disease is rarely observed, unless the child was infected at birth, because at this time passive maternal immunity and its estrogenic hormones are still operating.

When a girl is 2-3 years old, protective maternal antibodies are depleted and estrogen levels are reduced. During this period, the state of the mucous membrane of the external genital organs and the vagina changes in the child. In the cells of the cylindrical epithelium, the content of glycogen decreases, the activity of diastase decreases, the vaginal discharge acquires an alkaline or neutral reaction, Dederlein's sticks disappear and the pathological microbial flora is activated. That is why, between the ages of 3 and 12, children are prone to gonorrhea with non-sexual infection. Later, the functions of the endocrine glands are activated in them, the level of glycogen in the epithelial cells increases, the pH becomes acidic and the population of Dederlein sticks is restored, displacing the pathogenic flora.

Clinical picture

Immediately after contact with gonococci, the mucous membranes of the genital organs are affected, but subjective and objective symptoms of the disease appear after an incubation period (from 1-2 days to 2-3 weeks). In girls, gonorrhea occurs, as a rule, causing inflammation of the vulva, vagina, urethra, and labia majora. Children complain of pain, burning and itching in the vulva, pain during urination. In the lesions, there is a sharp swelling, hyperemia of the mucous membrane and abundant mucopurulent discharge. With insufficient care, the skin of adjacent areas is irritated, becomes loose and inflamed. Purulent-mucous discharge, drying into crusts, often causes dermatitis, as well as intertriginous eczema. An active inflammatory process may be accompanied by an increase in inguinal lymph nodes.

Gonorrhea in boys is less acute and with fewer complications, since their prostate gland and seminal vesicles are poorly developed before puberty, the glandular apparatus of the urethra is underdeveloped.

If a girl's gonorrhea is not diagnosed in a timely manner, it can become chronic. The reasons for the fact that the disease was not noticed in time can be different - for example, if it developed simultaneously with severe bronchitis or inflammation that required antibiotic treatment. Sometimes chronic gonorrhea is discovered during a dispensary examination, or parents accidentally notice suspicious stains on a child's underwear. In chronic gonorrhea, girls have slight swelling and hyperemia of the mucous membrane of the posterior commissure of the lips and folds of the hymen. The urethra is always affected, but the symptoms of inflammation are mild, dysuric phenomena are insignificant or completely absent.

Diagnosis

Laboratory findings are critical in making a diagnosis of gonorrhea. The necessary study of the discharge is carried out with obligatory staining with methylene blue and Gram, sowing of the discharge on special nutrient media. If typical gonococci are found in the preparations during bacterioscopy, then a cultural examination is not carried out.

Based on the results of bacterioscopic and bacteriological studies, differential diagnosis is carried out with urethritis of a different etiology (viruses, yeast-like fungi, various cocci, trichomonas, chlamydia, mycoplasmas).

To accurately determine the localization of the inflammatory process in the urethra, topical diagnostics are performed using a two-cup sample. Ureteroscopy can only be used for chronic gonorrhea, since in an acute process this procedure can contribute to the spread of infection to the upper parts of the genitourinary system.

Treatment

The treatment of gonorrhea in children is always strictly individual and complex. It consists of vaccine therapy, antibiotic therapy, local treatment, vitamin therapy, restorative and desensitizing agents. Unlike the treatment of gonorrhea in adult women, the use of physiotherapy procedures is not practiced in children.

In the acute stage of gonorrhea, treatment begins with antibiotic therapy, most often with benzylpenicillin, chloramphenicol. Long-acting sulfonamides may be used.

Local treatment in the acute period is reduced to hygienic measures and sitz baths with a decoction of chamomile or a solution of potassium permanganate.

If sulfanilamide therapy fails and in cases of chronic gonorrhea, gonovaccine is used (initial dose of 0.5-1 million), followed by the appointment of sulfonamides. The criteria for cure are the normalization of the clinical picture and the persistent disappearance of gonococci in the discharge after three provocations with an interval of 10 days.