Gonococci have been found in clap threads years after the last known infection, and this will illustrate why they are such a source of danger, and how an innocent woman has been made to suffer when it was supposed that all danger of infection had passed away.
GONORRHEA IN WOMEN.
This naturally assumes the type of a specific vaginitis, usually with active participation of the mucous membrane of the vulva and of the vulvovaginal glands, the urethra and bladder being sometimes secondarily involved, while the role of the lymphatics is about as described in the male. In the young, especially in young girls upon whom rape has been attempted, the mucosa is extremely susceptible. In adults, particularly in those who have borne children, the vaginal walls offer more resistance. The nature of the parts permits of more violent chemosis of the mucous membrane, while in serious cases there will be well-marked edema of the labia. The urethral orifice is usually inflamed and chemotic, even though the infection travel no farther in this direction.
It has been stated that 80 per cent. of deaths from pelvic disease in women are due directly or indirectly to gonorrhea, as well as one-half of the cases of involuntary sterility.
As in the male, there may be different types of so-called gonorrheal infection of the vagina, varying from the pure gonococcus type to that in which the preponderating bacteria are of the ordinary pyogenic varieties. The detection of gonococci in the discharges sometimes assumes medicolegal importance, and upon it has depended the guilt or innocence of more than one individual.
The intensity of the vaginitis will vary with that of the infection. In the worst cases the discharge is profuse and acrid. It may amount to 50 Cc. or even 100 Cc. in twenty-four hours. The burning pain will be extreme, while backache and pelvic soreness will be bitterly complained of. In mild cases the disease assumes the clinical form of a low-grade vaginitis with abnormal discharge, such as may be characterized as a severe case of “whites.”
In these cases of either type the question is, whether infection has already travelled upward beyond the vagina into the uterine cavity or through it into the tubes.
Gonorrhea is the most common, and some believe almost the sole, cause of pyosalpinx with its attendant complications and dangers. Even when not severe, vaginitis may permit of such extension, and so not only induce sterility, but compromise the physical welfare of the patient; while in acute cases the activity is so great that it occasionally terminates in peritonitis, primarily of gonorrheal origin. When both tubes have become involved, the patient is almost invariably sterile.
In nearly all of these cases strings of mucopus will be found hanging out, or beads of it presenting at the external os, and when examined this exudation will afford a fair test as to the character and degree of the infection. Here, as in the male, there are so many follicles difficult of access, and so many recesses in which germs may lurk, that a complete disinfection of the parts is almost impossible. For this reason, then, latent gonorrhea is a frequent outcome of the disease when once it has existed, and a possible and more or less constant source of danger to others.