A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
_Gonorrhea of the urethra_ is the most common form of the disease. The
great majority of the cases of urethritis in women are of gonorrheal
origin. Whenever there is a purulent or muco-purulent discharge
from the urethra gonorrhea should be suspected, whether or not the
gonococcus is found in it.
The disease may linger in the mucous glands found near the external
meatus and in Skene’s glands for a long time. The symptoms of this
condition have already been considered. The disease may present all the
phenomena of acute urethritis in the male, or it may be subacute from
the beginning.
_Gonorrhea of the cervix uteri_ occurs next in frequency. As far as
the few accurate observations that have been made teach us anything,
gonorrhea of the cervix is but little less frequent than gonorrhea
of the urethra. The disease may exist in conjunction with gonorrhea
of some other part, or it may occur alone. The infection takes place
directly from the discharge of the penis which comes in contact with
the external os. Gonorrhea of the cervix usually begins in a subacute
or an insidious manner. It is usually unattended by any general or
local symptoms sufficiently marked to attract attention. If the
woman had been free from a leucorrheal discharge, she may observe
a muco-purulent secretion caused by the gonorrhea. If she had a
leucorrhea, the alteration in the character and amount of the discharge
is usually not sufficient to attract her attention. In some cases the
discharge becomes more purulent in character; in others there is no
alteration perceptible to the naked eye.
If the disease runs an acute course, the appearance of the cervix
will be that characteristic of acute inflammation. The vaginal cervix
is congested; the external os is patulous and is surrounded by a red
granular or eroded area, while from it is seen escaping a purulent
discharge.
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.
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