Gonorrhea in children: features and treatment options. Gonorrhea The predominant route of infection for gonorrhea in children

Due to the increasing incidence of gonorrhea in adults, the risk of infection in children also increases. The disease can develop in both boys and girls. But among girls, the lesion is 10–15 times more common.

The main factor in the development of gonorrhea in a child is the morphofunctional physiological conditions in the genitourinary system that are favorable for the life of microbes.

Children aged 5 to 12 years are at higher risk. According to observations, gonorrhea in children in 90–95% of cases occurs as a result of non-sexual transmission. Diagnosis and treatment of gonorrhea should be organized immediately.

An infectious disease in older children occurs after contact with contaminated personal hygiene items - bedding, washcloth, toilet rim, towel. The disease is mainly detected before the age of 12. Gonorrhea (otherwise known as gonorrhea) is characterized by 4 modes of transmission. The causes of the disease are:

infection of the baby during childbirth - gonococci bacteria can colonize the vagina and birth
woman’s path (symptoms in newborns appear a few days after birth);
contact-household route - at the household level, infection is often observed in kindergartens,
in sanatoriums and even at home if you share a common set of personal hygiene supplies with other family members;
sexual intercourse - typical only for adolescents (according to statistics, gonorrhea rarely affects children in this way - only in 5% of cases);
intrauterine infection from mother to fetus is a rare route of transmission of infection through the placenta (in medicine, only a few cases have been officially registered in which a sick woman infected the fetus).

There are no symptoms, and the pathogen itself is in “hibernation” mode for a long time. It should be noted that due to the structure of the genital organs, girls get sick more often than boys.

Symptoms

For a child, gonorrhea is an atypical disease; cases of infection are extremely rare. It should be noted that gonorrhea is a common sexually transmitted disease in the world, and every year 150 - 180 million new cases are recorded, with the minimum percentage being children.

Gonorrhea is a serious problem in modern society. The prevalence of the disease is associated with the increased susceptibility of human mucous membranes.

Symptoms of infection vary. In a newborn, gonorrhea manifests itself in the form of eye damage - a few days after birth, the baby develops gonococcal conjunctivitis with mucous and purulent discharge in the corners of the eyes. This provokes swelling of the eyelids and severe suppuration.

For girls

Gonorrhea in girls usually occurs acutely with a noticeable deterioration in health, insomnia, fever, lack of appetite and irritability. The cause of such symptoms is exposure to toxins from gonococcal microbes.

When the genital organs become infected, girls develop the following local pathological signs:

frequent urge to urinate;
pain during urination;
purulent vaginal discharge;
redness and pain in the external genital area.

Urination becomes irregular and incontinence may occur. Mucopurulent discharge remains on the panties. When confirming the diagnosis, it is necessary to identify the source of infection, therefore an additional examination of the parents, as well as people who are in constant contact with the child, is carried out.

In boys

In boys, gonorrhea develops as a result of infection during childbirth or exposure to gonococcus with the onset of sexual activity. Household infection is very rare. Symptoms in boys are slightly different and manifest as:

swelling and redness of the head of the penis;
phimosis;
discharge of purulent secretion from the genitourinary canal;
pain during urination;
urethritis;
inflammation of the foreskin, it stops moving normally;
mucopurulent discharge in the morning.

Diagnostics

When carrying out diagnostics, the leading role is given to laboratory tests. Etiological examination involves the use of bacterioscopic and bacteriological smear examinations. If typical gonococci are detected, cultural examination is not required.

Gonococcal infection is diagnosed in children using a gable test. This helps to pinpoint the location of inflammation. An even more accurate topical examination is organized through urethroscopy. But this diagnostic method is prohibited during exacerbation. It is implemented only for chronic gonorrhea. Diagnostics can contribute to the spread of the acute process to the overlying parts of the genitourinary system.

Treatment

The treatment of acute gonorrhea in children is carried out in a hospital setting and under the strict supervision of doctors. First of all, the immune system is strengthened (maintained functions), then a course of antibiotics is prescribed.

For chronic or resistant gonorrhea, several medications are used at once. Vaginal rinsing is prescribed with 1% sodium permanganate solution, protargol solution and 0.25 - 1% lapis solution, 5 ml each.

When therapy for gonorrhea in children is completed, observation in the hospital is required for at least another month, smears from the vagina, urethra and rectum are examined, and a bacterial culture is performed.

In the absence of minimal signs, the child is considered healthy and is discharged.

Immediately after this, you can start visiting the garden and school again.

Why is childhood gonorrhea dangerous?

The chronic stage is most often diagnosed only when the situation cannot be corrected. Complications in a child’s body can cause the following pathologies:

joint damage - arthritis;
pathologies of the nervous system, manifested by deterioration of sleep, lack of appetite;
myositis – muscle inflammation accompanied by severe pain.

With a long-term course, gonorrhea in girls in adulthood disrupts the menstrual cycle, so subsequently there are problems with conceiving a child, and infertility progresses.

Another dangerous complication of gonorrhea is the chronic form of gonorrheal proctitis (inflammation of the rectal mucosa).

Prevention

To prevent a child from being affected by a disease such as gonorrhea, mandatory prophylaxis is required at home, in maternity hospitals and children's institutions.

Prevention of gonorrhea in everyday life requires the child to have separate hygiene items - a potty, toothbrush, towel, etc. To prevent intrauterine infection of the fetus, women are strictly prohibited from having sexual intercourse while carrying a child.

As children grow older, counseling about sexually transmitted infections is required. As a preventative measure in children's institutions, all personnel must undergo timely examinations by venereologists.

When the first suspicious symptoms develop in a child, you should urgently make an appointment with a doctor. By detecting and starting treatment for gonorrhea in the first stages of the lesion, dangerous consequences and the spread of infection in the body can be prevented.

Due to the increase in morbidity in adults, cases of the disease have increased noticeably gonorrhea children. Boys and girls can get gonorrhea. However, among girls gonorrheal infection occurs 10-15 times more often than in boys. The factor determining the development of the gonococcal process in children is considered to be favorable morphofunctional physiological conditions for the life of the infection in their genitourinary organs. Children aged 5 to 12 years are most often affected. Observations show that 90-95% of children are infected through extrasexual contact, which is due to the structural features of their genital organs, and therefore girls are infected much more often than boys.

Newborns become infected at birth, through contact with the mother's infected birth canal, and also in utero. There are cases of nosocomial infection in maternity wards from staff caring for a newborn. Infection of children in children's institutions is caused by the shared use of chamber pots, shared intimate toilet items, games using the genitals, and masturbation. The spread of infection in children is facilitated by overcrowding, which occurs in boarding schools, orphanages, kindergartens, pioneer camps, children's sanatoriums, etc. The appearance of gonorrhea in children may be a consequence of violation of hygiene rules when in contact with adult patients, as well as the use of objects , contaminated secretions containing gonococci.

Frequency of infections gonococci in girls it depends on age, chronological fluctuations in immunity and hormonal state. During the neonatal period, gonorrhea is rarely observed as a result of the presence of passive maternal immunity and maternal estrogenic hormones. At the age of 2-3 years, passive protective maternal antibodies are depleted, and the level of estrogen saturation decreases. During this period, the condition of the mucous membrane of the external genitalia and vagina changes. In the cells of the cylindrical epithelium, the glycogen content decreases, the activity of diastase decreases, the vaginal discharge acquires an alkaline or neutral reaction, Dederlein's rods disappear, and the pathological microbial flora is activated. Therefore, at the age of 2-3 to 10-12 years, children are susceptible to frequent illnesses from many infections, as well as gonorrhea due to extrasexual transmission. In subsequent years, due to the activation of the function of the endocrine glands, the level of glycogen in the epithelial cells increases, the pH becomes acidic, and the population of Dederlein rods is restored, displacing pathogenic flora.

Clinical picture of gonorrhea in children. Damage to the mucous membranes occurs immediately after contact with gonococci, but subjective and objective symptoms of the disease appear after the incubation period (from 1-2 days to 2-3 weeks).

According to the flow they distinguish fresh gonorrhea with a disease duration of up to 2 months, chronic gonorrhea- lasting more than 2 months. and latent. Fresh gonorrhea is divided into acute, subacute and torpid. The fresh acute form of gonorrhea in girls begins with a feeling of pain, burning and itching in the perineum, increased body temperature and dysuric phenomena. The process involves the labia minora, the mucous membrane of the vaginal vestibule, the vagina itself, the urethra and the lower rectum. In the affected areas, sharp swelling, hyperemia of the mucous membrane and abundant mucopurulent discharge are observed. In some places, the mucous membrane of the external genitalia is macerated and eroded. With insufficient care, the skin of adjacent areas becomes irritated by purulent discharge, macerates and becomes inflamed. An active inflammatory process may be accompanied by an enlargement of the inguinal lymph nodes, the appearance of polypous growths at the entrance to the vagina and the external opening of the urethra. The process often spreads to the vaginal part of the cervix and the mucous membrane of the cervical canal. The urethra is involved in the process very often. Its anterior and middle parts are affected. The external opening is dilated, the urethral sponges are swollen and hyperemic. When pressing on the lower wall of the urethra, purulent contents are released. Dysuric phenomena are pronounced, including urinary incontinence. Often the mucous membrane of the lower rectum is involved in the process, which is manifested by edematous hyperemia and mucopurulent discharge detected during defecation.

Acute gonorrhea in older people In girls, it can be complicated by inflammation of the excretory ducts of the large glands of the vestibule, skennits. In the area of the excretory ducts, inflamed red dots are clearly visible - maculae gonorrhoicae.

In subacute, sluggish forms, inflammatory changes are less intense. There is slight edematous hyperemia of the mucous membranes of the vestibule of the vagina, urethra, labia minora and majora with scant serous-purulent discharge. With vaginoscopy, clearly defined areas of hyperemia and infiltration are detected on the vaginal walls, and a small amount of mucus is found in the vaginal folds. In the area of the cervix, erosions are detected against a background of mild swelling and hyperemia. Pus is usually discharged from the cervical canal.

Chronic gonorrhea in girls is detected during the period of exacerbation of a torpid and undiagnosed disease in a timely manner. Sometimes chronic gonorrhea is discovered during a clinical examination or after parents notice suspicious stains on the child’s underwear. These girls experience slight swelling and hyperemia of the mucous membrane of the posterior commissure of the lips and folds of the hymen. Vaginoscopy reveals the affected last 7 vagina, especially in the posterior part of the fornix, where the mucous membrane is hyperemic and granular in nature - granulosa vaginitis. The urethra is affected in 100% of cases, but the symptoms of inflammation are mild, dysuric phenomena are insignificant or completely absent. Chronic gonorrheal proctitis found in almost all patients. The main symptoms of the disease are slight redness of the sphincter mucosa with the presence of erosions or cracks, as well as a network of dilated vessels on the skin of the perineum. In the stool you may notice an admixture of pus and mucus. Rectoscopy reveals hyperemia, edema, and purulent accumulations between the folds. Skenitis, damage to the paraurethral passages and large glands of the vestibule in chronic gonorrhea is observed more often than in the fresh form, but the symptoms are erased. As a rule, point hyperemia is detected in the area of the excretory ducts of the large glands of the vestibule. Involvement of the overlying parts of the genital organs in the process occurs less frequently, especially at the age of functional rest. Menstruating girls may develop ascending gonorrhea affecting the ovarian appendages and pelvic peritoneum. The disease is acute, with chills, high body temperature, vomiting, severe abdominal pain and other signs of peritonitis. With an ascending gonococcal process in girls, “benign gonococcal sepsis” can form, in which soreness of the uterus and genitourinary peritoneum is noted.

Gonorrhea in boys It is much less common than in girls. Boys become infected through sexual contact, and very young children become infected during household contacts. Gonorrhea in boys proceeds practically in the same way as in adult men, but less acutely and with fewer complications, since the prostate gland and seminal vesicles are poorly developed before puberty, and the glandular apparatus of the urethra is underdeveloped.

Gonorrhea of the eye is a common manifestation of gonococcal infection of newborns (gonococcal conjunctivitis). A newborn becomes infected when passing through the birth canal, but intrauterine infection with amniotic fluid is possible. Cases of infection of a child by care staff or transmission of infection from an infected newborn to medical personnel and other children are very rare. The incubation period varies from 2 to 5 days. With intrauterine infection, the disease may appear on the first day of life. Gonococcal conjunctivitis manifested by significant swelling of both eyelids, photophobia, and copious purulent discharge from the eyes. In the absence of timely treatment, inflammation spreads from the sharply hyperemic, edematous conjunctiva into the connective tissue of the conjunctiva and into the cornea, where it can lead to ulceration, followed by scarring and loss of vision. Treatment is carried out with antibiotics with simultaneous instillation of a 30% solution of sulfacyl sodium (albucid) into the eyes every 2 hours. For preventive purposes, all children after birth have their eyes wiped with a sterile cotton swab and a freshly prepared solution of 30% sulfacyl sodium is instilled into each eye. 2 hours after the child is transferred to the children's ward, instillation of a fresh (one-day preparation) 30% sodium sulfacyl solution into the eyes is repeated.

Diagnosis. IN diagnosis of gonorrhea Laboratory data are critical. Etiological diagnosis is carried out using bacterioscopic (examination of discharge with obligatory methylene blue and Gram staining) and bacteriological methods (inoculation of discharge on special nutrient media). If typical gonococci are found in the preparations during bacterioscopy, then a cultural examination is not carried out. Topical diagnosis is carried out to accurately determine the localization of the inflammatory process in the urethra using a two-glass test. More accurate topical diagnosis is carried out using urethroscopy, but this method of examining a patient can only be used for chronic gonorrhea, since in an acute process this procedure can contribute to the spread of infection to the overlying parts of the genitourinary system.

Differential diagnosis gonorrheal urethritis with urethritis of another etiology (viruses, yeast-like and other fungi, various cocci, trichomonas, chlamydia, mycoplasma, etc.) due to the great similarity of the clinical picture is practically possible only based on the results of bacterioscopic and bacteriological studies.

Infants become infected with gonorrhea from a mother infected with gonococci during natural passage through the birth canal. Subsequently, the child’s eyes suffer - acute conjunctivitis manifests itself - gonococcal blenorrhea, in the absence of proper attention and treatment, it threatens complete loss of vision. For girls, the infection can spread to the genitals.

Currently Prevention of blenorrhea is carried out for every child- by instilling a 30% solution of albucid into the eyes, and for girls also on the genitals. This procedure is carried out twice: immediately after birth, and a couple of hours later.

Is gonorrhea transmitted to children?

Older children can, through personal hygiene items - bed linen, washcloth, towel, toilet rim, sharing a potty with another, sick child, in rare cases, the infection can be transmitted sexually. Most often, girls aged 5 to 8 years old suffer from gonorrhea.

Signs of gonorrhea in children

Gonorrhea manifests itself in girls as follows::

the vulva and anus become inflamed;
swelling and hyperemia appear;
cutting pain when urinating;
profuse purulent vaginal discharge;
general malaise;
increase in body temperature.

Inflammation in acute gonorrhea covers the entire vagina, ending at the cervix; the uterus itself and its appendages are not subject to inflammation due to the insufficient development of these organs.

The inflammation spreads to the rectum and urethra. When the rectum is affected by gonococci, the skin around the anus turns red and cracks appear.

Threatens to become chronic. is dangerous due to the occurrence of synechia - fusion of the labia. Subsequently, in adulthood, the girl may have problems with menstrual irregularities, pregnancy, and possibly infertility.

It is almost impossible for boys to become infected with gonorrhea through everyday contact., infection of a baby during childbirth manifests itself only in the form of blenorrhea, and adolescents become infected through sexual contact.

Gonorrhea manifests itself in boys as follows::

the head of the penis becomes inflamed
swelling and redness appears
inflammation of the foreskin and urethra
purulent discharge appears.

In chronic form, inflammation affects the testicles, prostate and seminal vesicles.

The final diagnosis can only be made by specialists after tests.

Laboratory tests are especially necessary when the source of infection has not been identified, since there are a number of diseases that occur in a similar way to gonorrhea.

Treatment of gonorrhea in children at different stages

Treatment of acute gonorrhea takes place in a hospital under the supervision of doctors, in several stages. At the first stage, patients are strengthened with general immunity, after which they are prescribed a course of antibiotics.

For chronic forms of the disease or resistant types of infection, several drugs are used. In the acute form of vulvovaginitis, local treatment is prescribed: warm sitz baths with chamomile infusion or potassium permanganate.

In the chronic stage, vaginal rinsing is prescribed with a solution of potassium permanganate (potassium permanganate) instillation of 5 ml of a 1-2% solution of protargol or a 0.25-1% solution of lapis.

For chronic urethritis (inflammation of the walls of the urethra), 3-4 drops of a 2% solution of protargol or a 0.25-0.5% solution of lapis are administered.

Proctitis is a complication of gonorrhea that causes inflammation of the rectum and is treated with microenemas - 20-30 ml of a 1-3% solution of protargol or a 1-2% solution of collargol.

At the end of the course of treatment, the child is observed in the hospital for another month, during which smears taken from the vagina, urethra and rectum, cultures and other studies are examined.

In the absence of any manifestations of the disease, the child is considered cured and subject to discharge from the hospital. You can return to attending kindergarten and school immediately after discharge.

Gonococcal infection in newborns usually results from exposure to infected secretions from the mother's cervix during childbirth. It usually develops as an acute disease on the 2-5th day of life. The prevalence of gonococcal infection in newborns depends on the prevalence of infection in pregnant women, whether the pregnant woman was screened for gonorrhea, and whether the newborn received ophthalmia prophylaxis.

The most serious complications are ophthalmia neonatorum and sepsis, including arthritis and meningitis. Less serious manifestations of local infection include rhinitis, vaginitis, urethritis, and inflammation at the sites of intrauterine fetal monitoring.

ICD-10 code

A54 Gonococcal infection

Ophthalmia of the newborn caused by N. gonorrhoeae

Although N. gonorrhoeae is a less common cause of neonatal conjunctivitis in the United States than C. trachomatis and other nonsexually transmitted organisms, N. gonorrhoeae is a particularly important pathogen because gonococcal ophthalmia can lead to globe perforation and blindness.

Diagnostic notes

In the United States, infants at high risk for gonococcal ophthalmia include those who did not receive ophthalmia prophylaxis, whose mothers were not prenatally monitored, had a history of STDs, or were raped. Based on the identification of typical gram-negative diplococci in Gram-stained samples taken from conjunctival exudate, gonococcal conjunctivitis is diagnosed and, after taking the material for an appropriate cultural study, treatment is prescribed; At the same time, appropriate studies on chlamydia should be carried out. Prophylactic treatment for gonorrhea may be indicated in neonates with conjunctivitis who do not have gonococci detected on a Gram-stained smear of conjunctival fluid if they have any of the risk factors listed above.

In all cases of neonatal conjunctivitis, conjunctival fluid should also be examined to isolate N. gonorrhoeae for identification and to perform antibiotic susceptibility testing. Accurate diagnosis is important for health authorities and because of the social consequences of gonorrhea. Nongonococcal causes of neonatal ophthalmia, including Moraxella catarrahalis and other Neisseria species, are difficult to distinguish from N. gonorrhoeae on Gram stain, but can be differentiated in the microbiology laboratory.

Gonococcal infection in children

After the neonatal period, sexual abuse is the most common cause of gonococcal infection in preadolescent children (see Child Sexual Abuse and Rape). As a rule, in pre-adolescent children, gonococcal infection manifests itself in the form of vaginitis. PID as a result of vaginal infection is less common than in adults. Children who have been sexually abused often experience anorectal and pharyngeal gonococcal infections, which are usually asymptomatic.

Diagnostic notes

To isolate N. gonorrhoeae from children, only standard culture methods should be used. Non-culture tests for gonorrhea, including Gram stain, DNA probes, or ELISA without culture should not be used; None of these tests have been approved by the FDA for testing oropharyngeal, rectal, or genital tract samples in children. Specimens from the vagina, urethra, pharynx, or rectum should be tested on selective media for the isolation of N. gonorrhoeae. All presumptive isolates of N. gononhoeae must be accurately identified by at least two tests based on different principles (eg, biochemical properties, serology, or enzyme detection of the pathogen). Isolates should be retained for additional or repeat testing.

Children weighing > 45 kg should receive treatment according to one of the regimens recommended for adults (see Gonococcal infection).

Quinolones are not recommended for use in children because toxicity has been noted in animal studies. However, studies of children with cystic fibrosis treated with ciprofloxacin showed no side effects.

Ceftriaxone 125 mg IM once

Alternative scheme

Spectinomycin 40 mg/kg (maximum 2g) IM as a single dose can be used, but is not reliable against pharyngeal infection. Some specialists use cefixime to treat children, because... it can be given orally; however, there are no published reports on its safety or effectiveness in treating such cases.

Ceftriaxone 50 mg/kg (maximum 1 g) IM or IV once a day, daily for 7 days.

Ceftriaxone 50 mg/kg (maximum 2 g) IM or IV once a day, daily for 10-14 days.

Follow-up

Culture control of cure is not indicated if ceftriaxone has been prescribed. When treating with spectinomycin, a control culture study is necessary to confirm effectiveness.

Ceftriaxone 25-50 mg/kg IV or IM once, not more than 125 mg

Local antibiotic therapy alone is ineffective and unnecessary if systemic treatment is used.

Special notes on patient management

The possibility of co-infection with C. trachomatis should be considered in patients who have failed treatment. Mothers and their infants should be tested for chlamydial infection at the same time as testing for gonorrhea (see Ophthalmia of the newborn due to C. trachomatis). When prescribing ceftriaxone to children with elevated bilirubin and, especially, premature children, special caution should be used.

Follow-up

A newborn diagnosed with gonococcal ophthalmia should be hospitalized and evaluated for signs of disseminated infection (eg, sepsis, arthritis, and meningitis). A single dose of ceftriaxone is sufficient to treat gonococcal conjunctivitis, but some pediatricians prefer to give children antibiotics for 48 to 72 hours until culture results are negative. The decision on the duration of treatment should be made after consultation with an experienced physician.

Mothers of children with gonococcal infection and their sexual partners should be examined and treated according to regimens recommended for adults (see Gonococcal infection in adolescents and adults).

Sepsis, arthritis, meningitis, or a combination of these are rare complications of gonococcal infection in newborns. Abscesses of the scalp may also develop as a result of monitoring the vital activity of the blanket. Diagnosis of gonococcal infection in neonates with sepsis, arthritis, meningitis, or scalp abscess requires culture of blood, CSF, and joint aspirate using chocolate agar. Culturing specimens obtained from the conjunctiva, vagina, oropharynx, and rectum on gonococcal-selective media may indicate the primary site of infection, especially if inflammation is present. Positive Gram stain results on smears of exudate, CSF, or joint aspirate warrant initiation of treatment for gonorrhea. Diagnosis based on positive Gram stains or preliminary culture identification must be confirmed by specific tests.

Ceftriaxone 25-50 mg/kg/day IV or IM once for 7 days, if the diagnosis of meningitis is confirmed - for 10-14 days,

or Cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, if the diagnosis of meningitis is confirmed - for 10-14 days.

Preventive treatment of newborns whose mothers are sick with gonococcal infection

Children born to mothers with untreated gonorrhea are at high risk for this infection.

Recommended regimen in the absence of signs of gonococcal infection

Ceftriaxone 25-50 mg/kg IV or IM, but not more than 125 mg, once.

Mothers and infants should be tested for chlamydial infection.

Follow-up

No follow-up is required.

Management of mothers and their sexual partners

Mothers of children with gonococcal infection and their sexual partners should be examined and treated according to the regimens recommended for adults (see Gonococcal infection).

Other notes on patient management

In children, it is recommended to use only parenteral cephalosporins. Ceftriaxone is used to treat all gonococcal infections in children; cefotaxime - only for gonococcal ophthalmia. Oral cephalosporins (cefixime, cefuroxime axetil, cefpodoxime axetil) have not been adequately evaluated in the treatment of gonococcal infections in children to recommend their use.

All children with gonococcal infection should be examined for mixed infection with syphilis or chlamydia. For a discussion of sexual abuse, see Child Sexual Abuse and Rape.

Prevention of ophthalmia in newborns

Insertion of a prophylactic drug into the eyes of newborn infants to prevent gonococcal ophthalmia neonatorum is required by law in most states. All of the regimens listed below are effective in preventing gonococcal eye infections. However, their effectiveness against chlamydial ophthalmia has not been established and they do not prevent nasopharyngeal colonization with C. trachomatis. Diagnosis and treatment of gonococcal and chlamydial infections in pregnant women is the best method for preventing gonococcal and chlamydial diseases in newborns. However, not all women receive prenatal care. Therefore, prevention of gonococcal eye infections is justified, because it is safe, simple, inexpensive, and can prevent sight-threatening disease.

Silver nitrate (1%), aqueous solution, single application,
or Erythromycin (0.5%), eye ointment, single application,
or Tetracycline (1%), eye ointment, single application.

One of the above medications must be administered to both eyes of each newborn immediately after birth. If prophylaxis cannot be provided immediately (in the delivery room), the health care facility should have a monitoring system in place to ensure that all newborns have received prophylactic treatment. Prevention of eye infections should be carried out in all newborns, regardless of whether the birth was vaginal or cesarean section. The use of disposable tubes or ampoules is preferable to reusable ones. Bacitracin is not effective. Povidone iodine has not been studied enough.

Gonorrhea in children appears due to the entry of an infectious agent into the mucous membranes. The reason for this is often the presence of gonorrhea in the mother, including during pregnancy. Intimate transmission is typical for adolescents who began their sexual life with promiscuity.

Let's consider the main causes of gonorrhea in children, possible clinical symptoms, diagnosis and treatment methods.

Characteristics of the pathogen and route of infection

Gonococci, which are the culprits of the infectious process, are bean-shaped diplococci, which lose the blue dye in the classical Gram stain. They are not stable in the external environment. A toxic substance is released inside the human body, causing intoxication and inflammation.

Once in the body, microbes infect the cells of the mucous membranes of the genital organs, rectum, nasopharynx, and conjunctiva of the eyes, and when the infection spreads, they lead to pathology of the internal genital organs. The danger of decreased immune defense is the entry of gonococci into the blood, which leads to sepsis and involvement of other organs and tissues in the disease process.

For a child to get sick, the pathogen must be transmitted from a sick person. This happens in the following ways:

transplacental (through the placental bloodstream from the pregnant woman to the fetus);
intrapartum (at the birth of a baby through the mother’s infected birth canal);
household (when using shared towels with a sick family member, through bed linen, personal hygiene items, toys);
sexual (in adolescents who are sexually active and do not use contraception).

Gonorrhea in children - symptoms

When infected during childbirth, the baby's eyes often suffer. Conjunctivitis is the most common, and with further spread of infection, the cornea is affected (keratitis).

Damage to the nervous system during the acute course of the disease is more pronounced in children than in adults due to the greater influence of the gonotoxin entering the blood on brain cells. The effects on the central nervous system include insomnia, irritability, headache and fever.

Depends on the gender of the child and the route of infection.

For girls

In addition to the symptoms of general intoxication in girls, after 3-5 days of the incubation period, manifestations of the disease begin in the genital area. Pain, burning, itching in the genital area, pain and difficulty urinating, including urinary incontinence, appear.

Fresh lasts up to two weeks and upon examination is manifested by redness and swelling of the external genitalia, copious purulent discharge and crusts. When pressing on the opening of the urethra, pus is released.

Cervical lesions are more often found in girls aged three to seven years, as well as in children with a weakened immune system and chronic diseases, including tuberculosis.

After a poorly treated acute process, it can recur within a couple of weeks after the end of therapy, and sometimes after six months or more. In chronic gonorrhea, the discharge is abundant, inflammation often affects the glands of the vestibule of the vagina, the cervix, and the uterine cavity. When menstruation occurs, the process can spread further into the pelvis along the peritoneum. This is manifested by severe abdominal pain, fever and a significant deterioration in general condition.

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Antibiotics used for gonorrhea

In little girls, the course of the disease differs from that of adult women due to anatomical and physiological characteristics. The immune system, under the influence of hormones secreted by the thymus gland with a moderate influence of the ovaries, can produce a strong response to the introduction of the pathogen, which causes the cyclical nature of the disease with periods of exacerbations and remissions.

In adolescents, immune suppression occurs under the influence of thyroid and reproductive hormones, which easily leads to chronicity of the process. In a child with diathesis, obesity or anemia, gonorrhea is chronic and sluggish. The addition of childhood infections (measles, rubella, scarlet fever and others), as well as with frequent respiratory diseases of the nasopharynx, gonococcal damage makes itself felt, worsening.

For reference. “Gonorrhea in girls in 100% of cases affects the vestibule of the vagina, the vaginal wall, in 85-90% of cases – the urethra, in 50% – the rectum” (Yu. A. Gurkin, V. I. Gritsyuk, 2005).

In boys

In boys, symptoms of gonorrhea are similar to lesions in adult men. A special feature is the extremely rare infection with gonococci in everyday life.

Symptoms of gonorrhea in boys appear after an incubation period of 3-5 days in the form of burning and itching in the area of the external opening of the urethra. The head of the penis swells, and mucopurulent discharge appears. After a couple of days, the condition worsens, there is more pus, swelling and pain increase, which intensifies with urination.

If the infection is not treated, then after two weeks the urethritis will take a chronic course, and the gonococci will spread to other tissues, causing their damage. Complications include phimosis, when the foreskin prevents the head of the penis from being exposed, and paraphimosis, when the glans is pinched by the swollen foreskin.

For reference. When children pass through the genital tract of an infected mother during labor, the eyes are affected. Conjunctivitis is characterized by itching, hyperemia and swelling, as well as purulent discharge from the eyes. If the infection spreads to the cornea and iris, photophobia, blurred vision, lacrimation, and pus occur. To prevent the child from losing vision in the future, urgent diagnosis and treatment is required.

Diagnosis of the disease

To make a diagnosis, data from interviews with relatives, examination of the child’s affected organs, and smears are taken into account. Laboratory methods are crucial - it is necessary to see the pathogen in the discharge from the genital tract, rectum or eyes (with gonococcal conjunctivitis).

A bacterioscopic examination allows microorganisms that look like beans or coffee beans facing each other to be seen under a microscope. The taken material is stained with special Gram stains, where the gonococci acquire a pink-red color.
The bacteriological method involves sowing the discharge from the genital organs onto an ascites-agar nutrient medium. This technique is applicable when it is difficult to detect gonococci under a microscope, as well as for testing cure for the disease. In the latter case, it is necessary to sow the material a week after the last dose of antibiotic or local antiseptic.
Modern medicine helps make an accurate diagnosis based on polymerase chain reaction methods, when the reliability of detecting gonococci is on average 95%.
Enzyme immunoassay helps to determine gonococcal antigens with 100% accuracy. Even urine samples can be used for this examination.