Gonorrhea in women: symptoms, treatment, manifestation, incubation period

Gonorrhea is an infectious inflammatory disease that is classified as sexually transmitted. It affects both men and women equally.

They are caused by oval-shaped gram-negative microorganisms, diplococci. Gonococcus is a pathogen that is easily transmitted and causes disease.

This explains the widespread occurrence of the pathology. Pathology can develop even after a single contact with an infected person.

The main mechanism of transmission is any form of unprotected sexual contact. Gonorrhea requires immediate treatment because there is a high risk of complications.

In rare cases, they lead to life-threatening pathologies. Gonorrhea is also one of the most common causes of inflammatory infertility.

What is gonorrhea

Gonorrhea is an infection transmitted primarily through sexual contact.
The shyly veiled name of gonorrhea - “French runny nose”, familiar to us from the works of Guy de Maupassant and other classics, very accurately reflects its essence. Runny nose - because the main sign of infection is associated with characteristic mucous discharge from the genitals. And beautiful France is traditionally represented as a country of beautiful women and whirlwind romances. The causative agent of gonorrhea is the gram-negative bacteria Neisseria gonorrhoeae from the group of extremely infectious microorganisms - diplococci (Fig. 1).

Figure 1. The causative agent of gonorrhea is Neisseria gonorrhoeae. The bacterium got its name from the German doctor Albert Neisser, who discovered gonococci and studied the nature and complications of the disease for a long time. Source: Shutterstock/Fotodom

Gonococci parasitize naturally only in the human body. They are distinguished by their ability to live inside various cells: leukocytes, epithelial cells and even inside protozoa, for example, Trichomonas. Their life cycle begins when they enter the mucous membrane of the vagina, oral cavity, or rectum. The infection causes purulent inflammation of the mucous membranes.

It is a mistake to think that you can only get sick as a result of promiscuous sex life. Gonorrhea is very common. According to medical statistics, more than 60 million cases of gonorrhea are diagnosed annually in the world.

The danger of the disease is due to the fact that the carrier of the infection may not be aware that he is infected. This is especially true for women, in whom in half of the cases gonorrhea is asymptomatic. In men, asymptomatic gonorrhea is observed in approximately 20% of cases. Often, the chronic form of gonorrhea is diagnosed in women already when visiting a doctor with symptoms of other pathologies that have developed as a result of infection with gonococcus. In men, the asymptomatic form occurs only in 10% of cases.

Sexual contact with a person unaware of his illness or with vague symptoms is the most common cause of infection.

General information

Gonorrhea is a disease that is commonly called venereal. The causative agent of the pathology is gram-negative gonococci Neisseria gonorrhoeae, which colonize primarily on the mucous epithelium of the genitourinary system.

In the photo there is a microslide with the inclusion of gonococci (small dots)

In recent years, even acute forms of infection have been virtually asymptomatic. This leads to late diagnosis, the development of complications and can even cause irreversible infertility.

Routes of infection

Like any other sexually transmitted disease, gonorrhea is transmitted in the vast majority of cases through unprotected sex. The risks of infection in the home cannot be ignored.

Sexual tract

The very name of the group of diseases, which includes gonorrhea, speaks for itself: their main cause is sex with an infected partner. Intimate contacts account for 99% of infections in both men and women. Unprotected sex with a carrier of infection does not always lead to illness, but a woman is much more likely to get sick after such an intimate encounter than a man.

Contagiousness of gonorrhea, i.e. the ability of gonococci to be transmitted from one person to another is 50-70% in women, i.e. More than half of them are guaranteed to be infected if they have sexual intercourse with a sick partner. For men, this figure is slightly lower – 25-50%.

Important! One should not have any illusions about the possibility of infection only through traditional vaginal intercourse. Oral or anal sex will also open the way for bacteria. In some cases, multiple organ infection is observed. Gonococci enter the partner’s body not only during full sex, ending in ejaculation, but also during intimate caresses.

Who is at risk?

Risk factors for contracting gonorrhea include:

carelessness when choosing a partner,
neglect of basic means of protection (sex without using a condom),
presence of other sexually transmitted diseases or HIV,
antisocial lifestyle, prostitution,
for men - sex with men.

Doctors recommend regularly, once a year, to be screened for gonorrhea if you are a sexually active woman over the age of 15 who changes sexual partners (Fig. 2). Being careful during sexual intercourse and mandatory use of a condom should be a priority for every woman, and there should be no exceptions to this rule.

Figure 2. Incidence of gonorrhea in the United States in 2021, distribution by sex and age. Source

Household way

Infection with gonorrhea in everyday life is much less common in medical practice, since gonococci quickly die in the external environment and are unstable to physical and chemical influences.

The main cause of household infection is failure to comply with basic personal hygiene rules. The infection can enter the body by using towels and washcloths that a sick person used to wash and dry themselves, wearing someone else’s underwear, etc. Due to the anatomical features of the structure of the external genitalia, girls develop domestic gonorrhea much more often than boys.

A risk factor for infection of a newborn baby is the passage of an infected mother through the birth canal during natural childbirth. No cases of intrauterine infection have been identified in clinical practice. In newborns, gonococci most often affect the eyes, causing inflammation of the conjunctiva (gonoblenorrhea). For preventive purposes, immediately after birth, the baby’s eyes are washed with albucid or a 1% solution of silver nitrate.

I often diagnose gonoblenorrhea in adult women with a latent or mild form of gonorrhea. The infection reaches the conjunctiva through a towel used for intimate hygiene or through the hands.

Questions for the doctor

Incubation period of gonorrhea

Hello! A month and a half ago, while on vacation, I had unprotected sex with a guy (now I regret it). Now I am worried about discharge with an unpleasant odor and cutting pain when urinating.
Could this be something sexually transmitted? How many days does it take for gonorrhea to appear in women? The website says 3-15 days, but I’ve already had 45 days (no more sexual contacts).

Hello! Yes, it's possible it's a sexually transmitted disease. To find out for sure, you need to consult a venereologist and undergo a full examination. On average, the incubation period of gonorrhea does not exceed 14 days, but can sometimes extend to two months.

Problems with urination due to STDs

Hello! I'm 19 and sexually active. For six months now, I have been periodically bothered by sharp pains when urinating, and I have to run to the toilet frequently.
I thought it was cystitis, I took 5-NOK and Canephron on my own, everything went away temporarily, but then it came back again (and this has already happened four times). There was also discharge with an unpleasant odor. Could this be gonorrhea? What should I do? The guy seems to be fine.

Hello! Yes, the symptoms you describe may be signs of gonorrhea (most likely urethritis in combination with cervicitis). To make an accurate diagnosis, you need to contact a venereologist and undergo an examination. Also encourage your sexual partner to get tested.

Types of gonorrhea

Gonorrhea is classified according to different criteria. Depending on the duration of infection and the form of its course, gonorrhea is divided into:

acute - no more than two months have passed from the moment of infection to the onset of symptoms, there is no doubt that an infectious agent has entered the body, there is an active inflammatory process with copious discharge;
chronic – infection occurred quite a long time ago, symptoms appear periodically and are mild;
hidden - the woman does not suspect about infection, and associates a slight malaise with the menstrual cycle, fatigue, the presence of other diseases, for example, thrush and other reasons.

Gonorrhea: acute and chronic

Forms of gonorrhea differ in the severity of symptoms, the nature of the course, diagnostic features and approaches to treatment.

The acute form always appears after the end of the incubation period only in men. In women, in half of the observations, it can occur in the form of a mild malaise with minor discharge and some discomfort during urination or sexual intercourse.

But there may be a completely different situation: a woman suddenly notices that she has noticeable discharge of an unusual color, visits to the toilet have become painful, it is difficult for her to even touch the perineum, she feels that the vaginal tissues are inflamed and swollen.

In this case, you cannot hesitate. The sooner she consults a doctor, the greater the likelihood that the infection will be quickly and completely defeated.

Unfortunately, women are sometimes overly frivolous with their health. Having noticed minor discharge or feeling unwell, they do not rush to the doctor, hoping that everything will go away on its own. But the infectious agent will not disappear from the body; it will capture more and more new targets, causing damage to the entire reproductive system.

Chronic gonorrhea is spoken of after two months from the moment of infection. Sometimes it is discovered by chance when examining the condition of the vagina and cervix. During this time, a woman often develops symptoms of other pathologies, the cause of which is associated with gonococci living in the body.

Diseases that arise against the background of chronic gonorrhea can lead to the most dire consequences.

According to localization they distinguish:

genital gonorrhea - the infection affects the mucous membranes of the internal and external genital organs (vagina, cervix, labia, etc.);
extragenital, when during oral, anal sex or as a result of a breakthrough of a purulent abscess, the pathogen penetrates the oral cavity, pharynx, rectum, bladder and other organs.

Also, based on localization, gonorrhea of the lower urinary tract (urethritis) is differentiated from ascending gonorrhea, when the inflammatory process affects the pelvic organs (cystitis).

According to clinical varieties, the following types of “female” gonorrhea are distinguished:

Gonorrheal urethritis. The most common type of female gonorrhea. Severe symptoms of this form are absent in almost half of women, and in the rest they are similar to the signs of the disease in men. The main complaints are related to painful urination.

Vestibulitis is a gonococcal lesion of the vestibular glands located at the entrance to the vagina.
Bartholinitis is a complete or partial infection of the large vestibular glands with gonococci.
Endocervicitis is an inflammatory process localized on the mucous membrane of the cervix, often accompanied by erosion.
Gonorrheal vaginitis (colpitis) is an inflammation of the vaginal epithelium. It occurs quite rarely, mainly in women during menopause and pregnancy.
Gonorrheal endometritis - develops when pus enters the uterine cavity, accompanied by sanguineous or purulent discharge and pain in the lower abdomen.
Gonococcal salpingitis and salpingoophoritis are an inflammatory process in the ovaries and fallopian tubes, the consequence of which is often the formation of adhesions.
Pelvioperitonitis. When the gonorrhea pathogen enters the pelvic peritoneum, active inflammation begins with an increase in temperature, severe pain in the lower abdomen and problems with the digestive organs.

All clinical types of gonorrhea can occur in both acute and chronic forms with periodic exacerbations or without pronounced symptoms of pathology.

Etiology

The cause of this pathology is a diploid microorganism that lives in the body on the mucous membranes. The predominant place of its localization is the genitourinary tract, incl. urethra.

This bacterium has become more widespread due to the fact that it produces substances that help it quickly penetrate the mucous membrane and also become insensitive to the action of various body defense factors. In addition, it should be noted that it is almost unstable in the environment, which explains the main route of its infection.

Routes of infection:

This disease is transmitted in most cases only through sexual contact.
In women, due to easy access to the urethra and genital tract, contact transmission is also possible, which is quite rare.
There may be cases of infection of a child from an infected mother who was not treated before delivery, and after passing through the birth canal the newborn is contaminated with pathogenic pathogens.
There are also increasing cases of infection during non-traditional sexual intercourse, which may include oral, anal, etc.

Why is gonorrhea dangerous for women?

If gonorrhea is not treated, the infection can affect various organs of the patient. Thus, a long-term inflammatory process in the ovaries and uterine cavity can lead to the formation of adhesions in the fallopian tubes and their obstruction and subsequent persistent infertility.

Some of the complications of pelvic inflammatory disease:

The formation of scar tissue, as a result of which the fallopian tubes are blocked - the egg cannot pass through them, and pregnancy does not occur;
Ectopic pregnancy (pregnancy outside the uterus, a serious complication that can be fatal and requires urgent medical attention);
Prolonged pain in the pelvis and abdomen.
In rare cases, untreated gonorrhea can spread to the blood or joints, which can be life-threatening.

Danger during pregnancy

An infection that enters the uterus early in pregnancy can cause a miscarriage. Other complications include premature rupture of membranes and preterm labor. An infant becomes infected with gonorrhea from an infected mother during childbirth in approximately 30-50% of cases. Sometimes this leads to complete blindness of the child - most often the infection affects the eyes (Fig. 3).

Drawing. Gonococcal infection in a child. Source: CDC/J. Pledger

If you are diagnosed with gonorrhea during pregnancy, consult your doctor to help determine the appropriate treatment for you. Therapy should be started as early as possible to reduce the likelihood of complications for the health of the unborn child.

Complications

Gonorrhea is unpleasant both because of its manifestations and the high risk of complications:

infertility in women (defective endometrium, tubal obstruction);
bartholinitis (damage to the Bartholin glands);
decreased libido;
complication of pregnancy , postpartum period (intrauterine growth retardation, spontaneous abortion, high risk of ectopic pregnancy, early birth, premature rupture of amniotic fluid, postpartum septic diseases, antenatal death of a child, death of a child within 24 hours after birth, chorioamnionitis);
infection of the child (blennorrhea, otitis media, gonococcal sepsis, genital tract infection);
disseminated gonorrhea - entry of the pathogen into the blood and its distribution throughout the body (skin hemorrhages, damage to joints, brain, kidneys, liver, heart);
gonorrheal conjunctivitis (in case of poor hygiene).

Symptoms

The main difference between female and male gonorrhea is that in almost half of the patients, the signs of the disease are mild or go completely unnoticed. The diagnosis is determined when you consult a doctor with complaints characteristic of other inflammatory pathologies of the genitourinary system.

Patients' complaints are mainly related to painful urination, green or yellow discharge, discomfort during intimacy, pain in the lower abdomen, and menstrual irregularities.

Incubation period

The first signs of infection in women appear 3-5 days after the bacteria enter the body, but the duration of the incubation period is influenced by a number of factors.

For example, if, simultaneously with gonococci, infection with another pathogenic microflora also occurs, the first symptoms may appear only after two weeks, and sometimes after a month. During the incubation period, the pathogen penetrates from the mucous layer to the submucosal layer and then into the lymphatic system.

The incubation period increases if the woman was currently taking antibacterial drugs. In this case, the activity of the gonorrhea pathogen can be suppressed, and the disease will be asymptomatic.

Clinical manifestations

The symptoms of gonorrhea vary depending on the location of the inflammation and the form of the disease.

If the disease manifested itself immediately after the end of the incubation period, then the most common symptoms of gonococcal lesions include:

copious purulent or purulent mucous discharge from the vagina;
discomfort, itching in the area of the external genitalia and vagina;
painful urination;
hyperemia and swelling in the labia area.

These symptoms are typical when an infection enters the vagina.

When the oral cavity becomes infected, gonococcal tonsillitis develops, the symptoms of which are fever, sore throat and purulent plaque on the tonsils.

If gonococci have penetrated the rectum, then patients complain of acute pain during bowel movements and purulent discharge from the anus.

When the disease becomes chronic, its symptoms persist, but become less noticeable, appearing only during an exacerbation. The process can be activated:

sexual contact;
menstruation;
consumption of hot spices and alcoholic beverages;
hypothermia.

During the period of remission, the symptoms of the pathology are practically invisible, the woman considers herself healthy. Since there are no external manifestations of the disease, she can easily agree to unprotected sex, infecting an unsuspecting partner.

Latent form (hidden)

During sex, a woman spreads gonococci

The asymptomatic course of the disease is called that way because it does not make itself felt in any way. A woman may not even realize that she is infected, and at the same time the gonococcus will be easily transmitted to men during sex with her, to the fetus if she gives birth, to female children who share the same towel or bathing sponge with her , bathroom.

Gradually, epithelial tissue is replaced by connective tissue, which does not carry any function, which leads to the development of female infertility and adhesions in the fallopian tubes.

Diagnostics

A diagnostic algorithm for suspected gonococcal infection has been developed for a long time and is successfully used in practice.

The first and mandatory stage of diagnosis is collecting anamnesis, external examination of the genital organs and examination of the cervix using a gynecological speculum. Objective signs of gonorrhea that a doctor can see during an examination, even in the absence of severe symptoms, include:

swelling and redness in the urethra, blockage of the glands;
purulent discharge mixed with mucus from the urethra and vagina;
inflammation of the vaginal walls;
swelling and ulceration of the cervical canal;
swelling and hyperemia of the cervix and a number of other signs of purulent inflammation of the mucous membranes.

After the initial examination, the doctor prescribes the necessary tests and tests.

Diagnostic measures include a set of mandatory procedures:
taking anamnesis and examining the genital organs;
bacterioscopy - smear analysis to determine the pathogen;
bacterial seeding - placing biomaterial in a special nutrient medium.

Important! In advanced cases, with multiple courses of antibacterial therapy, a provocative test is prescribed to determine the presence of gonococci in the body: the urethra or vagina is treated with a solution of silver nitrate. If the infection is not completely defeated during treatment, after provocation, gonococci spread to the mucous membranes of the genitourinary tract and are easily detected in a smear.

In modern laboratories, the PCR diagnostic method is widely used, which makes it possible to isolate the DNA of the infectious agent from any biomaterial. PCR is used when there is doubt about the presence of gonococcus, since these bacteria are very sensitive to environmental influences and easily change their cultural and morphological characteristics.

Taking the test correctly You should properly prepare for the test for gonorrhea:

exclude sexual intercourse 24 hours before the test,
do not urinate immediately before the test,
do not take antibiotics for at least 14 days,
do not use vaginal suppositories and other local medications for 48 hours.

You cannot take a test during your period.

Prevention

In order to protect against such an unpleasant disease as gonorrhea, barrier methods of contraception should be used. Condoms should be made of high quality latex. Do not use sex toys that other people use in your sex life.

Visit your gynecologist in a timely manner and get examined. At the first sign of gonorrhea, register with a dispensary.

At the public level, it is necessary to carry out regular sanitary and educational work with the population. These can be lectures (or conversations) in educational and medical institutions.

Share the article on social media. networks:

Treatment of gonorrhea in women

The basis of treatment for gonorrhea is antibacterial therapy. It is carried out comprehensively and includes taking medications to protect the liver, probiotics to preserve normal vaginal microflora, antifungal and restorative drugs.

All sexual partners should undergo treatment! During the course of therapy, any alcoholic beverages and sexual contact are completely prohibited. You can have sex again 7 days after completing treatment. Remember that gonorrhea can be re-infected if you come into close contact with an infected person.

Important! If gonorrhea is suspected and the diagnosis is confirmed, any self-medication is excluded, even with the most advertised means! Gonococci may be resistant to some antibiotics. Symptoms of infection may practically disappear, but the disease will not go away, but will become chronic.

The development of a treatment regimen and the choice of antibiotics are within the competence of the attending physician. The components of the therapeutic complex are selected strictly individually depending on the nature of the disease and its form.

If there is no effect from conservative treatment and the clinical picture of acute inflammation increases, surgical intervention is prescribed to open and sanitize the purulent focus. This operation is performed using laparoscopy. If drainage (and release) of the contents of the purulent focus into the pelvic cavity occurs, emergency abdominal surgery is performed - sanitation and drainage of the abdominal cavity. With peritonitis, the risk of needing to remove appendages increases sharply.

Treatment for pregnant women In pregnant women, gonorrhea is treated using drugs from the cephalosporin group; they are safe for both the mother and the fetus.
Usually this is 1 dose of medication. You can start therapy at any time. Refusal of treatment is fraught with serious consequences, including termination of pregnancy.

Sources

Federal Service for Supervision in the Sphere of Protection of Consumer Rights and Human Welfare [Electronic resource] // Infectious morbidity in the Russian Federation - Moscow, 2021.
Kubanova A. A., Kubanov A. A., Melekhina L. E. Dynamics of changes in intensive rates of incidence of sexually transmitted infections in the assessment of the epidemiological process and health status of the population of the Russian Federation for 2006–2016. //Bulletin of Dermatology and Venereology. 2018;94(1):27–37.
Aniskevich A.V., Shimanskaya I.G. Antibacterial therapy of gonococcal infection: problems, issues of choosing etiotropic therapy //Military Medicine. – 2021. – No. 3. – P.28-33.
Yargin S.V. On the treatment of gonorrhea: recent history //Chief Physician. – 2021. – No. 3(56) – P. 50-52.
Olga Belokon. I am a woman. All about women's health, contraception, hormones and much more. – 2020

Diagnosis of the disease

Only a venereologist can confirm or refute the symptoms of gonorrhea in women, as well as other sexual diseases.

Most often, he prescribes a woman to take a couple of tests, namely:

Sowing, which will accurately determine the presence of bacteria.
A smear is also not so effective in recognizing the presence of gonorrhea; it only shows the number of leukocytes, which can be used to judge the inflammatory process.

Chronic gonorrhoea is much more difficult to identify, but it is also possible.