Developing gonorrhea during pregnancy is one of the most serious and dangerous diseases that threatens the life of the child and the health of the mother. In the absence of appropriate treatment, gonorrhea can early provoke labor, create conditions for premature rupture of amniotic fluid, or significantly affect the health of the baby.
Consequences of gonorrhea during pregnancy
Gonorrhea can have negative consequences during pregnancy.
The risk of spontaneous abortion is 15%. This is approximately twice the average for women. Most often, fetal development stops in the early stages. Including in the first weeks of embryonic development, when a woman does not even know about pregnancy. During this period, the fertilized egg is very small.
When pregnancy stops, a woman simply begins to menstruate. She only notices a delay in her period, but may not know that she was pregnant.
In other cases, pregnancy fading occurs at a later stage - at 10-12 weeks. Then it is necessary to perform endometrial curettage to remove the fertilized egg. The procedure is complicated by the presence of an active gonococcal infection. Because it can cause complications.
During the curettage process, the doctor damages the uterine mucosa, which can result in complications. This is post-abortion endometritis or even sepsis.
To avoid complications, curettage is carried out against the background of antibiotic therapy. It continues after the procedure.
The second common consequence of gonorrhea during pregnancy is premature birth. They can happen very early. Therefore, up to 30% of such children do not survive.
If the birth takes place on time, then there is a high risk of infection of the baby by the mother.
It reaches 40-50%.
To detect gonorrhea in time, screening is carried out. Tests are taken for gonococcus. And it does not matter whether there are symptoms and anamnestic data indicating the possibility of the presence of gonococcal infection.
Childbirth with gonorrhea
An infection suffered during pregnancy is not an indication for a cesarean section. If complications are avoided and the child feels normal, then the birth takes place naturally. Doctors insist on surgery only if the fetus is infected and the water breaks early.
Caesarean section is also done if the pathology was discovered immediately before childbirth. In this case, it will not be possible to avoid infecting the baby, and it is simply impossible to quickly cure gonorrhea. Symptoms of body intoxication will complicate the birth process and can provoke negative consequences in the form of injury to the baby.
Dr. Komarovsky in one of his programs focused the attention of women on the fact that it becomes necessary to perform a caesarean section if indicated. Many people think that surgery is much worse than natural childbirth, but often it can prevent health problems for the child and mother.
Regardless of whether the mother’s disorder has been completely cured or not, during the postpartum period the baby’s condition should be especially carefully monitored by doctors. A woman who has given birth also needs to undergo periodic tests to make sure there is no chronic gonorrhoea.
Incubation period of gonorrhea
Some women become pregnant due to gonorrhea. Others contract the disease after conception.
In the first case, we are usually talking about a chronic form of pathology. It has no symptoms and remains undiagnosed.
During pregnancy, in 25% of cases, such sluggish gonorrhea worsens. For others, symptoms may never appear throughout pregnancy.
If infection occurs already during pregnancy, acute symptoms may appear. The incubation period lasts from 5 to 7 days. Then signs of urethritis, vulvovaginitis, bartholinitis, and cervicitis appear.
Gonorrhea spreads upward in pregnant women extremely rarely. It does not rise above the cervix. This is due to the fact that starting from the 4th month of gestation, the fertilized egg closes the internal os.
Subsequently, the fertilized egg occupies the entire uterine cavity. Therefore, inflammation of the uterus and appendages can develop only after childbirth. If the infection is not cured, this often happens.
Variants of infection in pregnant women
In many general ways, gonorrhea during gestation is similar to that outside pregnancy, but there are a number of typical features. In medicine, the course of gonorrheal infection is conventionally divided into three stages, differing in clinical manifestations. This:
- Fresh infection and infection that occurs in acute or subacute, less often torpid (sluggish) form.
- Chronic gonorrhea with few and sluggish symptoms.
- A latent (or in other words) hidden infection that does not have any manifestations other than the presence of microbes.
A fresh form of gonorrhea will be diagnosed in cases where up to two months have passed since the infection was acquired. In this case, the acute form is understood as pathology in situations where the symptoms are clearly expressed and gradually increase during the first two weeks from the moment of intimate intimacy without protection. In subacute cases, symptoms do not increase so sharply and are not so clearly expressed.
The most dangerous form of gonorrhea is torpid , especially in pregnant women. With it, the signs of infection are very scant or practically absent, so nothing causes concern for the woman; she carries the baby without turning to a doctor for help and without proper treatment. This leads to the infection gradually developing into a chronic form . It is much more difficult and longer to treat than acute infection.
The latent form is rare during pregnancy and this is due to the fact that it does not have obvious symptoms, but at the same time it creates significant problems in the genital area and disrupts the process of conception, leading to infertility. This is usually formed due to the formation of adhesions in the area of the fallopian tubes, forming obstacles to the meeting of eggs and sperm. And besides, such a woman is a constant source of infection for sexual partners.
Symptoms of gonorrhea during pregnancy
Clinical signs of gonococcal infection in pregnant women are generally the same as in other women. But there are some peculiarities.
During pregnancy, vulvovaginitis develops much more often. This is due to the fact that their integumentary epithelium is loosened, like in girls before puberty. It is thin, so it is easily affected by gonococci. More often than other women, gonococcal vestibulitis is diagnosed.
In the acute phase, the disease manifests itself:
- redness of the vulvar mucosa
- her swelling
- purulent discharge
When the pus dries, it forms crusts. If they are separated from the mucosa, erosions are exposed.
Possible swelling of the labia minora. Often they stick together.
Gonococcal vestibulitis in pregnant women occurs in the following clinical forms:
- catarrhal
- hypertrophic
- suppurative
With catarrh, severe redness is observed. The crater-shaped recesses of the crypts (folds) are formatted.
In the hypertrophic form, they rise above the rest of the surface. With suppuration, they suppurate.
They increase in size, reaching the size of a pea or even a cherry.
Patients complain of heavy discharge and itching. They usually do not feel pain. Objectively, there may be redness on the skin of the thighs and perineum.
In 80% of clinical situations, the urethra becomes inflamed.
Gonococcal urethritis in pregnant women can occur in acute or chronic form. In acute cases, there is significant discharge and pain when urinating. When a urinary tract infection occurs, the urge to urinate intensifies and becomes more frequent. There is pain at the end of it.
The chronic course of the pathology may not give subjective sensations. Objectively, infiltration of the urethral wall is noted. When pressed, a cloudy drop is released.
During pregnancy, women develop paraurethritis in 30% of cases. But usually it occurs without symptoms. During pregnancy, gonorrhea often causes gonococcal bartholinitis. Its signs are observed in 20-30% of patients.
Damage to the Bartholin glands occurs secondary. They become infected 2-3 weeks after the onset of gonococcal urethritis or vulvovaginitis.
Bartholinitis can be complicated by an abscess or cyst of the Bartholin gland. An abscess usually forms when a secondary bacterial infection occurs. A cyst can form even after the infection has cleared. This occurs if obliteration (overgrowth) of the excretory duct has occurred.
The secret cannot leak out. It accumulates, forming a cavity.
Pregnant women may develop gonococcal vaginitis. It occurs extremely rarely in non-pregnant women. The exception is women in menopause.
Patients complain of a burning sensation inside the vagina. Upon examination, its walls are red or have a bluish tint. Infiltration of the papillary layer in the form of granularity is observed.
The cervix is often inflamed. Endocervicitis is found in 90% of pregnant patients.
Symptoms of the disease:
- sharp pain occurs when urinating;
- discharge of pus from the genital tract;
- appearance of fever.
Untimely treatment of the disease or complete lack of therapy threatens damage to many internal organs of the mother and fetus
The causative agent of gonococcus in gonorrhea in pregnant women affects:
- uterus;
- bladder;
- kidneys
In men, in addition to the kidneys and bladder, the testicles, their epididymis and the vas deferens are affected.
Gonorrhea often results in infertility in both women and men. The causative agent of gonorrhea, gonococcus, can provoke inflammation of other organs.
Gonococcus provokes inflammation:
- tissues with glandular or columnar epithelium;
- rectum;
- the appearance of conjunctivitis;
- inflammation of the pharynx.
The pathogen parasitizes both inside cells and on their surface. A harmful microorganism can settle in the genital tract, rectum and oral mucosa.
In pregnant women, the microorganism primarily affects the cervix and then spreads to the fallopian tubes.
Eventually the ovaries are damaged. In newly born children, gonorrhea can cause conjunctivitis.
The causes of gonorrhea can be:
- not using condoms;
- promiscuous sexual relations;
- violation of personal hygiene.
Based on the causes of gonorrhea, it can be avoided by following simple rules of personal hygiene and controlling sexual intercourse.
What tests to take for gonorrhea during pregnancy
A smear test for gonorrhea:
- for bacterioscopy
- for PCR
- for bacteriological culture
In 70% of women suffering from gonorrhea, other pathogens are detected simultaneously. Therefore, after discovering this disease, the doctor will probably prescribe additional tests.
Their goal is to identify concomitant STIs. Tests are taken for HIV, syphilis, chlamydia, and trichomoniasis.
About gonorrhea in a nutshell
Gonorrhea (popularly known as gonorrhea) is an infectious disease. It is caused by bacteria of the gonococcus type. This disease is a venereal disease - transmitted through sexual contact.
Gonorrhea is especially dangerous for a pregnant woman’s body, as it affects all her female organs. And the health of the reproductive system is most reflected in the health of the fetus.
Gripper is often classified as a diagnosis that is a social stigma for women. Many immediately begin to condemn the expectant mother for promiscuity in sexual contacts.
In fact, due to minor symptoms, a woman may not be aware of this enemy at all. And you can become infected with gonorrhea even in a legally married state.
Gonorrhea affects most of the internal organs of the female genital area (vagina, cervical canal, uterus and appendages). If this insidious disease is not detected and treated in a timely manner, then gonococci spread to many organs and systems (from the rectum to the larynx) of the expectant mother.
The main insidiousness of the clap is that it may not manifest itself in any way even for several years. Therefore, it is important for a pregnant woman to undergo all the necessary tests in a timely manner and to identify as early as possible the insidious enemy that has taken up residence in her susceptible body.
Treatment of gonorrhea during pregnancy
If a gonococcal infection is detected during pregnancy, treatment is carried out immediately and without fail. Moreover, it does not matter at what stage of gestation the woman is. Gonorrhea is treated both in the initial period of pregnancy and immediately before childbirth.
The patient usually undergoes therapy on an outpatient basis.
The exception is when:
- there is a threat to the normal course of pregnancy
- invasive procedures are planned
Drugs are selected taking into account their possible effect on the fetus, as well as on the course of pregnancy.
Features of gonorrhea during pregnancy and after delivery
Gonorrhea in pregnant women has its own nuances:
- if infection with gonococci is detected in the early stages, even with timely treatment, a relapse is possible in the third trimester;
- ascending inflammatory process occurs extremely rarely, and only when infected in the first trimester;
- During the normal course of pregnancy, the closure of the internal uterine os makes it impossible for the fetus to become infected.
Isolated gonorrhea in pregnant women and in the postpartum period is rare, and only in a chronic form. In the vast majority of cases, gonococci affect the membranes of the urethra and cervix.
More severe complications develop in women in labor who become infected with gonorrhea in the third trimester
Gonococci are very “fast” bacteria, and they penetrate the uterus and its appendages after birth before others. Therefore, for those who give birth with untreated gonorrhea, smears from the vagina, urethra and rectum are taken for analysis on the 3rd day, and when re-examined on the 7th day, a smear from the cervix is added to them.
Attention. Unrecognized “dormant” gonococci can wait until the onset of the first menstruation and infect the mucous membrane of the fallopian tubes. Ectopic pregnancy after gonorrhea occurs in a quarter of women who give birth with untreated gonorrhea.
Before talking about what and how gonorrhea is treated in pregnant women, it should be emphasized that antibiotic therapy should be carried out simultaneously for the sexual partner(s). Otherwise, re-infection of a woman, especially if not protected with a condom, is almost inevitable.
In addition, we warn about the possible ineffectiveness of self-medication for gonorrhea according to WHO standards. Their instructions strongly recommend that doctors choose medications based primarily not on their protocols, but on data from local health authorities about the levels of antibiotic resistance in gonococci common in the area of residence or infection.
So the information below is for informational purposes only and should not be considered either as a guide to action or as an assessment of the correctness of the doctor’s prescriptions.
Local treatment of gonorrhea during pregnancy
To increase the effectiveness of treatment, local drugs can be used in addition to antibiotics. These are antiseptic solutions.
During pregnancy, local treatment is allowed:
- urethra
- rectum
- vestibular glands
It is possible to use vaginal baths.
Injecting medications into the cervical canal is prohibited. Because the risk of spontaneous abortion increases.
If the pregnancy ends in abortion, local therapy for the cervix can begin after 10 days. If it ended in childbirth, then no earlier than a month and a half later.
Testing methods for gonorrhea
The main way to diagnose gonorrhea is a smear test.
Diagnostic material is taken from those areas of the epithelium that are sources of inflammatory phenomena:
- posterior vaginal fornix;
- cervical canal;
- anorectal smear;
- discharge from the urethra;
- oropharyngeal swab if the pharyngeal form is suspected.
The collection of diagnostic material is no different.
The only thing is, given pregnancy, it is necessary to take a smear from the cervical canal with great caution.
In addition to the smear, standard clinical tests are prescribed - blood, urine.
Subsequently, the smear is examined microscopically and bacteriologically.
If you quickly need an accurate analysis result, you can perform a polymerase chain reaction (PCR).
For screening and initial examination of pregnant women, microscopy of a smear from the urethra, cervical canal and other parts of the body is used.
It's fast and inexpensive.
If gonococci are found in the sample, the diagnosis is considered established.
The second option is if gonorrhea pathogens are not detected, but there are signs of inflammation (accumulation of leukocytes), then such a sample must be further examined.
The main method for clarifying the diagnosis is bacteriological or culture.
It takes several days to wait for the results, but eventually doctors will know whether there are gonococci in the smear.
If so, what drugs should the patient be treated with, and what pathogens have already developed resistance to them.
To increase the reliability of the data and avoid false negative results, a pregnant woman should prepare:
- do not take any antibiotics 10 days before the tests; if taken, inform your doctor;
- toileting of the external genitalia is carried out in the evening, it is better to refuse it in the morning;
- it is also not recommended to urinate 3 hours before collecting a smear from the urethra or a portion of urine;
- when diagnosing the oropharyngeal form, do not brush your teeth in the morning before the test;
- For an anorectal smear, you may need to take a laxative so that the rectal ampoule is empty in the morning.
A positive result of any research method is an indication for antigonorrheal therapy.
Does my partner need therapy for gonorrhea?
There is no point in treating just one woman. Because her husband or regular sexual partner is probably also a carrier of the infection.
If a woman continues to be intimate during gestation, she will become infected again. Therefore, it is necessary to treat your partner as well.
Therapy is prescribed to spouses simultaneously. If any of them have additional sexual partners, they should also be treated. A recent infection does not protect against reinfection. As soon as the antibiotics leave the blood, and this takes no more than a few days, infection with gonococcus will again become possible.
Danger to baby and mother
The consequences for the child can be the saddest - he can die. Most often this happens if a woman was infected with gonorrhea in the first trimester of pregnancy. According to statistics, miscarriages occur in 25% of cases.
If a woman successfully carried the baby to term and labor began on time, then in this case the baby will be infected while moving through the birth canal. Since gonorrhea in children occurs in complicated forms, in order to prevent infection of the baby, a caesarean section is prescribed.
However, during pregnancy, gonococcal infection harms the normal course of pregnancy. In addition to the fact that the infection can spread throughout the mother's body, it can cause gonococcal meningitis, pharyngitis, arthritis and other diseases that pose a danger not only to the mother, but also to the child.
Any infectious disease can lead to infertility. There is a concept of secondary gonorrheal infertility, which means that after childbirth or abortion, the pathogen penetrated into the tubes and into the uterus itself, which caused infertility. Gonorrhea can affect a woman’s nervous and cardiovascular systems.
Control tests after treatment for gonorrhea
After treatment, a pregnant woman requires control tests. They show whether gonorrhea has been cured or whether another antibacterial course is needed.
Control is carried out using PCR or bacteriological culture. It is prescribed on the second and then on the fourteenth day after discontinuation of the drugs.
A double negative result confirms that the woman is healthy. Most likely, she will not have infectious complications after childbirth. And the expectant mother will not infect the baby during childbirth.
If gonococci are detected again, a second course of therapy is required. It is carried out using other drugs.
Treatment
Gonorrhea is treated by a gynecologist or venereologist.
Pregnant women are treated regardless of the stage of pregnancy. This is necessary to prevent any negative impact on the developing fetus.
The complexity and duration of treatment primarily depend on how advanced the disease was at the time of initiation of therapy. During treatment, the pregnant woman is placed in a hospital.
The main drugs that affect gonococci are antibiotics. They are selected in such a way as not to harm either the expectant mother or the baby. Penicillin derivatives are rightfully considered the safest: Flemoxin, Augmentin, Benzylpenicillin, etc. But they have two drawbacks: firstly, they are quite weak and act slowly, and secondly, many strains have acquired resistance to them. In such cases, cephalosporin antibiotics are prescribed: Cephalexin or Ceftriaxone.
In the event that other STIs are treated along with gonorrhea, Erythromycin, Rovamycin, etc. are prescribed.
The full course of antibiotic therapy lasts a week and a half.
To strengthen the body’s immune forces, immunomodulators are necessarily prescribed: Beresh Plus, Limontar, Viferon, Magne B6, etc.
To maintain and strengthen the placenta, Trental, Actovegin, Curantil, etc. are prescribed.
If the course of the disease was complicated, then treatment can last up to 4 weeks. After completing the course, a control examination is carried out a week later, which will show whether the infection has been defeated. Such checks are repeated for 3 months in a row.
At the same time as a pregnant woman, her sexual partner should be treated, even if he has not been diagnosed with this disease. Also, if there are children in the family, they must undergo examination.
Complications of gonorrhea during pregnancy
Gonococcus does not have a direct effect on childbirth. But it can cause complications in women after giving birth. The most common of them is postpartum endometritis.
After childbirth, the lining of the uterus is damaged. Gonococci penetrate into it. Often the disease is accompanied by a general inflammatory reaction of the body. Fever appears up to 39 degrees.
My stomach and lower back hurt. Pus and ichor are released from the vagina. During bimanual examination, a painful uterus is palpated. Sometimes inflammation spreads to the muscle layer of the organ. Then endomyometritis develops.
His symptoms are similar, but more pronounced. The infection can penetrate the fallopian tubes and then into the abdominal cavity. In such cases, peritonitis develops. It begins with a sharp pain in the abdomen. Body temperature can increase to 40 degrees. Nausea, vomiting, constipation, and flatulence are observed. Symptoms of peritoneal irritation are positive.
The listed diseases can develop already in the first days after childbirth. Severe symptoms are observed within 1 week. Then the woman’s condition gradually improves.
Risks of gonorrhea for the fetus and woman
Acute forms of gonorrhea pose a great danger when a woman becomes infected while she is pregnant.
The incubation period in such cases is reduced to 1-4 days.
After which the first symptoms to appear are cervicitis, colpitis and urethritis.
Gonorrhea spreads to the internal reproductive organs within 7-20 days.
The endometrium is the first to be affected.
Subsequently, it is accompanied by salpingoophoritis and subsequently, in the absence of treatment, pelvioperitonitis.
Chronic processes are also aggravated, and the risk is no less.
With endometritis, the normal function of the placenta is disrupted.
And, although gonococci themselves are not able to overcome the placental barrier, their toxins enter the fetus’s body.
In addition, purulent processes can form in the area where the placenta is attached, causing its trophic function to suffer.
The consequence is often a miscarriage.
Even if the pregnancy is not terminated, feto-placental insufficiency and fetal malnutrition develop.
A child is born with a low body weight, and his period of physiological jaundice lasts longer.
During childbirth, another danger arises - infection with gonococci when passing through an infected birth canal.
Girls develop vulvitis as a result, children of both sexes are at risk of developing gonorrheal conjunctivitis (gonoblenorrhea).
Severely weakened newborns may face a dangerous process - generalized gonorrheal sepsis.
It develops against the background of a general unsatisfactory condition.
This complication of infection poses a direct threat to the child’s life.
As for extragenital forms (anal, oropharyngeal gonorrhea), they are no less dangerous during pregnancy.
Even if such localization of the process does not have a direct negative effect on the fetus.
With the development of anal or oropharyngeal gonorrhea, the risk of autoinoculation is very high.
When gonococci enter the genitals from other areas of the body (anus, oropharynx).
This can happen at any time with the development of already known consequences and complications.
As for the problems for the woman herself, gonorrhea is dangerous not only in terms of a chronic inflammatory process with intoxication, overgrowth of pipes, and so on.
The most modern studies show that the consequences of gonorrhea of any location are problems with the hormonal background of a woman.
In addition, gonococci are a cause of postoperative complications.
If during childbirth there was a need for surgical interventions (caesarean section, episiotomy).
They can also cause postpartum endometritis and sepsis.
Gonorrhea prevention for mother and child
A woman can infect her baby during childbirth. 40% of such children develop gonococcal ophthalmia. This is an eye infection. This condition requires treatment. Children are prescribed ceftriaxone. It is used at 25-50 mg per kg, but not more than 125 mg per administration. The drug is administered once a day for a course of 3 days.
Treatment must be carried out with the participation of a neonatologist. Therapy is prescribed in any case if a child was born from an infected mother. And it doesn’t matter whether he has signs of gonococcal infection.
But if there are no symptoms, then ceftriaxone is administered 1 time, not three times. This treatment is called prophylactic. Prevention of ocular gonorrhea in newborns can also be carried out with local medications.
0.5% erythromycin ointment or 1% silver solution is prescribed.
The use of silver nitrate reduces the risk of ophthalmia by 4-5 times. Without prevention, it develops in 40-50% of children born to mothers infected with gonorrhea.
With prophylaxis, the risk is reduced to 10% or less. Prevention of congenital gonorrhea in girls and boys also involves treating the mother. Therapy can be carried out in late gestation, shortly before birth.
Antibacterial therapy
During pregnancy, a woman with gonorrhea is prescribed antibacterial therapy. It can be prescribed at any stage of pregnancy.
The procedure involves administering cephalosporin drugs intramuscularly once.
Repeated administration of the drug may be required with rare exceptions.
Multiple clinical trials have proven that drugs in this group are safe for the health of the mother and child in the womb.
Refusal of therapy with antibacterial drugs leads to irreversible consequences, where termination of pregnancy cannot be ruled out.
Diagnosis of the disease
Pregnancy and gonorrhea are two incompatible concepts, therefore, if it so happens that a woman could not protect herself from this pathology, then it is necessary to begin treatment as quickly as possible.
Very often, if an infection already exists, the woman does not suspect it, because there are no obvious signs of the disease. Sometimes gonorrhea in pregnant women and others is similar in its manifestations to urological pathologies, so women try to cope with the symptoms on their own. There may be complaints about:
- some discomfort during urination.
- More vaginal discharge appears, but expectant mothers may attribute this to their condition.
- The discharge may have a rather unpleasant odor.
- A headache is common, but women do not associate this symptom with the presence of a serious infection in the body.
- A burning and itching of the genitals appears, the symptom resembles thrush, so it does not make women think seriously and visit a doctor.
- Pain and discomfort during intimacy.
- The temperature may rise.
Women may confuse discomfort during urination with symptoms of cystitis, but this may be a sign of a dangerous disease. The development of gonorrhea often provokes severe headaches, and expectant mothers do not in any way associate them with a dangerous pathology.
This is the whole danger of the situation: the infection continues to flourish and increases the risk of developing serious complications that will affect not only the woman, but also her unborn baby.
A diagnosis can only be made based on the results of the study, so a pregnant woman is simply obliged to regularly undergo all the necessary tests, and it is even better to do this before pregnancy. If you suspect gonorrhea, your doctor will definitely refer you for the following tests:
- Vaginal smear for gonococci.
- Since a smear for gonorrhea during pregnancy is only 60% accurate, it is therefore necessary to examine vaginal secretions.
- PCR research can detect the causative agent of gonorrhea in almost 100% of cases, since the method is based on determining the DNA of the gonococcus.
- The ELISA test is based on a blood test and allows you to accurately determine pathology.
First of all, the doctor will take a smear, but it will not give complete information, so other tests will be prescribed. Modern research methods make it possible to determine the pathogen; quite often, other pathogens are found along with gonococcus, for example, those that provoke chlamydia and trichomonellosis.
If in a normal state, when diagnosing gonorrhea, you can still get away with collecting an anamnesis and a visual examination by a doctor (and this is not always effective), then during pregnancy you cannot do without tests. The stakes are too high; the life and health of not only the woman, but also her unborn child are at stake. At the same time, the patient should undergo periodic examinations not only if there is a suspicion of an illness, but also to monitor the condition of the body. By the way, it is recommended to take the first tests even before the planned conception.
During pregnancy, doctors constantly keep the woman's condition under control. Their task is not to miss the moment when the disease begins to develop. For this, patients are prescribed:
- regular examinations for changes in the cervix, as well as the appearance of vaginal discharge;
- ELISA test (a specific blood test that allows in most cases to make an accurate diagnosis;
- PCR, which is not very accurate and therefore requires periodic repetition;
- bacteriological culture, which gives 100% accuracy of the study.
Also, three times during pregnancy, a woman should undergo a smear test for microflora. This will not help to make an accurate diagnosis, but it is possible to identify violations in this way. If any are identified, then further diagnostic measures are prescribed.
What is the cause of infection during gestation
The only reason for the development of gonorrhea is considered to be infection of the genitourinary area by a special type of microbe - Neisseria gonorrhoeae (gonococcus). This is a microbe from the genus Coccus, which has all the typical properties of this group of pathogens. For gonococcus, damage to the epithelium of the genitourinary tract (mucous membranes of the genitals, urethra, internal organs) is typical, and it is also possible to damage the rectum and nasopharynx. Therefore, in terms of infection, both traditional sexual contacts and all other possible options are dangerous.
note
During pregnancy, the pathogen is capable of damaging the cervical canal and external os of the uterus, with subsequent spread to the area of the body of the uterus, fallopian tubes and ovaries. It is also possible that the pelvis may be affected. Damage to the placenta and membranes, amniotic fluid and the fetus itself is also dangerous.
In newborns infected with gonococcus, neonatal gonoblennorrhea - damage to the mucous membranes of the eyes with the development of blindness.
A pregnant woman most often becomes infected through sexual contact in any form of intimate intimacy, although in rare cases, infection can also be transmitted through household contact from an infected family member. The main risk factors are unprotected sex with untested partners, refusal to use barrier contraception (condoms) and neglect of personal hygiene rules (using shared washcloths, towels, bathing in the same bath).
Important
Recently, due to active prevention and the presence of anonymous clinics, a decrease in the number of cases has been observed, but this is often also due to self-medication on the Internet. During pregnancy, this fact is unacceptable, it is dangerous for the life of the mother and fetus!
Symptoms
Treatment of women wishing to continue pregnancy should be carried out in a hospital setting.
Benzylpenicillin is indicated for any stage of pregnancy. Prescribing the drug to pregnant women is excluded in case of individual intolerance, then erythromycin, chloramphenicol or sulfonamides are used. In the second half of pregnancy, course doses of benzylpenicillin are increased by 1.5-2 times. The use of tetracycline drugs is contraindicated.
Among the immunotherapeutic agents, gonovaccine is prescribed (starting from the 2nd trimester of pregnancy) in reduced doses (100-150 million microbial bodies) for chronic gonorrhea and relapses.
Local treatment of the urethra, rectum, and large vestibular glands can be carried out during all stages of pregnancy. Treatment of the cervical canal can only be carried out in the form of vaginal baths without introducing medications directly into the cervical canal (keeping in mind the possible threat of miscarriage).
Pregnant women who have had gonorrhea during pregnancy should be reported to the antenatal clinic for special monitoring before and after childbirth, as well as for careful monitoring of the condition of the newborn.
In pregnant women with gonorrhea, the process of biogenesis of peptide and steroid hormones is disrupted, which is more pronounced in the chronic form of the disease. To correct identified disorders of the hormonal link of the fetoplacental system, papaverine and no-shpu should be prescribed in the treatment complex for this group of patients, which can reduce the threat of premature termination of pregnancy and prevent postpartum complications in women.
If a pregnant woman is diagnosed with gonorrhea, treatment involves several areas:
- Taking medications that strengthen a woman’s immune system.
- A course of antibiotic therapy. It must be at least 2 weeks.
- Recovery period, accompanied by taking vitamin preparations.
- Treatment of the partner to eliminate the risk of re-infection.
Considering that the causative agent is a bacterial organism, the woman is prescribed antibiotics. The safest ones for her are:
- Flemoxin.
- Benzylpenicillin.
- Ceftriaxone.
- Cephalexin.
- Erythromycin.
After completing the course of treatment, the woman must be prescribed vitamins and minerals to support the body and strengthen the immune system.
Any antibiotics during pregnancy should only be prescribed by a doctor; self-medication is unacceptable.
Treatment of a pregnant woman with gonorrhea is most often carried out in a hospital, in the infectious diseases department, in order to eliminate the risk of infecting household members. Every pregnant woman should be aware of the seriousness of the situation, so in no case should therapy be interrupted without the knowledge of the doctor.
Gonorrhea is an infectious disease transmitted primarily through sexual contact.
This disease is mentioned less and less often in the cards of pregnant women, but this does not mean that gonorrhea is a thing of the past.
This relative “rarity” is due to the fact that gonorrhea now practically does not manifest itself at all, but about 2% of all women are unaware that they are carriers of this disease.
A little history
Gonorrhea has been known since ancient times. It even earned mention in the Bible as an “unclean discharge” from the urethra in men. Gonorrhea was mentioned by Hippocrates, and the author of the name is the Greek physician Galen, who lived in the 2nd century AD.
Galen believed that the discharge from the urethra in men with gonorrhea is seminal fluid, so the name of the disease comes from the Greek words gone - seed and rhoia - discharge.
Despite the fact that it was subsequently established that the discharge is not seminal fluid, but is of inflammatory origin, the name stuck and is still used almost all over the world.
Except for Germany, where the name “tripper” is used (from the German trophen - drop), and France, where gonorrhea is called “blennorrhea”. In our country, blenorrhea is a specific eye lesion caused by gonorrhea.
The causative agent of gonorrhea
The likelihood of infection is the same during normal sexual intercourse, as well as anal and oral sex. During anal intercourse, damage to the rectum is observed; during oral intercourse, the symptoms of gonorrhea resemble a sore throat.
A non-sexual route of infection is possible during childbirth (when a child passes through the mother’s birth canal), very rarely - through close household contact of a small child with a sick mother (for girls - through a shared bed with the mother).
Gonorrhea symptoms
The incubation period—from infection to the onset of symptoms—ranges from one day to several weeks. In modern conditions, gonorrhea may not manifest itself at all. The majority of women (50%) may have no clinical symptoms, and the woman feels practically healthy.
The first classic signs of this disease are most often a burning sensation and pain in the urethra at the beginning of urination, frequent urge to urinate, and slight thick purulent discharge.
Then signs of damage to the genital organs appear: purulent vaginal discharge, itching, burning, discomfort in the external genital area, pain in the lower abdomen. Nonspecific symptoms may appear: fever, sore throat.
Upon examination, the gynecologist sees erosion of the cervix, redness around the external opening of the urethra and a wide purulent ribbon flowing from the cervical canal.
With gonorrhea, the large gland of the vestibule of the vagina can be affected (bartholinitis occurs - inflammation of this gland). At the same time, a painful formation the size of a small plum appears on the side of the vaginal opening, the body temperature increases, and the woman’s general condition worsens. Bartholinitis requires surgical treatment.
The most severe form of gonorrhea is acute gonorrhea of the uterine appendages. In this case, there is a sharp pain in the lower abdomen, the temperature rises to 38-40°C, the pulse quickens, and blood test values change.
In this form of the disease, the uterine openings of the fallopian tubes stick together, the tube swells due to impaired outflow of purulent contents, and surrounding tissues adhere to it, which is defined as a tumor-like formation. In this case, surgery is required to prevent the development of inflammation of the peritoneum - peritonitis.
After some time, obstruction of the fallopian tubes may develop, leading to infertility or ectopic pregnancy.
If gonorrhea is not treated, gonococcal sepsis may develop. The pathogen spreads through the bloodstream throughout the body, affecting the joints, heart, and brain.
Gonorrhea during pregnancy
The course of gonorrhea during pregnancy depends on when the infection occurred. If the infection occurs before pregnancy, then in the vast majority of patients the disease is mild, that is, the woman may not present characteristic complaints. Only a third of sick pregnant women have any complaints. Chronic gonorrhea increases the risk of ectopic pregnancy and infertility.
Gonococcus does not cause malformations in the fetus, but its proximity to pregnancy is unsafe. If infection occurs in the first half of pregnancy, inflammation of the uterine mucosa occurs, which can lead to miscarriage or non-developing pregnancy.
When infected in the second half of pregnancy, gonococci cannot penetrate the uterine cavity; they are opposed by the membranes of the fetal bladder, so termination of pregnancy usually does not occur, but placental insufficiency occurs, as a result of which the fetus lacks oxygen and nutrients.
Intrauterine infection of the fetus may occur, manifested by gonococcal sepsis of the newborn and chorioamnionitis (inflammation of the membranes of the amniotic fluid). Chorioamnionitis is accompanied by an increase in the body temperature of a pregnant woman, an increase in heart rate, and a change in the general blood test picture.
There may be no other symptoms. With chorioamnionitis, premature labor is more often observed, starting with the breaking of water.
During childbirth, a sick mother can infect the child, which can cause eye damage, including the death of the eyeball. Girls may also experience genital gonorrhea.
In our country, to prevent gonorrhea in newborns in the maternity ward, immediately after birth, all children’s eyes are wiped with sterile cotton wool and a 20% solution of sodium sulfacyl is instilled; after 2 hours the procedure is repeated. Girls' genitals are treated with the same solution at the same time.
- After childbirth, women with gonorrhea experience postpartum inflammation of the uterus.
- Diagnosis of gonorrhea
- Laboratory diagnosis is based on the following methods for identifying the causative agent of gonorrhea.
The culture method currently remains the gold standard. It consists of inoculating the discharge from the area of inflammation on special media and isolating gonococcus colonies, followed by determining the sensitivity of the bacterium to antibiotics.
The material for testing for gonorrhea is usually discharge from the urethra, the large gland of the vestibule of the vagina, the cervical canal, and the vagina. The material is collected by a gynecologist. The method allows you to detect gonorrhea in 95% of cases.
However, the result of such an analysis cannot be obtained earlier than in a week.
Diagnostics
To identify the pathogen, a scraping is taken from the mucous membrane of the woman’s genital tract. This procedure is completely safe and does not have any consequences for the fetus. The resulting material is examined under a microscope and also sown on special nutrient media. All pregnant women must be tested for the sensitivity of gonococci to antibiotics.
, the PCR (polymerase chain reaction) method has been actively used to diagnose gonorrhea . This method makes it possible to find out only the fact of the presence of gonococci, but not their number. Since gonococci should not normally be present on the mucous membrane of the genital tract, the PCR method is sufficient to establish an accurate diagnosis.
Causes of the disease
You can become infected with gonorrhea through sexual contact. In rare cases, infection occurs through household means through personal hygiene products, washcloths, towels, and underwear.
The spread of infection in the female body occurs by lymphogenous and hematogenous methods. The incubation period of the disease ranges from three days to two weeks. Chronic relapsing course of the disease also sometimes occurs. This disease is most often accompanied by complications such as:
- cervicitis;
- urethritis;
- proctitis;
- salpingo-oophoritis.
Diagnosis of gonococcal infection
According to medical documentation, testing for gonorrhea is carried out:
- women with manifestations of urethritis, cervicitis, adnexitis;
- ladies who confirm unprotected sexual contact with a patient with gonorrhea;
- any persons for a comprehensive diagnosis of STIs;
- pregnant women during registration;
- women preparing for termination of pregnancy;
- newborns with signs of purulent conjunctivitis (if gonorrhea is detected, parents are subject to mandatory examination).
In the diagnosis of the disease, an important place is given to the complaints of a pregnant woman (in the topic of the conversation, the doctor draws attention to changes in the nature of vaginal discharge, pain during urination, abdominal pain), data from a gynecological examination (hyperemia of the mucous membrane around the opening of the urethra, cervical erosion, purulent discharge from the cervical canal ).
