淋病与非淋菌性尿道炎

1Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage淋病与非淋菌性尿道炎GonorrhoeaeandNongonococcalurethritis广州医学院第二附属医院皮肤科黄新宇2Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage淋病—定义淋病是由淋病奈瑟菌(Neisseriagonorrhoeae，简称淋球菌)感染泌尿生殖系统所致的一种常见的性传播疾病淋病是我国法定报疫的传染病，亦是我国重点监测及报疫的八种性传播疾病之一3Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage非淋菌性尿道炎—定义非淋菌性尿道炎是指通过性接触传染的一种尿道炎，尿道炎症明显，但尿道分泌物中查不到淋球菌非淋菌性尿道炎亦是我国重点监测及报疫的八种性传播疾病之一4Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage病因淋病病原菌为淋病奈瑟菌,属革兰阴性双球菌淋球菌呈卵圆形或肾形，常成对排列5Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage病因非淋菌性尿道炎沙眼衣原体其血清型D～K型引起泌尿生殖器系统感染支原体解脲支原体(UU)、人型支原体(MH)、生殖支原体(MG)可引起泌尿生殖道感染6Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage病因非淋菌性尿道炎少数由阴道毛滴虫、单纯疱疹病毒、类杆菌等微生物引起7Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage病因淋球菌喜潮湿，怕干燥淋球菌、衣原体及支原体对热和一般消毒剂均很敏感8Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage发病机制淋病淋球菌通过侵袭生殖泌尿系统黏膜的柱状上皮细胞及移形上皮细胞在细胞内繁殖，通过内毒素、脂寡糖与补体、IgM的协同作用，引起化脓性炎症反应表现为充血、水肿，并有脓液9Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage发病机制非淋菌性尿道炎沙眼衣原体在宿主细胞内复制的组织损害和其引起的炎症反应及宿主细胞破坏的坏死物质等产生的综合影响支原体只能黏附在上皮细胞表面，通过吸收宿主细胞的养料，释放有毒代谢产物及尿素酶等，损害细胞炎症较轻，其分泌物以浆液性为主10Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床流行经过—传染源淋病感染淋球菌的患者和携带者非淋菌性尿道炎感染沙眼衣原体和支原体、阴道毛滴虫、单纯疱疹病毒、类杆菌等微生物的患者和携带者11Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床流行经过—传播途径主要通过性接触传染极少数可通过污染的衣裤、床上用品、毛巾、浴盆、马桶和手等间接传播幼女常通过间接接触感染新生儿的感染主要通过母体产道时被传染12Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现根据我国诊断标准淋病无合并症淋病、有合并症淋病和其他部位淋病非淋菌性尿道炎男性非淋菌性尿道炎、女性非淋菌性泌尿生殖道炎和新生儿感染13Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现均有较明显的潜伏期淋病1~10天，平均为3~5天非淋性尿道炎1~3周14Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现—淋病无合并症淋病男性淋菌性尿道炎尿道口红肿排出黏稠的深黄色脓液有尿频、尿急、尿痛体查见尿道口红肿，充血及脓性分泌物15Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage16Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage17Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage18Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage19Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－淋病无合并症淋病女性泌尿生殖系统淋病淋菌性尿道炎有尿频、尿急、尿痛、尿血及烧灼感尿道口充血，有脓性分泌物20Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage21Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage22Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－淋病无合并症淋病女性泌尿生殖系统淋病淋菌性宫颈炎白带增多，阴道口有黏液脓性分泌物外阴瘙痒，阴道内轻微疼痛和烧灼感体查见阴道口充血、水肿，子宫颈口充血、糜烂，有黏液脓性分泌物23Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage24Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage25Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage26Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－淋病无合并症淋病女性泌尿生殖系统淋病女童淋病可见阴道口、尿道口、会阴部红肿，可出现糜烂、溃疡和疼痛阴道有脓性分泌物，排尿困难27Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage28Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－非淋菌性尿道炎男性非淋菌性尿道炎较淋菌性尿道炎轻，有尿道刺痒、烧灼感和排尿困难，少数有尿频尿道口红肿，少量浆液性或脓性分泌物晨起尿道口有少量黏液性分泌物或仅有痂膜封口29Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage30Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage31Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage32Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－非淋菌性尿道炎女性非淋菌性泌尿生殖道炎宫颈炎主要感染部位宫颈白带增多子宫颈水肿或糜烂宫颈内黏液脓性分泌物可有异常阴道出血33Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage34Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－非淋菌性尿道炎女性非淋菌性泌尿生殖道炎尿道炎有尿道灼热或尿频症状尿道口充血，微红或正常挤压有分泌物溢出35Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－淋病有合并症淋病男性淋病合并症淋菌性附睾炎、睾丸炎淋菌性前列腺炎其他合并症36Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage淋菌性附睾睾丸炎37Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage淋菌性龟头包皮炎38Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage淋菌性尿道周围脓肿39Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－淋病有合并症淋病女性淋病合并症淋菌性盆腔炎淋菌性前庭大腺炎40Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage淋菌性前庭大腺炎41Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－淋病有合并症淋病播散性淋病淋球菌通过血行传播至全身，出现全身非特异性的临床表现。有高热、寒战、关节疼痛、皮损等临床表现。42Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage播散性淋病之关节炎43Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－非淋菌性尿道炎合并症附睾炎前列腺炎前庭大腺炎盆腔炎直肠炎44Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－非淋菌性尿道炎合并症Reiter综合征（Reiter’ssyndrome）关节炎、结膜炎、尿道炎三联征。肝周围炎45Dermatology&VenereologyThe2ndAff.HospitalofGuangzhouMedicalCollage临床表现－非淋菌性尿道炎合并症男女不育沙眼衣原体可引起输卵管性不孕；可使活跃精子数量减少，干扰精子成熟，引起男性不育。MG可导致输卵管炎，引起输卵管性不孕。UU使精子形态异常,活动力下降，影响精子对卵细胞的穿透力,妨碍受精卵的发育及种植。其他眼色素膜炎、强直性脊柱炎等。46Dermatology&VenereologyThe2ndAff.HospitalofGuangzho