Neisseria gonorrhoeae

“ Gonococci may remain in the genital tract during the entire period of pregnancy, without clinical manifestations, and yet become active during the puerperium, which explains many obscure cases of puerperal infection. In this way the ignorance of the prolonged infectious character of latent chronic gonorrhoea has ruined many and many a young wife. The individual considers himself cured, while in fact the gonorrhoea remains contagious for many years to the innocent wife and her child. ”

“ We must also remember that gonorrhea is less painful in woman than in man, and that, even in the latter, it ceases to be painful when it becomes chronic. We may add that the microbes (the gonococci) are very difficult to reach in all the recesses of the mucous membrane of the sexual organs in which they are hidden, and that in women they penetrate as far as the womb, when a cure becomes almost impossible. ”

“ One attack of gonorrhea in no way protects against a second infection, but rather predisposes to it, and when this disease becomes chronic exacerbations or relapses of the acute stage often occur without fresh infection.
In women the results of gonorrhea are, if possible, still worse than in men, because it is more difficult to cure. A prostitute affected with gonorrhea may infect an enormous number of men, and in this case medical inspection of brothels is no guarantee. ”

“ Gonorrhoea is a still commoner disease than syphilis; how common it is very difficult to say. It is also an older disease, for the ancient Egyptians knew it, and the Biblical King Esarhaddon of Assyria, as the records of his court show, once caught it. It seems to some people no more serious than a common cold, yet it is able to inflict much prolonged misery on its victims, while on the race its influence in the long run is even more deadly than that of syphilis, for gonorrhoea is the chief cause of sterility in women, that is to say, in from 30 to 50 per cent. ”

“ This fact is so well known that there is a widespread popular belief that gonorrhea may be acquired from coitus, during 453 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. ”

“ Otherwise, the health and life of the patient may be seriously compromised.
The social danger of gonorrhea introduced after marriage is not limited to the risks to the health of the woman. When a woman thus infected bears a child the contagion of the disease may be conveyed to the eyes of the child in the process of birth. Gonorrheal pus is the most virulent of all poisons. A single drop of the pus transferred to the eye may destroy this organ in from twenty-four to forty-eight hours. ”

“ It is in these tissues that the germ of gonorrhea finds lodgment, and once there its development is hard to interrupt. Although the growth of the gonorrheal germ produces acute symptoms, such as discharge and pain, these pass off under treatment in a few weeks. Unfortunately the disease is far from cured, for the microbe has found its natural habitat in the inter-cellular structure of the genital mucus, from which it cannot readily be dislodged, and from which it may invade other tissues. ”

“ In rare cases the germs find their way to the pleura or pericardium, setting up an inflammation which may even end fatally.
For a man to marry whilst there is the slightest risk of his still being the subject of gonorrhoea would be to subject his wife to the probability of infection, ending with chronic inflammation of the womb or of septic peritonitis. Yet it is often extremely difficult to say when a man is cured. That there is no longer any discharge does not suffice to show that he has ceased to be infective. ”

“ Through the ages great confusion existed as to the origin and nature of venereal disease, but in 1905 a micro-organism, the Spironema pallidum, was demonstrated as the infective agent in syphilis, and the gonococcus as the infecting organism of gonorrhœa had been discovered in 1879. As regards modes of infection, syphilis is contracted usually by sexual congress; occasionally the mode of infection is accidental and innocent, and congenital transmission is not uncommon. ”

“ Besides this danger of infecting the innocent mother and child, gonorrhoea is not such an innocent disease even for the man himself. It is not a local disease only, it is a general infection and its manifestations may be as grave to the individual as syphilis. The infection may ascend to the urinary passages and cause a catarrh of the bladder and an infection of the ureters and kidneys. It may affect the genital organs, as the testicles and prostate in men, and uterus and tubes and ovaries in women. The germs of gonorrhoea may enter the blood and attack the joints. ”

“ From the fact that about 90% of sterile women are married to men who have suffered from gonorrhoea either before or during their married life, he infers that the sterility is due to latent gonorrhoea communicated from husband to wife. If this inference were justified, sterility would be far commoner than it actually is. Nöggerath makes use of the term “latent gonorrhoea” because the woman becomes infected without the obvious outbreak of any acute phase of the disorder. The disease remains latent, and a radical cure is not to be expected until the menopause. ”

“ Some authorities claim that fully half the sterility in women is caused by gonorrheal infection of the Fallopian tubes. Gonorrheal infection of the eyes at birth is now prevented by first washing them in a saturated solution of boric acid, then treating them with a drop of weak silver solution. ”

“ In gonorrhoea, a cause of sterility, blindness of babies, and all manner of surgical operations and "diseases peculiar to women," so common among innocent wives, Miss Dock shows us that European records give about seventy-five per cent of men as infected. In America things are better, a conservative estimate giving the proportion of our men having either syphilis or gonorrhoea as about sixty per cent. ”

“ Gonorrhea in women is the most frequent cause of their sterility, and also is a common source of abortion and premature birth. It is the cause in most cases of blindness in infants (p. 205) and also of vulvo-vaginitis in girl babies. Furthermore, gonorrhea is so alarmingly prevalent that it is stated on good authority that the disease occurs in eighty per cent of all males some time during their lives. The disease is not confined to prostitutes, but is common, much more frequently than is suspected, in all walks and classes of life and at all ages. ”

“ I The child suffers the most tragic results of venereal infection, for it is always wholly innocent, yet infected to a greater or less extent, if the parents be syphilitic, and frequently if the birth-canal be gonorrheally infected. Although silver nitrate is a remedy for gonorrheal infection, if applied to the eyes immediately after birth, nevertheless the babe frequently suffers with infected eyes, and not infrequently with blindness. ”

“ While in this stage of latency it is difficult to destroy. At this time it is more likely to be further disseminated, as the patient, ignorant of the condition, is more likely to convey the disease, which so often occurs in married life after a long forgotten infection.
The gonococcus (the microbe of gonorrhea) is a pus—producing bacterium, occurring in pairs, resembling in form two coffee grains, generally with a distinct interval of separation. Although its natural habitat is the mucous membrane lining the genito-urinary tracts it [47] may invade the muscular and serous and other tissues. ”

“ That gonorrhoea in the acute form may extend by propagation from a vaginitis through the uterine cavity and Fallopian tubes to the peritoneum, and produce an inflammation of that membrane, is probable. Cases have been met with where a history of specific infection was undoubted, in which an attack of perimetritis followed soon after the initial symptoms and physical signs of gonorrhoea were manifested. But it is quite another thing to believe that the specific poison may remain latent and harmless in the genital system of the male to be transferred years afterward to that of the female. ”

“ The difficulty of proving the presence of gonorrhea in women is often very great. As has been said, the disease may begin and may exist for a long time without attracting the attention of the woman. She often pays no attention to a slight burning or tickling sensation in the urethra, which passes off in a few days. She may have had a leucorrheal discharge for a long time, and she may fail to notice any slight alteration in its character or quantity that may have been caused by gonorrhea. ”

“ Examination showed that he was suffering from cystitis, and that this was a sequel of gonorrhoea. As regards children of the other sex, I have myself seen cases of gonorrhoea in which sexually immature girls have been infected in sexual intercourse of which they themselves had been the instigators. In most cases, infection in children results from intercourse with grown persons, but it sometimes happens that children infect one another. ”

“ They are Gonorrhea, Syphilis, and Chancroid. These diseases are produced each by a different and separate kind of germ; they develop independently one from another, and they can never change one into another. But they can coexist in one patient; i. e., a man can get at the same time gonorrhea and Chancroid. If this double infection takes place, then both diseases have to be treated at the same time. ”

“ Although young men hear the mischievous lie that "gonorrhea is no worse than a bad cold," thousands of them are punished with sterility as a result of the disease. Nearly all the neglected cases result in so-called ascending infections, reaching the bladder and kidneys and causing many deaths, and many men carry the infection in dormant form, to infect innocent wives in later years. ”

“ In gonorrhoea gonococci are sometimes found in the sediment, but more commonly in the "gonorrheal threads," or "floaters." In themselves, these threads are by no means diagnostic of gonorrhea. Detection of the gonococcus is described later (p. 264) .
7. Animal parasites are rare in the urine. Hooklets and scolices of Tænia echinococcus (Fig. 55) and embryos of Filaria sanguinis hominis have been met. In Africa the ova, and even adults, of Distoma hæmatobium are common, accompanying "Egyptian hematuria." ”

“ The great significance of gonorrhoeal infection in relation to sterility in women depends, not only on the changes this disease causes in the Fallopian tubes, leading to interference with the necessary contact of ovum and spermatozoon, but further, upon the occurrence of gonorrhoeal cervical and corporal endometritis, of perimetritis, and secondary parenchymatous metritis. ”

“ The latter complication is a most common cause of sterility in men. Formerly it was thought that gonorrhea was a local inflammation confined to the urinary canal and neighboring parts, but advances in our knowledge have shown that the germs may be taken up into the general circulation and affect any part of the body, such as the muscles, joints, heart, lungs, liver, spleen, kidneys, etc., with results always serious and often fatal to life. ”

“ Gonorrhea in women may attack any part of the genito-urinary tract. It rarely attacks a number of structures at one time, but it usually becomes localized in one 451 or two parts, such as the urethra, the glands of the vestibule, the vulvo-vaginal glands, the vaginal fornices, or the cervix uteri, and runs a subacute course, and may remain quiescent for a long period. It may in time disappear spontaneously, or it may be excited into activity by a variety of causes, such as traumatism, unusual coitus, labor, or miscarriage. ”

“ When considering the etiology of acquired sterility, especial attention must be devoted to gonorrhoeal pyosalpinx, the most important and the most dangerous of the morbid manifestations of gonorrhoeal infection in the female. Gonorrhoeal salpingitis and perisalpingitis are very serious affections, in the first place because they are apt to give rise to oophoritis and perioophoritis, as well as to pelvic peritonitis, and other local inflammatory states. ”

“ But that the obstacle offered to conception by gonorrhoeal infection is by no means so powerful as Nöggerath and his supporters believed, is shown by the investigations of Oppenheimer, who, in Kehrer’s clinique at Heidelberg, examined 108 pregnant women for the presence of gonococci, and found these organisms, pathognomonic of gonorrhoeal infection, in no less than 30 of them, that is, in 27.7%. Thus, in this large number of cases, pregnancy had occurred notwithstanding the presence of gonorrhoea. ”

“ The disease is caused by extension of inflammation from the endometrium. The usual causes of this inflammation 288 are gonorrhea, or infection after a criminal abortion, a labor, or a miscarriage. The gonorrheal salpingitis is usually slow or insidious from the beginning. The symptoms of the disease are often not troublesome until many months after the primary gonorrheal infection. The closure of the tube is slow, and it is sometimes not until the tube becomes distended with pus that the woman experiences much suffering and is placed in imminent danger. ”