Gonorrhea
| Classification according to ICD-10 | |
|---|---|
| A54.0 | Gonococcal infection of the lower genitourinary tract |
| A54.1 | - with abscess formation |
| A54.2 | Gonococcal infection of other urogenital organs |
| A54.3 | Gonococcal infection of the eye |
| A54.4 | Gonococcal infection of the musculoskeletal system |
| A54.5 | Gonococcal pharyngitis |
| A54.6 | Gonococcal infection of the anus and rectum |
| A54.8 | other gonococcal infection |
| ICD-10 online (WHO version 2019) | |
The Gonorrhea (also gonorrhea and gonorrhea , from ancient Greek γονόῤῥοια gonórrhoia , literally "seeds River") is one of the most common sexually transmitted diseases . This bacterial infectious disease affects the mucous membranes of the urinary and sexual organs. It is triggered by gonococci ( Neisseria gonorrhoeae ), aerobic (oxygen-dependent), gram-negative , mobile bacteria that appear in pairs as so-called diplococci , which were first microscopically detected in 1879 .
The colloquial term Tripper ( borrowed from nl . Druiper , to nd . Druipen " drop ") has been used since the second half of the 17th century.
With syphilis, soft chancre and venereal lymph node inflammation, gonorrhea is one of the classic sexually transmitted diseases.
Epidemiology
Gonorrhea is a worldwide sexually transmitted disease that occurs only in humans. Correct use of a condom or a leak cloth protects against infection . The disease can be transmitted from the sick mother to the child during childbirth.
Until the year 2000 the disease was notifiable in Germany . The reporting requirement was lifted with the introduction of the Infection Protection Act , which replaced the Federal Disease Act and the Act to Combat Venereal Diseases .
According to the Austrian Venereal Diseases Act, gonorrhea is subject to limited reporting ( Section 4 in conjunction with Section 1 Venereal Diseases Act).
In Switzerland, gonorrhea also for doctors, hospitals, etc. a notifiable disease and that after the Epidemics Act (EpG) in connection with the epidemic Regulation and Annex 1 of the Regulation of EDI on the reporting of observations of communicable diseases of man . A positive laboratory analysis result is subject to reporting.
The number of cases has been falling since the late 1970s, but trends in Europe diverged in the 1990s. In the second half of the 1990s, Belgium, Great Britain and France reported an increase in the number of diseases, while in other countries the incidence remained the same or decreased.
Gonorrhea is a major health problem worldwide. According to estimates by the World Health Organization , the number of new cases is 60 million each year, about one percent of the world population.
Germany
In Germany there are around 11 to 25 patients per 100,000 inhabitants or around 10,000 to 20,000 cases per year. In 2000 there were 2,000 reported cases. In Saxony, the number of infections per 100,000 inhabitants rose from 6.8 in 2003 to 14.3 in 2010. The Robert Koch Institute estimates an unreported number of unreported cases in the 1990s of 85 percent.
United States of America
In the United States in 2007 there were 115.6 people with disease per 100,000 population. This is a slight increase compared to 2004 (112.4 patients per 100,000 population), after the number of patients in the United States remained roughly the same between 1997 and 2004 and fell by 74 percent between 1975 and 1997 as a result of government control programs .
Pathogenesis
The bacteria attach themselves to the mucous membrane cells of the urethra or the cervix . This is done using special pili , thread-like extensions on the bacterial wall made up of proteins . The adhesin pilin plays a major role in this.
Some strains stimulate the mucous membrane cells to take them up ( phagocytosis ) and to eject them on the other side facing away from the lumen. This process is known as transcytosis . Phagocytosis is induced by opa proteins (for opacity, "cloudiness", since they make the colonies appear cloudy).
Gonococci are phagocytosed by granulocytes (cells of the immune system ) and can therefore usually be killed by the body. Only a part survives in the cells. The tissue damage occurs by triggering a purulent inflammation with complement activation and the resulting destruction of the infected cover cells . The lipopolysaccharide of the bacterial cell wall seems to play a major role in this.
Clinical picture
The incubation period is usually two to three days, but sometimes up to seven days can pass. About five percent of those affected do not experience any symptoms despite the infection. These asymptomatic infected people do not have any symptoms themselves, but can infect other people.
In men, it leads to inflammation of the urethra ( urethritis (often in the morning as a "Bonjour drops", not to be confused with) with itching, purulent discharge Lusttropfen ) and pain during urination ( Algurie ). Symptoms of urethritis lasted about eight weeks before antibiotics were introduced. Rare complications are inflammation of the epididymis ( epididymitis ) and prostate ( prostatitis ), which can lead to infertility .
In women, the incubation period cannot be precisely determined, but symptoms usually appear after about ten days. Inflammation of the cervix with purulent discharge ( mucopurulent cervicitis ) can also occur here. Inflammation of the vaginal mucous membrane occurs only in very rare cases, as does inflammation of the Bartholin's glands . Affected uterine lining and fallopian tubes can stick together, which can lead to sterility. In the worst case, the gonococcal infection can spread to the peritoneum .
The gonococci can also be transmitted through the mucous membrane of the throat or rectum through oral or anal sex . Transmission from the throat to other sexual contacts is rare.
A gonococcal infection of the eyes ( ocular gonorrhea ) in adults is mostly caused by self-inoculation, i.e. by rubbing the eyes after touching infected genitals. The infection can be severe, but mild and asymptomatic courses are also possible. Symptoms are severely swollen eyelids, severe hyperemia (increased blood flow) and excessive pus formation. Lytic enzymes from infiltrating granulocytes of the immune response can occasionally cause ulceration of the cornea , in serious cases even perforation. The fastest possible diagnosis and treatment are required here.
Gonococcal infections during pregnancy can cause serious complications. In the first trimester , inflammation of the peritoneum and fallopian tubes can result in the loss of the fetus , in the second and third trimester ascending infections are rather rare, as a mucus plug closes the uterus. The most common type of illness in newborns after infection from the mother is gonoblennorrhea (also ophthalmia neonatorum ), an infection of the eyes resulting from contact with pathogens in the secretions of the uterus. Blindness can result. To avoid this, a Credé prophylaxis is carried out immediately after the birth , in which eye drops are administered that have an antibacterial effect. Other, less common manifestations in newborns are inflammation of the mucous membranes in the nose, vagina, and anus, and are often asymptomatic.
In rare cases, the gonococci can be distributed throughout the body via the bloodstream ( bacteremia ). This leads to skin infections that show up as hemorrhagic pustules. It can also lead to infection of joints (purulent arthritis ). This occurs mainly in the joints of the extremities and manifests itself as pain in several joints ( polyarthralgia ) and pus formation. Body-wide gonococcal sepsis is a serious and life-threatening disease.
Other complications that have become rare since the introduction of antibiotics are inflammation of the meninges ( meningitis ) and the heart ( endocarditis ).
Extragenital forms
Also little known to doctors are gonorrhea infections far away from the genital organs. However, according to the Robert Koch Institute, these may even be more common than the genital forms. An infection in the anus and throat is quite common. Since infections of the anus only occasionally cause discomfort and infections of the throat almost never, these infections usually go undetected. Therefore, various specialist societies recommend targeted screening by smear examinations of the pharynx, anus and urethral mucosa, as this is the only way to reliably detect such infections. Symptom-free infections usually heal on their own after a few weeks without complications, but until then they pose a risk of infection.
Diagnosis
A smear can be taken from the urethral secretion or the secretion of the cervix and the pathogen can be detected microscopically with the help of Gram stain or in the culture . While this evidence is very accurate in symptomatic men, it is only positive in about 50% of cases in cervicitis . Another method is the detection of nucleic acids specific for Neisseria gonorrhoeae . The sensitivity of this test is comparable to that of conventional cultures, but it is cheaper.
In the case of created cultures, an antibiogram is usually created at the same time to check for possible resistance to antibiotics .
therapy
It is an antibiotic treatment is necessary. These were originally the silver preparation Protargol from 1897 , discovered by the German chemist Arthur Eichengrün , from 1935 sulfonamides from Domagk and from 1944 penicillin was a sufficient treatment.
At the end of the 1960s, the pathogen's first resistance to penicillins was found in Bangkok , which may be connected to the local brothel streets . Due to the increasing development of resistance of the gonococci, the administration of other antibiotics, for example cephalosporins or gyrase inhibitors (especially fluoroquinolones ), is recommended. But there is also increasing resistance to fluoroquinolones. The Robert Koch Institute therefore only recommends group 3 cephalosporins in high doses, for example ceftriaxone or cefixime . Alternatives include cefotaxime or spectinomycin . Ceftriaxone is mainly used in ophthalmia neonatorum. In Japan, in May 2011, a strain was described for the first time that had developed resistance to all cephalosporins. Resistant strains have now also appeared in Australia, France, Norway, Sweden and Canada. The WHO warned in 2012 that there could be no cure for millions of infected people in the foreseeable future.
For complicated gonorrhea, the same antibiotics are used for a long time (seven days to a month). Newborn infections can now be largely avoided through preventive medical examinations for pregnant women.
Since gonorrhea is often accompanied by a chlamydial infection , other antibiotics, so-called oral tetracyclines , are sometimes given for a week to combat it.
The treatment of the sexual partner is also important, as otherwise reciprocal infection can occur over and over again ( ping-pong effect ).
Neonatal prophylaxis
When Crede prophylaxis infants was immediately after birth earlier silver nitrate - today mostly tetracycline - or erythromycin -containing eye drops into the conjunctival sac instilled to a Neugeborenenblennorrhoe prevent with maternal gonococcal infection.
Historical aspects
A very early description of gonorrhea with information on treatment can be found in the writings of Aretaios , a Greek doctor of the Hippocratic school . At Celsus the disease is called "Nimia profusio seminis".
Gonorrhea, with purulent discharge as the main symptom, is mentioned around 1200 BC. In the Torah .
The difference between urethral discharge and semen flow was already known to the Persian doctor Haly Abbas in the 10th century.
In 1837, the French doctor Philippe Ricord was able to prove for the first time that gonorrhea is an independent disease that can be distinguished from syphilis . Up to that point in time, both diseases were grouped together as venereus disease (or “lust epidemic”). Albert Neisser first discovered gonococci in the urethral swab of a patient in 1879, which is why the entire Neisseria group was named after him. Carl Siegmund Franz Credé introduced the eye prophylaxis named after him in 1881 . Ernst Bumm succeeded in growing gonococci for the first time in 1885.
In the United States of America , gonorrhea, like other sexually transmitted diseases, was extremely prevalent in the 1970s, particularly among homosexual men. The gay rights organizations, which emerged in large numbers during this time, complained about the failures of the health authorities, which did not provide any clarification that gonorrhea could also be transmitted through oral and anal intercourse. These sexual practices were illegal in most American states at the time. Doctors, too, were usually unable to diagnose oral and rectal forms of gonorrhea because the patients did not talk about their sexual habits or their symptoms for fear of prosecution. As a result, homosexual organizations set up their own clinics in many American cities.
literature
- Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 200 f.
- Birgit Adam : The punishment of Venus. A cultural history of venereal diseases. Orbis, Munich 2001, ISBN 3-572-01268-6 , passim.
- Tinsley R. Harrison et al. a .: Harrison's Principles of Internal Medicine. 17th edition. Mcgraw-Hill, New York 2008, ISBN 978-0-07-007272-5 .
- Enno Christophers, Markward Ständer, Kathleen Desert: Skin and sexually transmitted diseases. 7th edition. Urban & Fischer, Munich 2003, ISBN 3-437-26710-8 .
- Werner E. Gerabek : Gonorrhea (gonorrhea). In: Werner E. Gerabek, Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 502 f.
- Dominique Puenzieux, Brigitte Ruckstuhl: Sexuality, Medicine and Morality. The fight against venereal diseases syphilis and gonorrhea. Zurich 1994.
- Walther Schönfeld : Medical terms for the "gonorrhea of the man's urethra" in historical light. In: Sudhoffs Archiv 34, 1941, pp. 169–178.
- Walther Schönfeld: From the local treatment of gonorrhea in men with injections to the discovery of the gonococcus and the syringe shapes used. In: Sudhoffs Archiv 35, 1942, pp. 43-67.
Web links
- Gonorrhea - information from the Robert Koch Institute
- Chapter gonorrhea. urologielehrbuch.de
Individual evidence
- ↑ gonorrhea. In: Jacob Grimm , Wilhelm Grimm (Hrsg.): German dictionary . tape 22 : Treib – Tz - (XI, 1st section, part 2). S. Hirzel, Leipzig 1952 ( woerterbuchnetz.de ). trip . In: Jacob Grimm , Wilhelm Grimm (Hrsg.): German dictionary . tape 22 : Treib – Tz - (XI, 1st section, part 2). S. Hirzel, Leipzig 1952 ( woerterbuchnetz.de ).
- ^ Heinrich Lippert: The pathology and therapy of venereal diseases. Edited from Philippe Ricord's latest lectures and remarks. BS Berendsohn, Hamburg 1846, p. 147 ff.
- ↑ The Punishment of Venus. A cultural history of venereal diseases. Orbis, Munich 2001, ISBN 3-572-01268-6 , pp. 14-17.
- ^ Homepage of the Child and Adolescent Gynecology Working Group ( Memento from August 2, 2007 in the Internet Archive ) accessed on May 1, 2007.
- ↑ U. Marcus, O. Hamouda, W. Kiehl: Reported incidence of gonorrhoea and syphilis in East and West Germany 1990-2000 - effects of reunification and behavior change . In: Eurosurveillance . 10, No. 43, October 25, 2001.
- ↑ WHO experts warn of incurable gonorrhea . Welt Online , June 6, 2012; Retrieved July 10, 2017
- ↑ Information from the Robert Koch Institute on the epidemiology of gonorrhea (PDF) accessed on September 24, 2012.
- ↑ STD Surveillance 2005 on Gonorrhea by the CDC ( Memento from October 5, 2007 in the Internet Archive ), accessed on May 18, 2007 (English)
- ↑ Gonorrhea and chlamydia in men who have sex with men . In: RKI (Ed.): Epid. Bull. No. March 9 , 2006 ( rki.de [PDF]).
- ↑ Alice Reyn: Antibiotic sensitivity of gonococcal strains isolated in the South-East Asia and Western Pacific regions in 1961-68 . In: Bulletin of the World Health Organization . tape 40 , no. 2 , 1969, ISSN 0042-9686 , p. 257-262 , PMID 4979392 , PMC 2554611 (free full text).
- ↑ Public Health Agency of Canada ( Memento June 2, 2008 in the Internet Archive ) (English) accessed on May 3, 2007
- ↑ On the occurrence of resistances in Neisseria gonorrhoeae in the Rhine-Main area . In: RKI (Ed.): Epid. Bull. No. March 13 , 2009 ( rki.de [PDF]).
- ↑ Marianne Abele-Horn (2009), p. 200.
- ↑ M. Ohnishi, D. Golparian, K. Shimuta, T. Saika, S. Hoshina and a .: Is Neisseria gonorrheae initiating a future era of untreatable gonorrhea ?: detailed characterization of the first strain with high-level resistance to ceftriaxone. In: Antimicrob Agents Chemother . 2011 Jul; 55 (7), pp. 3538-3545. PMID 21576437
- ^ Neisseria gonorrhoeae Treatment Failure and Susceptibility to Cefixime in Toronto, Canada. In: Journal of the American Medical Association. (English) accessed on January 9, 2013
- ↑ WHO experts warn of incurable gonorrhea . Welt Online , June 6, 2012; Retrieved July 10, 2017
- ↑ A. Mann (translator): The writings of the Cappadocier Aretaeus that came upon us. Hall 1858.
- ↑ Julius Rosenbaum : History of the lust epidemic in antiquity together with detailed studies of the Venus and phallic cults, brothels, Νοῦσος ϑήλεια of the Scythians, paederasty and other sexual excesses of the ancients as contributions to the correct explanation of their writings . [1839]. 7th edition. H. Barsdorf, Berlin 1904, pp. 375-387.
- ↑ Werner E. Gerabek: Gonorrhea (gonorrhea). In: Encyclopedia of Medical History. 2005, p. 502 f.
- ↑ Birgit Adam : The punishment of Venus. A cultural history of venereal diseases. Orbis, Munich 2001, ISBN 3-572-01268-6 , p. 91.
- ^ Ricord: Traité pratique des maladies vénériennes. 1838, p. 104 f.
- ^ Hendrik Christian Voss: The representation of syphilis in literary works around 1900. Impact of scientific concepts and social ideas. Medical dissertation, Lübeck 2004, p. 9; uni-luebeck.de (PDF)
- ↑ Julius Rosenbaum: History of the lust epidemic in antiquity […] . Hall 1839; 7th edition, H. Barsdorf, Berlin 1904
- ^ Philippe Ricord: Lexicon of natural scientists . Spectrum, Heidelberg 2000.
- ↑ Stefan Winkle: Cultural history of epidemics . Komet, Düsseldorf / Zurich 1997, ISBN 3-933366-54-2 .
- ^ Mark Thompson (Ed.): Long Road to Freedom. The Advocate History of the Gay and Lesbian Movement. St. Martin's Press, New York 1994, ISBN 0-312-09536-8 , p. 138.
