itchy urethra
Introduction
Introduction Sexual gonococcal urethritis (acute gonorrhea): The incubation period is 1-14 days, often 2-5 days. From the beginning, it is acute anterior urethritis, redness, itching and slight tingling of the urethra, followed by thin mucus effluent, causing urination discomfort.
Cause
Cause
The clinical manifestations of gonococcal infection depend on the degree of infection, the sensitivity of the organism, the virulence of the bacteria, the location of the infection and the length of the infection. At the same time, it is related to the health of the body, whether sexual life is excessive, and alcoholism. Also pay attention to the possibility of diseases such as urethritis, cystitis, balanitis. And the possibility of spicy stimulation and other reasons.
Examine
an examination
Related inspection
Urethral examination for urethral secretion examination
According to clinical manifestations, gonorrhea can be divided into no gonorrhea and comorbid gonorrhea; asymptomatic and symptomatic gonorrhea; disseminated gonorrhea and acute and chronic gonorrhea.
First, no complication gonorrhea
(a) male no complication gonorrhea
Acute gonococcal urethritis (acute gonorrhea): The incubation period is 1-14 days, often 2-5 days. From the beginning, acute urethritis, redness, itching and slight tingling of the urethra, followed by thin mucus effluent, causing urination discomfort. After about 2 days, the secretion became sticky, the urethra overflowed, and the pus was deep. Yellow or yellow-green, accompanied by increased symptoms of urinary tract discomfort, redness and swelling developed throughout the penis glans and part of the urethra, frequent urination, urgency, dysuria, difficulty urinating, inconvenient movement, and frequent penile erections at night. There may be swelling of the inguinal lymph nodes, redness and pain, and may also purulent. The first week of acute symptoms is the most serious. If left untreated, the symptoms gradually decrease or disappear after about one month. Two weeks after the onset of acute anterior urethritis, about 50-70% of patients have gonococcal invasion of the posterior urethra, which is characterized by urinary distress, frequent urination, and acute urinary retention. The characteristic of dysuria is that the pain or pain is exacerbated at the end of urination, and it is acupuncture-like. Sometimes there is a perineal pain, and there may be no hematuria. After 1-2 weeks, the symptoms gradually disappeared. Systemic symptoms are generally mild, a few may have fever up to 38 ° C, general malaise, loss of appetite and so on.
Chronic gonococcal urethritis (chronic gonorrhea): Symptoms lasting more than 2 months are called chronic gonococcal urethritis. Because the treatment is not thorough, Neisseria gonorrhoeae can be concealed in the urethral body, paraurethral glands, and urethral crypts to make the disease course chronic. If the patient's constitution is weak, suffering from anemia, tuberculosis, the condition begins with a chronic process, mostly for the anterior and posterior urethra combined infection, good invasion of the urethral bulb, membrane and prostate. Clinical manifestations of the urethra often have itching sensation, burning sensation or mild tingling, fine urine flow, urination weakness, drips. Most patients have a small amount of serous sputum seal in the urinary tract in the early morning. If the genital or penile roots are squeezed, the thin mucus overflows. The urine is basically clear, but there is silk.
(2) Women without complication gonorrhea
The main site of female primary gonococcal infection is the cervix. Neisseria gonorrhoeae can adhere to the stratified squamous epithelium. The infection site of Neisseria gonorrhoeae is observed at the junction of the squamous-columnar epithelium of the cervix. Patients with gonorrhea cervicitis often have no symptoms at an early stage, so the incubation period is difficult to determine. Cervical congestion, tenderness, increased purulent secretions, often genital itching and burning sensation, occasionally lower abdominal pain and low back pain. These atypical symptoms make patients often do not go to the clinic, so they become the main source of infection; gonococcal urethritis often occurs 2-5 days after sexual intercourse, urethral congestion, tenderness and purulent secretions, mild Frequent urination, urgency, dysuria, burning sensation during urination, purulent discharge in the urethra; gonococcal vestibular gland inflammation often unilateral, redness and swelling in the opening of the gland, severe pain, severe abscess formation. There are fever and other systemic symptoms; gonococcal vaginitis is less common, the symptoms of the elderly are mild, some patients have abdominal swelling, back pain, vaginal discharge, some patients have lower abdominal pain and menorrhagia; women gonococcal vulva Vaginitis, manifested as vulvar and vaginal inflammation. There are more vaginal purulent secretions, sometimes yellow and green secretions in the vagina and urethra, painful urination, and redness in the vulva. Secretions can flow to the anus, causing irritation. In severe cases, it can infect the rectum and cause gonococcal proctitis.
Second, there are complications of gonorrhea
(a) Men have comorbid gonorrhea:
Gonorrhea urethritis has various comorbidities, mainly prostatitis, seminal vesiculitis, epididymitis.
1. Prostatitis: Acute prostatitis is caused by the discharge tube and gland of Neisseria gonorrhoeae entering the prostate. There are fever, chills, perineal pain and urinary tract infections accompanied by dysuria. The prostate is swollen and tender when examined. However, Neisseria gonorrhoeae is not a common cause of acute prostatitis. The prostate caused by Neisseria gonorrhoeae is mainly characterized by chronic lesions. The symptoms are mild, there is perineal discomfort, penile pain, there is a "mouth" phenomenon in the morning urethral opening, and the lymph in the urine is seen. The prostate massage fluid has pus and lecithin. , smear or culture to find gonococcus, anal examination can touch small nodules on the prostate, and there is discomfort or pain, drainage of pus near the drainage tube to form scar contraction affects ejaculation, resulting in infertility.
2. Epididymitis: usually occurs after acute urethritis, mostly on one side. There is low fever, epididymis swelling pain, ipsilateral groin and lower abdomen have reflex pain, the beginning and testicular boundaries are clear, gradually unclear, testicular tenderness, swelling, severe tenderness. The urine is often cloudy. There can be prostate and seminal vesiculitis at the same time.
3. Seminal vesiculitis: fever, frequent urination, urgency, dysuria, no urinary turbidity and blood. Rectal examination can touch the swollen seminal vesicle and have severe tenderness. Chronic seminal vesiculitis generally has no symptoms. Rectal examination shows that the seminal vesicle is hard and fibrotic.
4. Urethral gland inflammation: occurs in the perineum or around, there are finger size nodules, pain, acute suppuration and ulceration, compression of the urethra and dysuria, may have systemic symptoms such as fever, slow progress.
5. Urethral stricture: repeated authors can cause urethral stricture, a small number of vas deferens or obstruction can occur, dysuria, thinning of the urinary tract, and severe urinary retention. Secondary vas deferens, seminal vesicle cysts and infertility.
(2) Women have comorbid gonorrhea
The main complication of female gonorrhea is gonococcal box inflammation, such as acute salpingitis, endometritis, secondary fallopian tube ovarian abscess and pelvic abscess caused by rupture, peritonitis. Sudden onset after menstruation, there are high fever, chills, headache, nausea, vomiting, lower abdominal pain, increased purulent leucorrhea. Both sides of the attachment are thickened and tender.
Third, other parts of gonorrhea:
1. Gonorrhea conjunctivitis: Newborns appear more than 2-3 days after birth, mostly bilateral, eyelid swelling, purulent secretions, adults mostly self-inoculation, often unilateral, showing the same newborn. Due to the pus overflow, if the "pust eye" is delayed, the cornea is steamy and the cornea is perforated. Lead to blindness.
2. gonococcal pharyngitis: mainly seen in oral sex, the so-called "mouth" Western homosexual or heterosexuals are more common, manifested as acute pharyngitis or acute tonsillitis, occasional fever and cervical lymphadenopathy. There are symptoms such as dry throat discomfort, sore throat, sore throat.
3. Neisseria gonorrhoea: mainly seen in male homosexuality. Women are mostly caused by vaginal infections. The table is urgent and heavy, there are pus and blood, anal canal mucosa congestion, purulent secretion, gonococcal culture positive.
Fourth, disseminated gonococcal infection
The disseminated gonococcal infection is due to the spread of gonococcal bacteria through the bloodstream to the whole body, resulting in a more serious systemic infection. The incidence rate is about 1% of gonorrhea patients. Most of the strains causing disseminated gonococcal infection are AHU-nutritive. The strain has stable resistance to normal human serum. In addition, normal human serum has IgM antibody against gonococcal lipopolysaccharide. With the help of complement, it is large. Most gonococcus have a bactericidal effect, and patients lacking C5, C6, C7 and C8 complement components are prone to gonococcal sepsis or gonococcal meningitis.
(1) gonococcal sepsis: the patient begins to have fever, the body temperature can be as high as 40 ° C, but usually between 38 ° C and 40 ° C, chills are not common, some patients have skin papules, ecchymoses, pustules, hemorrhagic Or necrotizing skin damage, some skin lesions have pain symptoms. In the lesions, fluorescent immunostaining can be used to detect the growth of Neisseria gonorrhoeae or cultured Neisseria gonorrhoeae, and PCR to detect Neisseria gonorrhoeae DNA positive. The pathological tissue of the lesion is superficial ulcer with pus formation, diffuse inflammation of the dermis and subcutaneous tissue, polymorphonuclear leukocyte infiltration, involvement of small blood vessels, thrombosis and localized necrosis.
(B) gonococcal arthritis: joint swelling, pain, for one or several septic arthritis. Generally asymmetrical, rarely involving the hip, shoulder and spine joints. The joint fluid test has the presence of gonorrhea, which can lead to fibrosis caused by bone destruction and rigidity of the bones and joints.
(C) gonococcal keratosis: may be due to gonococcal or its toxins, can not find gonococcal lesions in the skin lesions, often with gonococcal arthritis, skin lesions are good for the hands and feet, ankle heel and waist . Patches or plaques that are usually flattened and slightly swelled, conical, yellow, or copper red or grayish white. The skin lesions of the palmar sputum showed horny hyperplasia and large keratinization.
(D) gonococcal endocarditis: gonococcal is the main pathogen of endocarditis in the first few decades of antibiotic use, gonococcal endocarditis is almost invisible, gonococcal endocarditis and other types Endocarditis has the same clinical manifestations. Endocarditis often involves aortic or mitral valve, subacute or acute endocarditis due to rapid destruction of the valve, leading to death.
(5) gonococcal meningitis: uncommon, may be associated with arthritis and a typical rash to distinguish meningococcal meningitis.
Diagnosis
Differential diagnosis
Differential diagnosis:
Vulvar itching: Vulvar itching is a symptom caused by various vulvar lesions, but it can also occur in patients with completely normal vulva. It is more common in middle-aged women. When the itching is aggravated, the patient is more restless, which affects life and jobs.
Urethral adhesion: normal urethra has urethral glands, which can secrete a small amount of mucus every day to play a role in lubricating and protecting the urethra. Under normal circumstances, these mucus remain in the urethra and have a protective effect on the urethra mucosa. When the urethra or prostate is inflamed, the secretions may increase. After the urethral secretions are dried in the outer urethra, the mucosa and the skin on both sides of the urethra are slightly adhered, the urinary passage is slightly unsatisfactory, and bifurcation occurs in the initial stage of urination. The urine will stick out and the fork will disappear.
Urinary tract pain: prostatitis patients with symptoms include: dysuria, urgency, frequent urination, waiting for urine, urinary interruption, urinary weakness, urine drip, urinary bifurcation, urinary retention, urethral drip, blood in the urine, waist and knee pain, groin And radiation pain on both sides of the thigh root, abdominal and perineal discomfort have pain or swell, anal pain, dizziness, fatigue, urinary tract itch burning, testicular pain, scrotum moist, nocturnal emission. Sexual desire and sexual function decline, infertility, etc.
