For the treatment of patients with gonorrhea, it is recommended to use drugs of the penicillin group (benzylpenicillin, bicillin-1, -3, -5, ampicillin, ampiox, oxacillin), chloramphenicol, tetracycline drugs (tetracycline, oxytetracycline, metacycline, doxycycline, vibramycin), macrolides (erythromycin, oletethrin, ericycline), aminoglycosides (sisomycin, kanamycin), rifampicins (rifampicin, benemycin), long-acting sulfonamide drugs (sulfamonomethoxine, sulfadimethoxine) and combined sulfonamide drugs (biseptol, sulfatone).
Antibiotics
For warning allergic reactions It is recommended to prescribe one of the following 20–30 minutes before administering the antibiotic. antihistamines(diphenhydramine, pipolfen, suprastin, tavegil, fenkarol, etc., 1 tablet each).
Penicillin group drugs are the main antibiotics for the treatment of gonorrhea, and the rest are reserve antibiotics.
In men with acute and subacute gonorrheal urethritis and in women with acute and subacute gonorrhea of the lower section genitourinary system The recommended course dose of benzylpenicillin is 3.4 million units.
In fresh torpid cases of uncomplicated gonorrhea, acute complications gonorrhea in men, ascending and chronic gonorrhea, the course dose of benzylpenicillin should be 4.2–6.8 million units (depending on the severity of the disease).
At the first injection, 600,000 units are administered, and at subsequent injections, 400,000 units are administered per saline solution at intervals of three hours without an overnight break.
In exceptional cases (impossibility of a second visit) in men with acute and subacute urethritis, you can use the simultaneous administration of the entire course dose (3 million units) of benzylpenicillin with 5 ml of your own blood or durant penicillin preparations.
Penicillin in a course dose of 4,000,000 units can also be administered intramuscularly at once (2,000,000 units in each buttock), while 0.7 g of etamide is prescribed orally 30 minutes before the injection and every 6 hours, the total dose of etamide is 2.8 g.
For chronic gonorrhea in women, it is advisable to use regional administration of benzylpenicillin. For this purpose, from the beginning of treatment, 200,000 units of the drug are injected into the thickness of the muscular layer of the cervix. At the same time, intramuscular injections of benzylpenicillin are given in single and course doses recommended for chronic gonorrhea.
Course doses in children should be the same as in adults. For children, the drug is administered in single doses of 50,000 - 200,000 units (depending on age) with an interval of 4 hours around the clock.
Bicillin - 1, 3, 5. Men with acute and subacute urethritis and women with acute gonorrhea of the lower genitourinary system are administered in the form of 6 injections of 600,000 units with an interval of 24 hours or 1,200,000 units after 48 hours at a course dose of 3 .6 million units Patients with other forms of gonorrhea are prescribed 7–10 injections of 600,000 units each with an interval of 24 hours, at a course dose of 4.2–6 million units.
Bicillin injections are performed in two stages - first, a needle is inserted into the outer upper quadrant of the buttock, and then, if there is no blood from the needle, an antibiotic is injected.
As an exception, only for fresh and subacute gonorrheal urethritis in men, single injections of bicillin-3 in a dose of 2,400,000 units (1,200,000 units of the drug into each buttock) are possible. In this case, 30 minutes before the antibiotic injection, patients receive 1.05 etamide (3 tables). The same dose of etamide is then given at 3, 6 and 9 hours; a total of 4.2 g of the drug per course.
Ampicillin. Patients with acute and subacute gonorrhea are prescribed 3.0 g, chronic - 8.0 g of the drug (0.5 g every 4 hours a day).
Ampiox. For patients with acute and subacute gonorrhea, the drug is prescribed orally at a dose of 0.5 g every 4 hours for 4–5 days; for chronic gonorrhea for 5–7 days. For children under 12 years of age, the drug is prescribed orally at the rate of 0.1 g per 1 kg of body weight, over 12 years of age - in the same doses as for adults.
If the drug is prescribed intramuscularly, daily dose for newborns and children under 1 year of age – 0.1–0.2 g per 1 kg of body weight; from 1 to 6 years – up to 0.1 g; from 7 to 14 years – 0.05 g per 1 kg of body weight; adults – 2.0 g per day. The daily dose is administered in 3-4 doses with an interval of 6-8 hours.
Oxacillin. For acute and subacute forms of the disease prescribed orally 0.5 g 5 times a day, for a course of 10.0. For other forms of gonorrhea – 14.0 g.
The drugs ampiox and oxacillin are also active against penicillinase-producing strains of microorganisms.
Carfecillin. Prescribed 0.5 g 3 times a day, for fresh uncomplicated gonorrhea - 5.0 g per course of treatment, for chronic and complicated gonorrhea - 8.0 g.
A contraindication to the use of penicillin drugs is a history of intolerance to this antibiotic and novocaine (when penicillin is dissolved in novocaine).
Augmentin. Prescribed for fresh uncomplicated gonorrhea, 375 mg every 8 hours. Per course – 1.875 g. For complicated and chronic gonorrhea: during the first three days 750 mg every 8 hours, the remaining two days - 375 mg every 8 hours.
Sulacillin. The drug is administered intramuscularly at a dose of 1.5 g with an interval of 8 hours, the course dose for fresh forms is 6.0 g; for chronic and complicated cases – 9.0 g.
Levomycetin. For men with acute and subacute urethritis and women with acute gonorrhea of the lower genitourinary system, chloramphenicol is prescribed orally at a course dose of 6 g (3 g per day), for other forms of gonorrhea - 10 g (the first two days, 3 g, the rest - 2 g). g per day). Single doses of 0.5 g are given at equal intervals with a night break of 7–8 hours, 30 minutes before meals.
For children, chloramphenicol is prescribed 0.2 - 0.25 g 4 times a day. The course dose is the same as for adults with acute gonorrhea (6.0 g).
Tetracycline antibiotics (tetracycline, chlortetracycline, oxytetracycline). In men with acute and subacute urethritis and in women with acute gonorrhea of the lower genitourinary system, tetracycline, chlortetracycline and oxytetracycline are prescribed in a course dose of 5 g (5 million units).
For acute complicated gonorrhea in men, ascending gonorrhea in women, as well as for chronic gonorrhea, the course dose should be increased to 10 g. The first 2 days are prescribed 0.3 g and subsequent days 0.2 g 5 times a day at regular intervals. . The night break should not exceed 7–8 hours. To prevent the development of candidiasis, nystatin 500,000 units 4 times a day or levorin 250,000 units 4 times a day should be prescribed simultaneously.
Metacycline, Rondomycin. For fresh acute and subacute uncomplicated gonorrhea, it is prescribed orally after meals in a dose of 0.6 g (first dose), then 0.3 g every 6 hours; per course of treatment 2.4 g. For other forms of gonorrhea per course 4.8 g.
In men and women with fresh uncomplicated gonorrhea, one-day treatment with metacycline (rondomycin) can be used: for patients with fresh acute gonorrhea, the drug is given in 2 doses of 1.2 g after meals with an 8-hour break; for a course of treatment 2.4 g. Patients with fresh torpid gonorrhea are prescribed 1.2 g in 3 doses after meals with an 8-hour break; for a course of treatment 3.6 g, and for fresh complicated gonorrhea - in 4 doses of 1.2 g after meals with an 8-hour break; per course of treatment 4.8 g.
Doxycycline (Vibramycin). For patients with fresh, uncomplicated acute and subacute forms of gonorrhea, the drug is prescribed orally at a dose of 0.1 g (first dose 0.2 g) every 12 hours, for a course of treatment of 1.0 g. For other forms of the disease, the drug is prescribed according to the same method, but for a course 1.5 g.
Macrolide antibiotics
Erythromycin. For men with acute and subacute gonorrheal urethritis and women with acute gonorrhea of the lower genitourinary system, erythromycin is prescribed around the clock at a course dose of 8.8 million units (two days, 400,000 units 6 times a day and subsequent days, 400,000 units 5 times a day ). For patients with other forms of gonorrhea - 12.8 million units using the same method.
Macropen. Patients with acute and subacute gonorrhea are prescribed 400 mg 3 times a day at a course dose of 3.6 g; for other forms of gonorrhea, the course dose is 6.0 g.
Olethetrin. For men with acute and subacute gonorrheal urethritis and women with acute gonorrhea of the genitourinary system, oletethrin is prescribed in a course dose of 4 million units; for other forms of gonorrhea - 7.5 million units or more. The first day is given 1,250,000 units (the first dose is 500,000 units and 3 doses of 250,000 units each), and on the remaining days - 250,000 units 4 times a day at equal intervals.
Eratsin. Prescribe 400 mg 4 times a day every 6 hours. The course dose for fresh gonorrhea is 8 g (5 days); for chronic – 11.2 g (7 days).
Azalids
Aminoglycoside antibiotics
Kanamycin is an antibiotic wide range actions. It is used in the form of kanamycin mono- or sulfate, highly soluble in water. For acute and subacute gonorrheal urethritis in men and acute gonorrhea of the lower genitourinary system in women, kanamycin is prescribed intramuscularly at 1 million units after 12 hours in a course dose of 3 million units, for other forms of gonorrhea - 6 million units. With long-term use, the drug can have nephro- and ototoxic effects. Kanamycin should not be prescribed simultaneously with other antibiotics that have oto- and nephrotoxic effects.
Cephalosporins
Berlocid 960, Berlocid 480. For fresh acute and subacute gonorrhea, 2 tablets of Berlocid 960 (or 4 tablets of Berlocid 480) are prescribed every 12 hours for 2 days; per course 8 tablets of Berlocid 960 (or 16 tablets of Berlocid 480). For chronic gonorrhea, the course dose is up to 20 tablets of Berlocid 960 or 40 tablets of Berlocid 480. If necessary, a shortened method of treatment with Berlocid can be prescribed: 2.5 tablets of Berlocid 960 every 8 hours (5 tablets per course), or 5 tablets of Berlocid 480 after 8 hours (10 tablets per course).
Fluorinated quinolones
Fresh acute uncomplicated gonorrhea:
Eracin. Prescribed 400 mg 4 times a day every 6 hours. The course dose for fresh gonorrhea is 8 g (5 days); for chronic – 11.2 g (7 days).
Ericicline. For patients with acute and subacute course of the disease, the drug is prescribed 0.25 g five times a day after meals, per course - 3.0 g; for other forms of the disease – 6.0 g (complicated forms – 7.0).
Azalids
WHO experts recommend azithromycin (sumamed), an antibiotic from the azalide group, as the drug of choice for the treatment of gonorrhea and combined infections of the urogenital tract.
Azithromycin. When treating fresh gonorrhea, 1.5–2.0 g is prescribed once or in 2 doses of 1.0 g. For fresh torpid and chronic gonorrhea, the total dose is 2.0 g according to the following scheme: first dose 1 g, then every 24 250 mg per hour until the course dose is reached.
Roxithromycin (medicamicin, josamycin) is used 1.0 g once in the treatment of fresh uncomplicated gonorrhea.
Aminoglycoside antibiotics
Kanamycin is a broad-spectrum antibiotic. It is used in the form of kanamycin mono- or sulfate, highly soluble in water. For acute and subacute gonorrheal urethritis in men and acute gonorrhea of the lower genitourinary system in women, kanamycin is prescribed intramuscularly at 1 million units after 12 hours in a course dose of 3 million units, for other forms of gonorrhea - 6 million units. With long-term use, the drug can have nephro- and ototoxic effects. Kanamycin should not be prescribed simultaneously with other antibiotics that have oto- and nephrotoxic effects. Cephalosporins
Cephalexin (Clarcef, Ceporex) – in the first 2 days, 0.5 g 4 times a day, from the third day, 0.25 g 4 times a day. The course dose for fresh uncomplicated gonorrhea is 5.0 g, for complicated and chronic forms – 7.0 g.
Ceftazidime (Fortum) is administered intramuscularly in a course dose of 2 g for acute gonorrhea.
For acute and subacute gonorrheal urethritis in men, claforan is administered intramuscularly, 1.0 g every 12 hours, 2 times a day, for a course of 2.0 g. For other forms of gonorrhea, a course of treatment of 8.0–10.0 g of the drug.
Ketocef is administered intramuscularly at a dose of 1.5 g once for acute, subacute and chronic gonorrheal urethritis.
Ceftriaxone (Rocephin, Longacef) is administered intramuscularly, 1.0 g every 12 hours, 2 times a day for acute and subacute gonorrheal urethritis; per course 2.0 g.
Cephobid is administered intramuscularly at 1.0 g per day; for a course of treatment for fresh forms – 3.0 g; for all others - 5.0 g.
Long-acting sulfa drugs
Sulfamonomethoxine and sulfadimethoxine. Prescribed for intolerance to antibiotics and after unsuccessful penicillin therapy. The first 2 days are prescribed 1.5 g 3 times a day at regular intervals and in subsequent days - 1.0 g 3 times a day. The course dose for acute and subacute uncomplicated gonorrhea is 15.0 g; for other forms – 18.0 g.
Biseptol, Bactrim. For patients with fresh acute and subacute gonorrhea, the drug is prescribed 4 tablets every 6 hours; per course 7.68 g (16 tablets); for other forms – 9.6 g (20 tablets). As an exception, men may be prescribed a shortened (one-day) method of treatment with Biseptol. In this case, for acute and subacute forms of gonorrhea, the drug is prescribed 5 tablets (2.4 g) in two doses after meals with an 8-hour interval; per course - 4.8 g. For fresh acute torpid and complicated forms - 5 tablets (2.4 g) in three doses after meals with an 8-hour interval, per course 7.2 g.
Berlocid 960, Berlocid 480. For fresh acute and subacute gonorrhea, 2 tablets of Berlocid 960 (or 4 tablets of Berlocid 480) are prescribed every 12 hours for 2 days; per course 8 tablets of Berlocid 960 (or 16 tablets of Berlocid 480). For chronic gonorrhea, the course dose is up to 20 tablets of Berlocid 960 or 40 tablets of Berlocid 480. If necessary, a shortened method of treatment with Berlocid can be prescribed: 2.5 tablets of Berlocid 960 every 8 hours (5 tablets per course), or 5 tablets of Berlocid 480 after 8 hours (10 tablets per course).
Sulfatone. For patients with fresh acute and subacute gonorrhea, the drug is prescribed 4 tablets (1.4 g) with an interval of 8 hours, per course - 4.2 g. For other forms of the disease - 5.6 g (complicated forms - 7.0 g).
Fluorinated quinolones
Synthetic broad-spectrum antimicrobials (fluorinated hydroxyquinolone carboxylic acid derivatives) with excellent ability to penetrate tissues and liquids.
– Fresh acute uncomplicated gonorrhea:
abactal (pefloxacin) – once 0.6 g;
maxaquin (lomefloxacin) – once 0.6 g;
nolicin (norfloxacin) – once 0.8 g;
ciprofloxacin (Tsifran) – once 0.5 g;
Siflox – once 0.75 g.
– Fresh complicated and chronic gonorrhea:
abactal – 0.6 g 1 time per day, 2.4 g per course;
maxaquin – 0.6 g once a day, 2.4 g per course;
Siflox – 0.5 every 12 hours, 4 g per course;
ciprobay (ciprofloxacin) – first dose 0.5 g; then 0.25 g every 12 hours, for a course of 1.25 g;
tarivid (ofloxacin) – first dose 0.4 g, then 0.2 g every 12 hours, for a course of 1.6.
The use of fluorinated quinolones is contraindicated in pregnant women and children under 14 years of age.
Spectinomycin (trobicin)
For the treatment of gonorrhea caused by (beta-lactamase-producing strains of gonococci, more than effective antibiotics(spectinomycin, rosoxacin, 2nd and 3rd generation cephalosporins). Against this background, trobitsin (spectinomycin) from the group of aminocyclitols stands out positively. Trobitsin is chemically different from all other antibiotics and its antibacterial activity is directed specifically at Neisseria gonorrhoeae. The course of treatment of uncomplicated gonorrheal urethritis, cervicitis or proctitis requires a single intramuscular injection of the drug (2.0 g for men and 4.0 g for women). A dose of 4.0 g is administered equally into the upper outer quadrant of each buttock. For the treatment of children, 40 mg of the drug once is sufficient.
Rifampicin
For patients with fresh acute and subacute and uncomplicated forms of gonorrhea, the drug is prescribed orally at a dose of 0.3 g (first dose - 0.6 g) every 6 hours 30-60 minutes before meals, for a course of 1.5 g. For other forms of gonorrhea - according to the same technique for a course of 6.0 g. Rifampicin is contraindicated for pregnant women.
Gonorrhea is an infectious disease that is transmitted primarily through sexual contact. But, despite the predominance of the sexual route, there are also household routes of infection and infection during childbirth.
The causative agent is the gram-negative diplococcus Neisseria, which causes purulent inflammation genitourinary tract. Most often the disease manifests itself in the form of urethritis, salpingitis, cervicitis, but it can also be in the form of proctitis, conjunctivitis and pharyngitis. If the pathogen penetrates the blood, the process generalizes and then damage to the joints, heart and meninges is possible.
After penetration of the pathogen, antibodies begin to be produced in the body, but without the formation of immunity, which is why a person can get sick with gonorrhea repeatedly.
The disease occurs in acute form, and without proper treatment it goes into a chronic phase that lasts for years. The transition to this form is often associated with a mild or asymptomatic course of the disease, which is very often observed in women. In addition, carriage is possible without showing symptoms of the disease. Women are carriers of the disease in half of the cases, although they may not have clinical manifestations and they feel quite satisfactory.
How does gonorrhea manifest?
Gonorrhea can affect any level of the genitourinary system. Most often, inflammation occurs in the lower parts - the urethra, Bartholin's glands, cervical canal, and vagina. Without treatment, the pathogen penetrates further into the uterus and its appendages or the prostate gland and testicles. Also, gonococci can penetrate the bladder and ascend to the kidneys.
Most severe complication gonorrheal chronic process is:
- Infertility;
- Rupture of the fallopian tubes;
- Adhesive process in the abdominal cavity;
- Pelvioperitonitis;
- Menstrual irregularities.
- Orchiepididymitis;
- Prostatitis;
- Testicular death;
- Narrowing of the urethra;
- Infertility and impotence.
The most characteristic manifestations of infection with gonococci are burning and pain in the genitals and urethra, which occur 3-7 days after questionable sexual intercourse.
The symptoms of acute gonorrhea in men and women have similar manifestations:
- Discharge of pus from their genitals;
- Burning and itching of the genitals, aggravated by urination and during sexual intercourse;
- Pain in the lower third of the abdomen;
- Frequent urination;
- Redness of the skin in the genital area;
- Regional lymphadenitis may be observed;
- Temperature increase.
Without treatment, after 2-3 months the acute process enters the chronic phase, and other parts of the genitourinary system may be affected. Chronic forms of the disease are much more difficult to treat, and the number of undesirable consequences increases sharply. This is why it is preferable to treat gonorrhea in the early stages.
How to treat gonorrhea
Antibiotics for gonorrhea occupy the main place. But the success of treatment depends on the combination of all treatment methods. For the best effect, it is necessary not only to confirm the diagnosis of gonorrhea, but also to determine the sensitivity of the pathogen to certain pharmaceuticals.
General principles of treatment
Drugs for the treatment of gonorrhea are divided into etiotropic, symptomatic, pathogenetic.
- Etiotropic drugs are aimed at destroying the pathogen and fighting gonococcus.
- Symptomatic treatment involves the use of medications to reduce or completely eliminate all symptom complexes characteristic of a given disease.
- Pathogenetic therapy blocks the disease and prevents links in the pathological chain from developing.
Each clinical form of gonorrhea requires an individual approach and the use of a specific set of medications that have best effect precisely with these clinical manifestations.
In acute cases, antibiotics have a good therapeutic effect. They are used regardless of gender. At chronic course process, it is more expedient to start treatment not with antibacterial therapy, but with an increase immune status patient and local resistance, and only then include antibiotics and physiotherapeutic measures.
A patient with gonorrhea is usually treated by two doctors - a gynecologist or urologist and a dermatovenerologist. The success of treatment largely depends on their common and coordinated efforts. In this case, the active participation of the patient himself is necessary.
Antibiotics for gonorrhea
To treat gonorrhea, various groups of antibacterial drugs are used, the most common of which are the penicillin group - benzylpenicillin, bicillin. Typically, benzylpenicillin is administered intramuscularly at 300,000–600,000 units (every 3–4 hours, 10 days). However, the effectiveness of the drug depends on the degree of sensitivity of the gonococcus to it. Bicillin is also administered intramuscularly at 600,000 units once a week.
Bicillin is characterized by the ability to long-term block the synthesis of bacterial cell structures and stop the proliferation of gonococci. A total of 6 injections are required. When using bicillin-5, the frequency of injections is 1 time every 4 weeks, 1,500,000 units intramuscularly only. Thanks to the prolonged action of this drug, it is possible to use therapy at home. Among patients, this method was called one-injection treatment of gonorrhea.
In addition to injectable drugs, it is possible to use tableted antibiotics - ampicillin, oxacillin, augmentin.
Ampicillin is taken for 7-14 days, 1-2 tablets three times a day.
Oxacillin is taken according to the same regimen, always 1 hour before meals, for 5 days. The drug has great activity against diplococci and pathogens develop resistance to it much more slowly.
Augmentin has a bacteriolytic effect against gonococci. In acute cases, it is prescribed for 5 days, 1-2 tablets 3 times a day.
Also, there are a number of tablets that provide complete recovery for fresh gonorrhea with a single dose - norfloxacin - 2 tablets, abactal - 1-2 tablets, ciprofloxacin - 1 tablet, spectinomycin - 2 g once or 2 injections in different places (total 4 g ).
If these drugs do not have the desired effect, then use cephalosporins (cephalexin 1-2 capsules 4 times a day; cefazolin 0.5 g up to 6 times a day), macrolides (amimycin 2 tablets 4-6 times a day; josamycin 1−2 g per day between meals, 10 days) and fluoroquinolones (ofloxacin - 2 tablets once).
Suppositories for gonorrhea
As local treatment gonorrhea in women is used vaginal suppositories with various active ingredients. Ovules are not absorbed into the blood; they decompose into separate components, which come into contact with the protein of the pathogen cells and inhibit its further reproduction. Suppositories are very convenient; it is enough to insert them into the vagina 1-2 times a day.
Moreover, many of them act on a number of pathogenic microorganisms that inhabit the vagina during gonorrhea. Very often, gonorrhea is accompanied by chlamydia, ureoplasma, trichomoniasis, syphilis, etc. Suppositories for gonorrhea have a combined effect on almost all pathogenic microorganisms; among them, suppositories with protargol, Betidine, Clotrimazole, and Hexicon have proven themselves well.
Immunocorrectors
Immunomodulatory drugs are an important link in complex treatment gonorrhea and prevent the persistence of gonococcus activity in tissues and blood. Enhancing immunity can be carried out in parallel with chemotherapy or after it.
Among the drugs that enhance immunity, T-activin, thymogen, and immunofan have proven themselves well. Cycloferon and neovir are also used, which normalize the function of the body's immune cells. They can be taken from the first day of antibiotic therapy, 2 ml intramuscularly once a day. The next injection is given on the second day, then on the sixth and eighth days of antibiotic therapy. A total of 5 injections are required.
After completing a course of antibiotic therapy, it is necessary to undergo a course of restoration of microflora in the intestines. For this purpose, eubiotics are prescribed - narine, colibacterin, lactobacterin, bifidumbacterin, etc. They should be used for at least 2 weeks.
It would not be amiss to remind you that during the period of therapy all sexual relations must be stopped. Any alcoholic drinks are also strictly prohibited.
The disease is considered cured after receiving negative tests no earlier than 7-10 days after antibiotic therapy, as well as the disappearance of clinical manifestations characteristic of gonorrhea.
Gonorrhea is infection, transmitted sexually and sometimes through household contact. Treatment of gonorrhea with Bicillin is one of the most effective and common methods.
To understand how to get rid of this unpleasant disease with the help of Bicillin, it is worth studying the nature of the disease.
The disease is acute, and without proper treatment it can become chronic. The course is often asymptomatic and can last for years. This phenomenon is often observed in women, who may be carriers of pathogenic microorganisms without knowing it.
How does Bicillin work?
The drug is effective in the treatment of diseases caused by both gram-positive and gram-negative bacteria (Neisseria, actinomycetes).
The effectiveness of the drug lies in the long-term inhibition of the synthesis of mucopeptides that are part of the cell wall of microorganisms. When administered intramuscularly, a depot of the active substance is formed at the injection site, from which the drug gradually enters the bloodstream over 28 days. The slow distribution of the drug in the body ensures the duration of the therapeutic effect. This method of treating gonorrhea is often called.
Excretion of the drug occurs through the kidneys. A small amount of it is excreted with saliva and other liquids.
Treatment regimen
It is best to treat gonorrhea with antibiotics. To achieve maximum effect during treatment, it is first necessary to determine the sensitivity of bacteria to different drugs.
The results of the studies showed that the causative agent of gonorrhea has a high degree of sensitivity to Bicillin. Gonorrhea can be cured with both Bicillin 5 and Bicillin 3. Only a specialist can determine which drug is best to use in a particular case.
The treatment regimen for this drug looks like this:
- and the subacute form requires injection of an antibiotic. The full course consists of 6 injections, which are given once every 4 weeks. The drug must be administered intramuscularly. Due to the long-lasting effect of the drug, treatment can be carried out.
- Bicillin 5 for gonorrhea shows itself best in the treatment of the chronic form.
- In no case should you skip injections, otherwise the microorganism may become resistant to the antibiotic.
Bicillin suspension should be prepared immediately before injection. Bicillin cannot be administered intravenously or subcutaneously - injections are carried out only intramuscularly. To avoid accidentally injecting the drug into a vein, after inserting the needle into the buttock, first pull the syringe plunger towards you. If there is an admixture of blood in the medicine, remove the needle from the muscle and re-inject, changing the injection site.
In case of severe allergic reactions, Bicillin therapy is discontinued. You need to see a doctor to prescribe an alternative drug.
Contraindications and side effects
Not everyone can use Bicillin for gonorrhea. Like any antibiotic, it has a strong effect on the body. Before starting therapy, you should familiarize yourself with the contraindications and side effects of the drug.
The antibiotic is contraindicated in people with:
Due to the fact that the drug is excreted through the kidneys, it should also be used with extreme caution by people with severe diseases of this organ.
Side effects of Bicillin are as follows:
- On the part of the immune system, fever, swelling, anaphylactic reactions, etc. may occur.
- From the genitourinary system - a disorder in the form of interstitial nephritis.
- From the heart - tachycardia, fluctuations in blood pressure.
- From the outside digestive system- nausea, vomiting, diarrhea, glossitis, etc.
Can the drug be used by pregnant and lactating women? There is no clear answer to this question, since the necessary research has not been carried out. In women suffering from gonorrhea and carrying a child, taking the drug is possible only after consultation with a specialist. Children can use the product from 3 years of age, but in this case it is prohibited to use procaine when preparing the suspension.
MINISTRY OF HEALTH OF THE USSR
CLASSIFICATION OF GONorrhea.
The classification is based on the duration of the disease and in-
the intensity of the body's reaction to the introduction of infection, reflecting
which is clinical course diseases.
Based on this, there are 2 forms of gonorrhea:
1. Fresh (with a disease duration of up to 2 months), which
in turn is divided into:
a) acute;
b) subacute;
c) torpid.
2. Chronic gonorrhea.
Fresh torpid or asymptomatic gonorrhea is considered to be gono-
A number of patients who have minor symptoms of the disease are
last no more than 2 months.
Under chronic - a sluggish disease for more than 2 months or
with an unknown date. One should keep in mind the possibility
exacerbation of a chronic process.
In addition, the localization of the process is determined.
GENERAL PRINCIPLES OF TREATMENT
The success of treatment of gonorrheal infection depends on the rational use
use of antimicrobial therapy, immunotherapy, local treatment
nia, physiotherapeutic procedures.
In the acute and subacute stages of uncomplicated gonorrhea in men and
gonorrhea of the lower genitourinary system in women and children, le-
treatment should begin with the use of an antibiotic, according to the instructions
the diagrams below. Local treatment is carried out only for contra-
indications for the use of antibiotics. In all other cases
local treatment is not carried out. Basic antibiotics - group of peni-
cillina.
As a result of such therapy, inflammatory phenomena usually occur during
After 5-7 days, the discharge decreases sharply, the discharge becomes scarce,
mucous, gonococci are not found in them. In case of successful treatment
nia after 7-10 days after the end of antibiotic administration
it is necessary to begin to establish cure.
If, after 10-12 days after the end of antibiotic therapy,
pii and exclusion of gonococci after provocation, inflammatory manifestations
leniation (discharge from the urethra, strings in the urine, cervical erosion and
etc.) persist, then these phenomena should be considered as
gonorrhea. The patient or patient should be examined and accordingly
according to the etiological and topical diagnosis and begin treatment
cheniya.
In case of failure following antibiotic therapy, clinical
nic improvement turns out to be short-lived; as a rule, maybe
Early relapses of the disease disappear. After 3-5 days (and sometimes
later) within 1 month after the end of the antibiotic administration
discharge from the urethra and cervix increases and may contain
gonococci were found.
Late relapses, which are less common, are characterized by
sluggish, asymptomatic clinical course.
In case of acute uncomplicated relapses of gonorrhea,
should use another antibiotic from the group of tetracyclines, macro-
leads, aminoglycosides, etc. In patients with sluggish, asymptomatic
course of relapses, which is observed more often in women with repeated
significant relapses, antibiotic therapy should be carried out only after
local treatment and immunotherapy. Treatment of patients with relapse
noreas are recommended to be carried out in a hospital.
Complicated and ascending gonorrhea is treated in a hospital setting.
In the acute stage of the disease, treatment should begin with administration
benzylpenicillin against the background of autohemotherapy. Only after decreasing
acute inflammatory phenomena, you should start immuno- and fi-
Ziotherapy. Local treatment should be carried out after completing the course of anti-
biotics.
For indolent (torpid) and chronic forms of gonorrhea
treatment should be comprehensive, preferably in a hospital.
When treating such patients in a hospital, antibiotics are prescribed
should be preceded by immunotherapy and local treatment. In the outpatient
conditions, in order to prevent spread of infection,
antibiotics are prescribed simultaneously with immunotherapy, followed by
general purpose of local treatment.
Men and women, suspected sources of infection or
sexual contacts in which gonococci are not detected must
carry out treatment according to chronic gonorrhea regimens.
GENERAL CHARACTERISTICS AND METHOD OF APPLICATION
ANTIGONORRHEA DRUGS.
PENICILLIN GROUP DRUGS.
Penicillin group drugs are the main antibiotics
for the treatment of gonorrhea, and the rest are reserve antibiotics.
1. Benzylpenicillin
For medicinal purposes, sodium or potassium is usually used.
benzylpenicillin salts.
In men with acute and subacute gonorrheal urethritis and in women -
women with acute and subacute gonorrhea of the lower genitourinary system
topics, a course dose of 3.4 million units is recommended.
In fresh torpid cases of uncomplicated gonorrhea, acute
cases of gonorrhea in men, ascending and chronic gonorrhea,
course dose should be 4.2-6.8 million units (depending on the severity
tin diseases).
Treatment should begin with a loading dose to create a more intense
high concentration of antibiotic in the lesion: at the first
injection, 600,000 units are administered, and for subsequent injections, 400,000 units per
saline solution at intervals of 3 hours without overnight
tear.
In exceptional cases (impossibility of a second visit)
in men with acute and subacute urethritis, you can use injection
by simultaneously taking the entire course dose (3 million units) of benzyl penicillin
line with 5 ml of own blood or durant penicillin preparations
on the.
Penicillin in a course dose of 4,000,000 units can also be administered
den intramuscularly at once (2,000,000 units each
buttock), while 30 minutes before the injection and every 6 hours
owls are prescribed etamide 0.7 g orally, the total dose of etamide is
weighs 2.8 g.
For chronic gonorrhea in women, it is advisable to use
be administered by regional administration of benzylpenicillin. To this end, in
At the beginning of treatment, a single dose is injected into the thickness of the muscular layer of the cervix
equal to 200,000 units of the drug. At the same time, internal
muscular injections of benzylpenicillin in single and course doses,
recommended for chronic gonorrhea.
Course doses of benzylpenicillin in children should be the same as in
adults. For children, the drug is administered in single doses of 50,000 -
200,000 units (depending on age) with an interval of 4 hours round-
just a little bit.
2. Bicillinum-1, bicillin-3, bicillin-5, (Bicillinum-1,
Bicillinum-3, Bicillinum-5).
gonorrhea of the lower genitourinary system is administered in the form of 6
injections of 600,000 units at intervals of 24 hours or 1,200,000 units
after 48 hours at a course dose of 3.6 million units; patients with other forms -
for gonorrhea, 7-10 injections of 600,000 units are prescribed with an interval of
24 hours, at a course dose of 4.2-6 million units.
Injections of bicillin are carried out in two stages - first the needle is injected
Lu into the outer upper quadrant of the buttock, and then, in the absence
blood from a needle, an antibiotic is injected.
As an exception, only with fresh acute and subacute gonorrhea
urethritis in men, a one-time administration of bicillin-3 before
ze 2,400,000 units (1,200,000 units in each buttock). At the same time, for
30 minutes before the antibiotic injection, patients will receive 1.05 etamide (3
table). Then the same dose of etamide is given after 3, 6, 9 hours;
a total of 4.2 g of the drug per course.
Patients with acute gonorrhea with unknown sources of infection
tion, if it is impossible to install a dispensary behind them -
people (persons without a fixed place of residence, work or leadership)
those who have an immoral lifestyle, etc.) are subject to preventive
vosyphilitic treatment in a hospital setting. In those cases
when hospitalization of these patients is not possible,
preventive treatment is carried out on an outpatient basis by one of the durant
penicillin drugs.
Patients with gonorrhea with unknown sources of infection, but
having a permanent place of residence and work. preventive pro-
antisyphilitic treatment is not carried out, but subsequent clinical
co-serological control (after treatment of gonorrhea) is carried out by -
for 6 months.
3. Ampicillin (Ampicillinum) is a semi-synthetic antibiotic.
Men with acute and subacute gonorrheal urethritis and women with
acute gonorrhea of the lower genitourinary system, prescribed in
course dose 3.0 g (0.5 g every 4 hours a day). Sick friends
For other forms of gonorrhea, the course dose is increased to 8.0 g.
4. Ampioxum (Ampioxum) - a mixture of two semi-synthetic penicyl-
lins (ampicillin and oxacillin). In men with acute and subacute
gonorrheal urethritis and in women with acute gonorrhea of the lower section
genitourinary system, the drug is prescribed orally at a dose of 0.5 g every 4
hours for 4--5 days: for others clinical forms gonorrhea -
5-7 days. For children under 12 years of age, the drug is prescribed orally from
couple 0.1 g per kg body weight, over 12 years - in the same doses as
and adults.
If the drug is prescribed intramuscularly, the daily dose for no-
newborns and children under 1 year of age - O.1 - 0.2 g per 1 kg
body weight; from 1 to 6 years - up to O.1 g; from 7 to 14 years - About.05 g per
1 kg body weight; adults - 2.0 g per day. The daily dose is administered in
3-4 doses with an interval of 6 - 8 hours.
5. Oxacillin - semi-synthetic penicillin.
For fresh and subacute forms of the disease, it is prescribed orally according to
O.5 g 5 times a day, per course 10.0 g; for other forms of gonorrhea
- 14, About the city
The drugs ampiox and oxacillin are also active against pe-
niclase-producing strains of microorganisms.
A contraindication to the use of penicillin drugs is:
a history of intolerance to this antibiotic and new
cain (when penicillin is dissolved in novocaine).
Levomycetinum.
Men with acute and subacute gonorrheal urethritis and women
with acute gonorrhea of the lower genitourinary system chloramphenicol
prescribed orally in a course dose of 6 g (3 g per day), for other
forms of gonorrhea - 10 g (the first 2 days 3 g, the rest - 2 g
in a day). Single doses of 0.5 g are given at equal intervals with
night break 7-8 hours, 30 minutes before meals.
For children, chloramphenicol is prescribed 0.2-0.25 g 4 times a day. Kur-
The daily dose is the same as for adults, i.e. 6 g.
Side effects at the indicated doses of the drug are observed
are rare and manifest themselves in a short-term headache,
loss of appetite, nausea, somewhat frequent bowel movements, fluid
com chair, which do not require cancellation. Only in some patients
There are more severe side effects, accompanied by increased
fever, general weakness, vomiting, diarrhea. In such cases
teas, it is necessary to discontinue further use of the drug. In price
To reduce side effects, it is recommended to prescribe vitamins
B1, B2, C in the form of dragees.
TETRACYCLINE ANTIBIOTICS.
1. Tetracycline (Tetracyclinum)
2. Chlortetracyclinum
3. Oxytetracyclinum
In men with acute and subacute urethritis and in women with acute
gonorrhea of the lower genitourinary system tetracycline, chlortet-
racycline, oxytetracycline are prescribed in a course dose of 5 g (5 million.
ED).
For acute complicated gonorrhea in men, ascending gonorrhea in women -
chin, as well as for chronic gonorrhea, the course dose should be increased
up to 10 g. The first two days are prescribed at 0.3 g and the following days
0.2 g 5 times a day at regular intervals. Night
the break should not exceed 7-8 hours. To prevent the development
for candidiasis, nystatin 500,000 should be prescribed at the same time
Units x 4 times a day or levorin 250,000 units x x 4 times a day.
Side effects during treatment with these antibiotics in the indicated
doses are rarely observed. Some patients may experience different
personal damage to the mucous membranes and skin (stomatitis, gloss
sits, vulvovaginitis, etc.) caused by yeast-like fungi Kan-
dida. Candidiasis usually occurs 4-10 days after starting treatment
antibiotic. In some patients, yeast infections may cause
stop the protracted current. In such cases, treatment is recommended
large doses of nystatin or levorin, multivitamins, rinse
mouth with a 5% soda solution, followed by lubricating the tongue with 3-5% soda
solution of copper sulfate, 10-20% solution of borax in glycerin, etc.
4. Metacycline, Rondomycin (Methacyclinum, Rondomycinum) synthetic
tic derivative of tetracycline, For fresh acute and subacute
uncomplicated forms of gonorrhea is prescribed orally after meals in a dose
O.6 g (first dose), then O.3 g every 6 hours: for a course of treatment
2.4 g. For other forms of gonorrhea, 4.8 g per course.
In men and women with fresh uncomplicated and complicated gono-
rhea can be treated with metacycline (rondomycin):
to patients with fresh acute gonorrhea, the drug is given in two doses
1.2 g after meals with an 8-hour break: 2.4 g per course of treatment.
Patients with fresh torpid gonorrhea are prescribed 1.2 g in three doses.
after meals with an 8-hour break: for a course of treatment 3.6 g, and fresh
complicated gonorrhea - in four doses of 1.2 g after meals from 8 hours
with an owl break: 4.8 g per course of treatment.
5. Doxycycline (Doxicyclinum). For patients with fresh, uncomplicated
for acute and subacute forms of gonorrhea the drug is prescribed orally
0.1 g (first dose 0.2 g) every 12 hours, for the course of treatment
1.0 g. For other forms, the drug is prescribed according to the same method.
ke, but for a course of 1.5 g.
ANTIBIOTICS MACROLIDES.
1. Erythromycin (Erythromycinum). For men with acute and advanced
three urethritis and women with acute gonorrhea of the lower urinary tract
reproductive system, erythromycin is prescribed around the clock in the course
dose of 8.8 million units (two days of 400,000 units 6 times a day and subsequent
current days 400,000 units 5 times a day). Patients with other forms
gonorrhea - 12.8 million units using the same method.
2. Oletetrin (Oletetrinum). For men with acute and subacute urethra-
rhitis and women with acute gonorrhea of the lower genitourinary
oletethrin systems are prescribed in a course dose of 4 million units; with os-
tal forms of gonorrhea - 7.5 million units or more. The first day is given
1,250,000 units (first dose 500,000 units and three doses of 250,000 units each),
and on other days, 250,000 4 times a day at equal intervals
the horrors of time.
3. Erycyclinum - contains erythromycin and oxytetra-
cyclin 0.125 g. For patients with acute and subacute course of the disease -
The drug is prescribed 0.25 g five times a day after meals,
course 3.0 g; for other forms of the disease 6.0 g (complicated -
7.0 g).
ANTIBIOTICS AMINOGLICOSIDES.
Kanamycin (Kanamycinum) is a broad-spectrum antibiotic.
Used in the form of kanamycin mono- or disulfate, it is well dis-
we create in the water.
Men with acute and subacute urethritis and women with acute
gonorrhea of the lower genitourinary system, kanamycin is prescribed -
1,000,000 units intramuscularly every 12 hours at a course dose of 3
million units, for other forms of gonorrhea - 6 million units
With long-term use, the drug may have nephro- and
ototoxic effect. Kanamycin should not be co-administered
with other antibiotics that have oto-nephrotoxic effects
action.
RIFAMPICINS
Rifampicin (Rifmoicinum) is a semisynthetic antibiotic. Husband-
officials with acute and subacute urethritis and women with acute gono-
rhea of the lower genitourinary system, the drug is prescribed orally
0.3 g (first dose 0.6 g) every 6 hours 30-60 minutes before
food; for a course of 1.5 g. For other forms of gonorrhea - according to the same method
todica, for a course of 6.0 g. Rifampicin is contraindicated for pregnant women.
CEPHALOSPORINS
Cephalexin (Cephakexinum) is a domestic drug cephalospo-
rhin series, available in capsules of 0.25 g. In the first two days
0.5 4 times a day, from the third day 0.25 4 times a day. Kur-
The daily dose for fresh acute uncomplicated gonorrhea is 5 g, for acute
tal forms - 7 g.
COMPLEX USE OF ANTIBIOTICS
Complex, i.e. simultaneous treatment with several antibiotics -
mi, are prescribed for severe forms, complicated and
ongoing gonorrhea, rectal gonorrhea, presence of mixed infection
or suspicion of such and unsuccessful treatment with several
consequently antibiotics used; course doses and methods
are the same as with the separate use of antibiotics.
Recommended combinations: penicillin + streptomycin, oxacillin + am-
picillin (ampiox), carbenicillin+kanamycin, cephalexin+ampicil-
lin (both drugs orally), cephalosporins + kanamycin, cephalosporin
ny + metronidazole, kanamycin + levomycetin, biseptol + kanamycin, tet-
racycline + nystatin or levorin.
IMMUNOTHERAPY
Immunotherapy is an adjuvant treatment for gonorrhea.
diseases and is used with other types of therapy to
increasing the body's reactivity in the fight against infection.
Specific immunotherapy
Vaccine therapy. The use of gonococcal vaccine is indicated
patients after unsuccessful antibiotic therapy for indolent
relapses, with fresh torpid and chronic forms of the disease,
men with complicated and women with ascending gonorrhea (according to
chronic inflammatory phenomena).
On an outpatient basis, vaccine therapy is prescribed simultaneously
especially with antibiotics; in a hospital setting, antibiotics are prescribed
tea during or at the end of vaccine therapy. The vaccine is administered intra-
muscularly into the gluteal region or intradermally. Reaction to introduction
vaccine can be general (malaise, headaches, general weakness)
bost); temperature, focal (increased discharge, painful
pain in the affected organs, cloudy urine); and local (disease)
inaccuracy in the field of injections).
For complicated gonorrhea, vaccination should begin with 200-250
million microbial bodies. For complications accompanied by high
temperature, disturbance general condition body, severe pain
usefulness in the affected organ, it is necessary for torpid and chronic
nic forms of gonorrhea, the initial doses of gonovaccine are 300-400
million microbial bodies.
Gonovaccine injections are given at intervals of 1-2 days, depending on
from the reaction, and the dose is increased each time by 150-300 million.
microbial bodies Allowable maximum single dose should not
exceed 2 billion microbial bodies, and the number of injections is up to 6-8.
In women with torpid and chronic forms of gonorrhea,
change focal vaccination into the submucosa of the cervix and urethra. IN
In these cases, vaccination begins with small doses: from 50 million microbes
bodies, gradually increasing to 150-200 million. This vaccine method
can be accompanied by a very violent general and temperature reaction
tion, occurring 20-30 minutes after administration of the vaccine. Ocha-
regular vaccination should be used only in hospital settings and
strictly take into account contraindications to it (pregnancy, menstruation)
tion, acute inflammatory process).
In children, the initial dose of gonovaccine should not exceed 50-100
million microbial bodies. Highest single dose of 500 million microbes
tel. Vaccine therapy is not given to children under 3 years of age.
Contraindications: active tuberculosis, organic lesions
of cardio-vascular system, hypertonic disease, heavy
kidney and liver diseases, exhaustion, severe anemia, allergies-
logical diseases, menstruation.
Nonspecific immunotherapy.
Pyrogenal is used for the purpose of nonspecific immunotherapy in
patients with fresh torpid and chronic forms of gonorrhea and
non-gonorrheal inflammatory diseases lower genitourinary
organs, as well as in case of complications (prostatitis, epidymitis, adnec-
sit, periadnexitis, etc.).
Contraindications: acute febrile illnesses, pregnancy
ness, hypertension, active tuberculosis, menstruation.
Sick diabetes mellitus and persons over 60 years of age, the drug is prescribed
drink with caution, starting with reduced doses and increasing them
just depending on the reaction.
The drug is prescribed from 25-50 MTD in women and from 50 -
-75 IVD in men in the form of intramuscular injections, which are repeated
ripen in 1-2 days. Dose of pyrogenal for subsequent injections
increases by 25-50-100 MTD (depending on the reaction). Maxi-
The small dose (single dose) should not exceed 1,000 MTD. Course of treatment
niya consists of 10-15 injections. It is necessary to strive to increase the temperature
body temperature within one degree. When excessively high
fever, severe chills, headache, vomiting, pain
in the lower back and lower abdomen (these phenomena usually last 6-8
hours and disappear without treatment), it is recommended not to reduce the dose of the drug
paratha, but increase the interval between injections (by 1-2 days) or
repeat last dose.
Pyrogenal is also used simultaneously with gonovaccine. At
In this case, the initial dose of pyrogenal is 25-50 MTD, gonovaccine is 200--300
million microbial bodies. Then single doses of pyrogenal are increased by
50--150 MTD, gonovaccines for 150--300 million microbial bodies. Maxi-
small dose of pyrogenal 1,000 MTD, gonovaccine 1.2 billion microbes
tel. Both drugs are prescribed in the same syringe.
Prodigiosan is a nonspecific immunostimulant that increases in-
intensity of reparative and restoration processes. Indications for
applications are the same as pyrogenal and also for long-term gono-
coccal processes that cannot be treated with antibiotics.
Contraindications: diseases of the cardiovascular and nervous
systems. Prodigiosan is administered intramuscularly. The dose is set in-
individually, depending on the tolerability of the drug, starting with
15 mcg. Then the dose is increased by 10-15 mcg depending on
body reactions (general, local, focal). For a course of treatment 4
injections at intervals of 4-5 days. The maximum single dose is 75 mcg.
Autohemotherapy. Indications: gonorrheal complications, accompanied by
given by sharp pain, and the affected organ, high temperature
fever and serious condition of the patient. After the pain stops,
lowering the temperature and improving the general condition should be
ti more active vaccine immunotherapy.
When treating with the patient’s own blood, clinical reactions
(general, temperature, local, focal) are usually absent. By
In its therapeutic effectiveness, autohemotherapy is inferior to go-
novel vaccine, but unlike it, has a pronounced analgesic effect
general effect, which occurs 5-6 hours after the injection.
Levamisole - administered orally in cycles. Prescribe 150 mg one
once a day for 3 days. After a 4-day break, the cycle resumes
They're sticking around. The course of treatment is 4 cycles. Levamisole is prescribed for re-
torrid diseases of gonorrhea, torpid and chronic course of go-
nococcal infection complicated by gonorrhea.
Potassium orotate - stimulates recovery processes in inflammation
ly-modified tissues. Patients with gonorrhea are prescribed orally
0.5 4 times a day for 20-30 days.
Methyluracil stimulates the production of antibodies, increases phagocytic
reaction, accelerates the reverse development of inflammatory processes
owls, has an anti-inflammatory effect. Taken orally
after meals, 0.5 g 2 times a day, for a course of treatment of 10-14 days
BIOGENIC STIMULANTS
Used to accelerate the resorption of infiltrates in the urethra and
gonads.
Contraindications: cardiovascular diseases, hypertension, os-
three gastrointestinal disorders, nephrosonephritis, liver cirrhosis
nor,pregnancy over 7 months.
Aloe extract - prescribed as daily subcutaneous injections
1 ml, per course 15-30; maximum daily dose 3-4 ml. For more
usefulness of injections, pre-administer 0.5 ml of 2% solution of no-
Vocaine.
FIBS - injected under the skin 1 ml once a day, for a course of 15-20
injections.
Peloidodistilate - indications for use, doses, duration
The course of treatment and contraindications are the same as for the drug FIBS.
Vitreous body- inject 2 ml daily under the skin for
nii 15-20 days.
Note: it is more rational to carry out all types of immunotherapy before
prescribing antibiotics. For outpatient treatment, taking into account the epidemic
mic alertness, antibiotics and immunotherapy are prescribed -
at the same time.
TREATMENT OF RECURRENT DISEASE
Before prescribing therapy, it is advisable to determine the sensitivity
resistance of gonococci to antibacterial drugs.
1. Doxycycline 0.1 g (first dose 0.4 g) every 12 hours. On
course 1.0 g of the drug. Simultaneously with the first dose of doxycycline
4 tablets (1.92 g) of biseptol are given orally and then 4 tablets
ki after 8 hours, per course 16 tablets (7.68). Simultaneously or behind
4 days before the appointment of etiotropic therapy, levamisole is prescribed 1
0.15 tablet once a week, 8 tablets per course.
2. Ericicline 0.25 orally 5 times a day, 6.0 g per course.
At the same time, sulfatone, 4 tablets 1.4 g once a day, for
course 5.6 g.
3. While using an antibiotic simultaneously intramuscularly
trypsin is administered 5 mg 2 times a day or 10 mg 1 time a day in
within 6 days.
TREATMENT OF MIXED INFECTION
(gonorrheal-chlamydial, gonorrheal-trichomonas, etc.)
For gonorrheal-trichomoniacal infection in acute and subacute
form of the disease, antigonorrheal and pro-
anticystodic treatment; for chronic, complicated and protracted
In many cases, anti-trichomonas treatment is initially carried out based on
nonspecific and nonspecific immunotherapy and local treatment
niya, upon completion local therapy antigonorrheal medication is prescribed
reading.
For gonorrheal-ureoplasma infection, doxycycline is prescribed
0.3 first dose, then 0.1 after 12 hours; per course 1.0 g.
Or metacycline 0.6 g at the first dose, then 0.3 after 6 hours
owls; per course for men 3.9-4.8 g, for women 7.1 g.
With gonorrheal-chlamydial-ureoplasma infection there may be
appointed combined use antibiotics rifampicin and
erythromycin. With this technique, rifampicin is prescribed once
but 0.9 g on the first day, 2-3 days - 0.15 4 times a day, 4-5
day - 0.15 3 times a day, for a course of 3.0 g. At the same time it is given
erythromycin orally 0.5 4 times a day, for a course of 12.0 g. Against the background
antibiotic therapy is administered intramuscularly with deoxyribonuclease
daily 25 mg per day for 6 days.
In torpid and chronic cases, immunotherapy is prescribed and
local treatment. Antibiotics are used in the middle or at the end of the
munostimulants.
EXTRAGENITAL GONORRHOEA
Gonorrheal proctitis. Occurs in women and girls, patients
gonorrhea, and is combined with damage to the genitourinary organs. Maybe
there may also be passive homosexual men. Subjective symptoms
we with gonorrheal lesions of the rectum in most cases
absent, but some patients experience itching, burning,
slight pain during defecation, rectal discharge,
mucus, pus, blood in the stool. Sometimes there is hyperemia and maceration
tion of the anal area, thickening of the sphincter folds. "
Antibiotics are used in a course dose, as for complicated and
chronic forms of gonorrhea with mandatory follow-up
local treatment: suppositories with protargol (0.02 g of protargol
on a candle), into the rectum from a syringe or rubber bulb
give 40-50 ml of 2-5% solution of protargol or collargol every other day,
a total of 5-6 procedures per course.
1. Benzylpenicillin in a course dose of 6 million units followed by
administration of chloramphenicol orally for 3 days, in total
new dose of 10 g (1 day - 4 g; 2-3 days, 3 g per day). -
2. Bicillin-3 at a course dose of 6 million units followed by
taking 10 g of chloramphenicol according to the above method.
Oropharyngeal gonorrhea. At the same time, it is time for men and women
predominantly the mucous membrane of the tonsils and pharynx is compressed,
there is hyperemia and swelling of the mucous membrane, sometimes on the tonsils
purulent plaque and regional adenitis occur. In some patients
Gingivitis and stomatitis occur.
Treatment: antibiotics are prescribed in a course dose, as for acute
false and chronic gonorrhea.
GONORRHOEA EYE
Adults become infected if hygiene rules are not followed. Sick
With gonorrhea, a person can infect the eyes with contaminated
kami.
In newborns, gonococci enter the eyes during the passage
through birth canal sick mother.
Treatment of blenorrhea should be carried out by a dermato-venereologist.
locally with an ophthalmologist, with mandatory intramuscular injection of anti-
biotic without taking into account the dose of antibiotic administered locally (into the eyes).
Patients with blenorrhea are treated after consultation with an ophthalmologist, according to
but his recommendations. Deregistration of a patient with blenorrhea is carried out by
after consulting an ophthalmologist.
In order to prevent gonoblenorea, all children immediately after birth
wipe the eyes with sterile cotton wool and instill a 30% solution
sodium sulfacyl, repeat the procedure after 2 hours. Girls one-
At the same time, the genitals are treated with the same solution.
POSTGONORHEAL INFLAMMATORY
DISEASES
Patients with post-gonorrheal diseases should include persons
in which, despite the disappearance of gonococci, inflammation remains
bodily phenomena (discharge from the urethra, cervix, threads in the urine and
etc.) to eliminate which requires the use of additional
treatment methods.
Post-gonorrheal inflammatory process is maintained more often
total vaginal trichomonas, chlamydia, ureaplasma,
bami of the genus Candida, L-forms, bacteria, less often - simplex virus
herpes serotype 2 and other microorganisms, as well as neurotrophic
chemical changes in the mucous membrane of the genitourinary organs, etc.
With post-gonorrheal, as with gonorrheal, inflammatory pro-
In the process, urethritis with soft or hard infiltrate is distinguished in
depending on the predominance of round cells or connectives in it
textile elements. Between these two main forms of su-
There are many transitional ones. Damage to the urethral glands leads to
the occurrence of open or closed adenitis.
It is necessary to point out desquamative urethritis caused by transition
home of the columnar epithelium of the urethral mucosa in a multilayer
flat.
Anamnesis data from an objective examination and especially urethro-
copies make it possible to establish the localization and nature of the pathological
th process in the urethra. It is important to establish not only the topical, but also
etiological diagnosis, since only under this condition can
a rational treatment plan should be outlined.
It is obligatory to study the discharge of everyone
patient for vaginal trichomonas, Candida fungi and
possibilities - for chlamydia and ureaplasma.
Principles and methods of treating patients with post-gonorrheal diseases -
we do not differ from the treatment of patients with inflammatory diseases -
mi gonorrheal etiology.
When prescribing antibiotics and other chemotherapy drugs, it is necessary
we can take into account the characteristics of the infectious agent and its sensitivity
interest in these means.
In post-gonorrheal inflammatory processes caused by
chlamydia, mycoplasma, the most effective drugs are
you are of the tetracycline series.
To establish the cure of gonorrhea, certain methods are used:
our criteria.
CRITERIA FOR CURE GONORRHOEA.
Cure of gonorrhea is established with with the help of clinical,
bacterioscopic and bacteriological research. However,
absence of secretions and disappearance of gonococci from the surface of the mucus
zona zygos does not always indicate recovery, since gono-
cocci can retain their viability and virulence for a long time
density in encysted foci of infection.
Difficulty in detecting gonococci using bacterioscopy
investigation of secretions has led to the use of various methods
provocations: these methods of provocation are based on tissue irritation with
in order to detect infection in hidden foci.
The following methods of provocation are used: chemical (for men
instillation into the urethra of 0.5% silver nitrate solution, in women -
lubrication of the urethra with 1-2%, cervical canal with 2-5% nitrate solution
silver or Lugol's solution on glycerin); mechanical (for husbands)
chin - insert a straight bougie into the urethra for 10 minutes or make an anterior
urethroscopy); biological (intramuscular administration of gonovacci-
we are in the amount of 500 million microbial bodies or pyrogenal - 200 MTD:
if gonovaccine was used during treatment, then for provocation
double the last therapeutic dose is prescribed, but not more than 2
billion microbial bodies), nutritional (salty, spicy foods); termi-
logical (warming of the genitals with inductothermic current) fi-
physiological (taking smears during menstruation).
The best are combined methods of provocation. More often than not,
they perform chemical and nutritional provocation with simultaneous
ny administration of the gonovaccine. In protracted, chronic cases
for men, it is advisable to cause irritation of the urethral mucosa mass
press on a straight bougie or urethroscope tube and introduce intramuscular
gonova vaccine. In women, it is advisable to carry out provocation
immediately after the end of menstruation. In men after 24, 48, and 72
hours after provocation, they are taken for bacterioscopic examination.
discharge from the urethra, and in the absence of such - threads from mo-
chi, scraping from the urethral mucosa. In women, smears from the discharge
All lesions are also examined after 24, 48 and 72 hours. At
the purpose of thermal provocation - inductothermy is carried out
daily for 3 days consecutively 15-20-30 minutes. Dept.
The material to be examined is taken every day an hour after warming up.
vaniya.
ESTABLISHING CURE IN MEN
To establish cure in patients who have suffered acute gono-
Rhine urethritis, should be started 7 - 10 days after the
treatment expectations. In the absence of post-gonorrheal inflammatory
phenomena from the urethra, it is necessary to palpate the prostate
and seminal vesicles and microscopic examination their secret.
If there are no pathological changes, then a combined
provocation. After provocation, 24, 48, and 72 hours later, they are studied from
dividing from the urethra, urine strings, scraping for the presence of gonococci. At
favorable clinical and bacteriological results
Thorough clinical and laboratory examination, including urethroscopy and
serological control for syphilis is carried out 1 month after
what is deregistered?
The criteria for curing acute and chronic gonorrhea are:
a) persistent absence of gonococci (during bacterioscopic examination);
dovovaniya and crops) in urethral discharge, scrapings or threads from urine;
b) no change during palpation of the prostate and seminal pu-
zyrkov, normal content (5-10 per field of view) of leukocytes in
their secretion if it contains a significant amount of lipoid
grains;
c) absence or mildly expressed inflammatory changes in
urethra during urethroscopy.
These conditions give the doctor the right to stop treatment and
begin to establish cure in the same way as in patients with acute
three gonorrhea in the same time frame.
ESTABLISHING CURE IN WOMEN
Establishment of cure begins 7-10 days after
end of treatment. After bacterioscopic examination, the excretion
leniy from the urethra, cervix and other lesions of the voluntary
give a combined provocation, examine after 24, 48 and 72 hours
discharge from these foci. In the absence of gonococci, follow-
The next control study is prescribed during the next menstrual period.
strutation and at its end they carry out a provocation with research
discharge after 24, 48 and 72 hours.
Such studies are carried out over 2 menstrual periods,
after which, with favorable clinical and laboratory results,
Thorical studies, the patient is removed from the register.
During 3 menstrual cycles, women should be monitored
le treatment of ascending gonorrhea and women who were ill during pregnancy
timeliness.
The criterion for the cure of ascending gonorrhea is the absence
gonococci, normal menstrual cycle, absence of pain and symptoms
significant palpation changes on the part of the internal genital organs.
Employees of children's institutions with direct con-
tact with children, patients with gonorrhea are suspended from work for a while
treatment. Inpatient treatment is carried out only for medical reasons
(complications, ascending process, relapse) and social (violations)
change of outpatient treatment regimen) indications.
Gonorrhea is considered one of the most common diseases that is transmitted through sexual contact. Men and women face this problem equally, but due to the structural features of the reproductive and reproductive systems, the disease occurs with some peculiarities in different sexes. However, the treatment is absolutely similar. Differences may lie in the use of different antiseptic drugs for male patients. Before starting therapy to eliminate the causative agent of gonorrhea, it is important to understand its symptoms so as not to make mistakes with the prescribed drugs.
The disease can be recognized by the presence of a number of characteristic symptoms, which include:
- constant discomfort in the urethra, which begins to be accompanied by itching;
- purulent discharge gradually appears from the penis, and at first it comes out only with pressure, but gradually its quantity increases and the pus flows out on its own;
- the infection gradually penetrates higher up the urethra and begins to affect the bladder, which leads to signs of cystitis;
- there is pain and pain when urinating;
- as soon as the bacteria reach prostate gland, gonorrheal prostatitis may develop, which is characterized by a constant urge to go to the toilet, especially often at night.
Attention! In many cases, the disease is sluggish in nature, which creates difficulties in diagnosing it. Only a smear for the presence of pathogenic pathogens can make an accurate diagnosis.
Injections for gonorrhea in men
The drug is taken only intramuscularly, and the dosage of the drug should be carefully selected for each patient. The classic dose, taking into account the severity of damage to the body, can be 1-2 g of Longacef daily for 3-7 days. The drug must be dissolved in a lidocaine solution, since the drug is very painful. Due to this combination, the risk of anaphylactic shock increases, so injections can only be carried out in medical institutions.
For gonococcal infection, the drug can be administered intravenously or intramuscularly. In this case, the dosage can be from 1 to 2 g of Cefotaxime in the morning and evening. The antibiotic is quite painful, but at the same time it allows you to achieve good results. Be sure to dissolve the drug in a sodium chloride solution. The duration of therapy is selected individually for each patient; treatment usually lasts 3-5 days.
The drug is most often prescribed for intolerance or resistance to the penicillin series of antibiotics. Take the drug intramuscularly or intravenously. The dosage of Ketocef, taking into account the severity of the patient’s condition, can be 750-1500 mg. At this dose, injections must be given three times a day, and it is imperative to maintain equal intervals between procedures.
Attention! Injections allow you to cure the disease as quickly as possible. At the same time, they increase the risk of developing allergic reactions and kidney problems.
Pills for gonorrhea in men
The drug is produced in the form of tablets, which are coated with a special coating. It prevents the early release of the active substance due to the action of gastric juice and saliva. This allows you to achieve quick results using minimal therapeutic doses. Patients are prescribed 500 mg of the active substance in the morning and evening, in some cases an increased dose of Tsiprolet of 0.75 g is prescribed. The drug is taken before meals or an hour after it.
This drug is most often prescribed in situations where gonorrhea has already caused complications in the prostate gland. In such a situation, the patient is prescribed 2 tablets of Co-Trimoxazole after breakfast and dinner. If the patient has been diagnosed with chronic gonococcal prostatitis, treatment consists of one tablet in the morning and in the evening. Therapy continues for an individually selected time for each man.
For an uncomplicated form of the disease, take 100 mg of the drug in the morning and evening, the recommended interval between doses is 12 hours. Treatment for mild gonorrhea lasts one week. In complicated cases of the disease, Unidox is taken according to a special regimen. It involves first using 300 mg of antibiotic at a time, after which the remaining dose is divided into 6 doses. Each subsequent dose consists of 100 mg of the main substance until the course dosage of 900 mg is reached.
A traditional antibiotic that is well tolerated by patients. But due to frequent use for the treatment of other diseases, some patients may develop resistance to Levomycetin. Thanks to the destruction of the chain of protein synthesis in gonococcal cells, it is possible to eliminate the infection in 10 days. Taking into account the severity of the lesion, a man may be prescribed an antibiotic dosage of 250-750 mg. Take tablets three times a day. In severe cases of gonorrhea, especially complicated ones, a dosage of 3 g for three uses may be prescribed. Levomycetin should be taken half an hour before the main meal.
A modern antibiotic, which is most often prescribed when the penicillin series is ineffective. Taking into account the severity of the patient’s condition, he may be prescribed either 0.8 g of Norilet once, if the disease is at initial stage, or 600 mg of Norilet in the morning and evening. In the second case, therapy can last from 7 to 14 days.
The medicine is taken for just a few days, most often it is used for mild gonorrhea or for its minor complications. To achieve the required therapeutic result, it is recommended to take 0.3 g of Doxilan for 2-4 days. In some cases, a simplified treatment regimen may be used, which involves taking 300 mg tablets of the main substance twice with an interval of one hour.
Attention! In most cases, treatment using the described antibiotics lasts at least 10-14 days. This is the only way to achieve complete destruction of pathogenic pathogens and prevent recurrence of the problem.
Preparations for single use
A very powerful antibacterial drug that kills most types of pathogenic pathogens. An antibiotic is usually taken at the acute stage of gonorrhea, when it is characterized by its classic symptoms. Patients may be prescribed an oral or intravenous form. In the first treatment option, 250 mg is taken, sometimes a double dosage of the active ingredient is required, chewing is not required, it is better to drink one hour before meals. For intravenous infusions, 100 mg of the active ingredient is prescribed.
It is a solution for intramuscular injections. The dosage of the drug is quite large, so it should be injected only with qualified medical assistance, so that quick first aid can be provided if necessary. The dose of Spectinomycin is 2 g of the active ingredient; it can be taken at any time of the day.
The drug is administered intramuscularly only; it can be injected into the gluteal region or thigh. The treatment regimen involves the immediate administration of 1.5 g of the active ingredient. If such dosages are poorly tolerated or high risk If complications occur, you can divide the single dosage into two injections. They are injected at one-minute intervals, but strictly into different areas; they can be injected into the left and right buttock.
The medication is available in tablet form for oral use. To suppress the gonococcal pathogen, 800 mg of the active substance is taken, and the drug must be washed down well clean water to ensure maximum absorption. Take Renor without taking into account food intake. In some cases, Renor caused severe vomiting and diarrhea; exceeding the dosage is strictly prohibited.
Available in the form of a solution intended for intramuscular injection. Treatment may involve administering 1.5 g of Zinacef at a time. The injection is carried out strictly under medical supervision. Currently, a second treatment regimen for gonococcal infection has also been developed using this antibacterial drug. It involves injecting Zinacef into both buttocks at a time, with the dosage being halved and amounting to 750 mg per injection.
Attention! Such treatment is possible only in cases where the disease is at the very initial stage and is not complicated by other pathologies.
Video - Treatment of gonorrhea
Antiseptic solutions against gonorrhea in men
Chlorhexidine and potassium permanganate
Both solutions are used once a day. To do this, an individual amount of solution is selected for each patient, which is injected into the urethra using a special device. These substances allow you to disinfect the mucous membrane and reduce the intensity of the disease. This treatment can continue for 3-7 days, taking into account the severity of the lesion.
Silver solution and protargol
Medicines are used for complicated forms of the disease. For this, a 0.5% silver solution or a 2% protargol solution is used. They are also infused into the urethra using a small tube. Repeat the procedure once a day; in exceptional cases, a second wash during the day may be required. Typically, such solutions are prescribed in the presence of a mild infiltrate.
Attention! Such treatment can only be carried out under the supervision of the attending physician if there are significant complications. An exception may be antiseptic solutions for external use, which are used to wash the penis for external disinfection.
Cost of drugs against gonorrhea in men
| A drug | Image | Price in Russia in rubles | Price in Belarus in rubles | Price in Ukraine in hryvnia |
|---|---|---|---|---|
| 150 | 5 | 62 | ||
| 200 | 7 | 82 | ||
| 100 | 3,3 | 41 | ||
| 100 | 3,3 | 41 | ||
| 100 | 3,3 | 41 | ||
| 200 | 7 | 82 | ||
| 300 | 10 | 123 | ||
| 300 | 10 | 123 | ||
| 500 | 16 | 205 | ||
| 200 | 7 | 82 | ||
  | 300 | 10 | 123 | |
| 50 | 1,6 | 21 | ||
 | 100 | 3,3 | 41 | |
| 300 | 10 | 123 | ||
| 200 | 7 | 82 | ||
| 300 | 10 | 123 | ||
| 1300 | 43 | 523 | ||
| 100 | 3,3 | 41 |
Attention! All of the drugs described have a significant effect on the gastrointestinal tract. When taking them, it is advisable to take supportive agents for the microflora of the stomach and intestines to prevent vomiting, nausea and diarrhea.
