Pregnant women are more liable to infection by the gonococcus than non-gravid women, because of the increased blood supply to the generative organs in gestation, and the softening of these organs. For the same reason, latent gonorrhea is likely to become active and to spread during pregnancy. A like activity and extension of latent gonorrhea often occurs during menstruation. Women with gonorrhea are commonly sterile--this is the chief reason why prostitutes are usually sterile. In married women gonorrhea may cause dyspareunia; it may bring on abortion through endometritis; it may shut the tubes and prevent conception; it may destroy the ovaries.
The disease is extremely frequent during pregnancy. Gurd[194] isolated the gonococcus in 52 of 113 pregnant women who came to his dispensary service because of pelvic pain. Leopold, Stephenson, Fruhinholtz, and many others estimated that about 20 per cent. of all pregnant women have gonorrhea, but more recent observers think that from 5 to 10 per cent. is nearer the truth.
[194] _Montreal Med. Jour._, vol. xxxvii.
When a pregnant woman has gonorrhea great care must be taken in treatment to prevent abortion. Powerful antiseptics in the cervix, or dilatation of the cervix, are not permissible, and operative interference is to be delayed as long as possible--in each instance to avoid abortion. The vaginal douche as a routine treatment is not used now by obstetricians in these cases. When the gonorrhea is in the uterus douches of hot bichloride solution, 1 to 10,000, are used twice daily during the last few weeks of gestation, with the intention of saving the infant's eyes from infection during delivery. After delivery the cavity of the uterus should not be entered with instruments lest infection be carried in, unless absolute necessity requires this instrumental procedure. Post-partum gonorrheal sepsis is differentiated from other septic conditions chiefly by the history of gonorrhea in the husband, by bacteriological examinations, and by the technical differentiation of symptoms.
The moral guilt of a person who infects another with gonorrhea is affected by the extent of the physical injury done. Gonorrhea causes, besides the effects already described: (1) chronic cystitis, with all the suffering, loss of work, and danger of renal infection in such a condition; (2) lymphadenitis of the inguinal canal, and rarely of other places; (3) proctitis, or inflammation of the rectum, especially in women and young children; (4) ophthalmia, vaginitis, and proctitis in infants and children, and metastatic conjunctivitis; (5) stomatitis or inflammation of the mouth in adults and children; (6) nasal gonorrhea (a doubtful condition); (7) gonorrheal septicemia, bacteremia, or toxemia, which may affect any organ in the entire body; (8) bone and joint lesions: (_a_) gonorrheal arthritis in any joint in the body (this condition may be fatal, or it may leave permanent disability, or it may disappear); (_b_) tenosynovitis, or pain, swelling, and edema along affected tendon sheaths; (_c_) gonorrheal periostitis, where the bone and periosteum near a joint are affected; (_d_) perichondritis and chondritis, a rare condition, where cartilage is attacked; (9) endocarditis, or inflammation of the lining membrane of the heart (one of the most frequent secondary lesions of gonorrhea); (10) pericarditis, or inflammation of the sac which contains the heart; (11) myocarditis, an inflammation of the heart muscle itself, usually as an extension of endocarditis; (12) aortitis, or inflammation of the aorta--a rare condition; (13) phlebitis, an inflammation of the veins--a very rare condition; (14) thrombosis, or blocking of a blood-vessel by exudate (this may be fatal); (15) skin lesions, as erythema, erythema nodosum, bullous and hemorrhagic eruptions, hyperceratosis, and ulcers; (16) gonorrhea of the lungs in septicemia; (17) gonorrheal pleurisy in septicemia; (18) gonorrheal nephritis, which is frequent in gonorrheal septicemia--the condition is often fatal; (19) perinephritis, a very rare condition; (20) gonorrhea of the nervous system, as neuritis or neuralgia, or neuroses, which vary from slight melancholia to severe mental disturbances; (21) parotiditis, a very rare condition; (22) otitis, or inflammation of the middle ear, a very rare condition; (23) suppuration in muscles, or under the skin; (24) wound septicemia; (25) venereal warts; and (26) epididymitis, which often causes not only sterility but impotence.