A Text-book of Diseases of Women

by Charles B. Penrose

Pelvic pain or discomfort is not usually present unless the body of the uterus is attacked.

All the symptoms of gonorrheal inflammation of the cervix are found in simple non-specific conditions. The only certain diagnosis is made by means of the microscope; and even failure to find the gonococcus will not enable the physician to say with certainty that the disease is not of gonorrheal origin. The gonococcus may be found in any form of discharge from the cervix, even that which to gross examination appears most innocent.

Consequently, in every suspected case a microscopic examination should be made.

The discharge, for examination, should be taken from the cavity of the cervix by means of a sterile platinum loop. If no gonococci are found, a strip of mucous membrane from the cervical canal should be removed with a sharp curette, and it, with the discharge that adheres to it, should be carefully examined.

It may be advisable to examine the discharge immediately after menstruation. A cervical discharge is always increased immediately before, during, and after a menstrual period. This is probably the reason that men are more liable to contract gonorrhea at that time. This fact is so well known that there is a widespread popular belief that gonorrhea may be acquired from coitus, during a menstrual period, with a healthy woman. This is not true. A man cannot acquire gonorrhea from a woman unless she had been previously infected with the disease; otherwise a woman might develop gonorrhea in herself spontaneously, for her discharges come in contact with her own genito-urinary tract.

The greater liability to infection at the time of menstruation is due to the fact that an existing pathological discharge is increased in amount; a subacute disease is rendered more active by the menstrual congestion; and gonococci, quiescent in the superficial cells, are more likely to be thrown off at this time.

Gonorrhea of the cervix very often stops at the internal os. It may, however, extend to the body of the uterus and to the Fallopian tubes, as has already been described. The diagnosis of gonorrheal endometritis can be made only by microscopic examination of the discharge or of a strip of the endometrium removed with the curette.

The gonorrheal discharge of the cervix may infect, secondarily, local areas of the vagina. The most usual position of secondary infection is the posterior vaginal fornix. A red eroded area, caused in this way, is often found. The prolonged contact of the pus produces a localized vaginal gonorrhea.

Primary vaginal gonorrhea is rare in the adult woman, in whom there is the usual resistant power of the epithelium. The mucous membrane of the vagina becomes tough from coitus and childbirth, and is usually impregnable to the gonococcus. Bumm has kept gonorrheal pus in contact with the vaginal wall for twelve hours without producing any inflammatory reaction.

In girls and in young women, in whom the mucous membrane of the vagina is soft and hyperemic, vaginal gonorrhea is more likely to occur. Like gonorrhea in other parts, the disease may be acute or chronic. It may involve the whole vaginal tract or it may be restricted to local areas.