GONORRHOEA Gonorrhoea is a specific inflammation of the mucous membrane of the urethra and other passages caused by M. gonorrhoea, diplococcus discovered by Neisser and often called the gono coccus.
The germs find entrance during coitus and multiply at enormous rate, spreading to all the glands and crevices of the membrane, and setting free in their development a toxin which causes great irritation of the passage with inflammation and swelling. They remain quietly incubating for three or four days, or even longer; then acute inflammation comes on, with profuse discharge of thick yellow matter, with much scalding during micturition, and there may be so much local pain that it is difficult for the person to move about. Microscopic examination of the discharge shows abundant pus corpuscles and epithelial cells from the membrane, together with swarms of intra- and extra-cellular diplococci (gonococci).
The inflammatory process may extend backwards and give rise to acute prostatitis (see BLADDER AND PROSTATE, DISEASES OF), with retention of urine; to the duct of the testes and give rise to acute epididymitis (swollen testicle) ; and to the bladder, caus ing acute cystitis. It may also cause local abscesses, or, by irrita tion, set up crops of warts.
In ten days or a fortnight the inflammation gradually subsides, a thin watery discharge remaining which is known as gleet. But inasmuch as this discharge contains gonococci it may, though scarcely noticeable, set up acute specific inflammation in the opposite sex.
In the case of the female the inflammation is apt to extend to the uterus and along the Fallopian tubes, perhaps to give rise to an abscess in the tube (pyosalpinx) which, bursting, may cause fatal peritonitis.
A lingering gleet may be due to the presence of a definite ulcera tion in the urethra, and this, being chronic, is accompanied by the formation of much fibrous tissue which contracts and causes narrowing of the urethra, or stricture. Thus gleet and stricture are often associated, and the occasional passage of a large bougie may suffice to cure both. Often, however, a stricture of the
urethra proves rebellious in the extreme, and leads to diseases of the bladder and kidneys which may prove fatal.
One of the most important points in the management of a case of gonorrhoea is to prevent risk of the septic discharge coming into contact with the eye. If this happens, prompt and energetic measures must be taken to save the eye. If at the time of delivery a woman be the subject of gonorrhoea, there is great probability of the eyes of the infant being affected. The symptoms appear on the third day after birth, and the disease may end in complete blindness. The name of the disease is ophthalmia neonatorum. (See BLINDNESS.) By the term gonorrhoeal rheumatism it is implied that the gono cocci have been carried by the blood stream to one or more joints in which an acute inflammation has been set up. It is apt to occur in the third week of the disease, and may end in permanent stiff ness of the joints or in abscess.
In rare cases the germs find their way to the cardiac valves, pleura or pericardium, setting up an inflammation which may end fatally.
For a man to marry whilst there is the slightest risk of his still being the subject of gonorrhoea is to subject his wife to the prob ability 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. Noth ing less than repeated examinations of the urethral mucus by the microscope, ending in a negative result, should be accepted as evidence of the cure being complete. And these examinations should be made after he has returned to his former ways of eating, drinking and working.