GONORRHEA

venereal disease characterized by inflammation of the mucous membranes of the genital tract and urethra. It is caused by the gonococcus, Neisseria gonorrhoeae-a bacterium with a predilection for the type of mucous membranes found in the genito-urinary tract and adjacent areas. All gonococcal infections except eye infections in newborn infants (ophthalmia neonatorum), some instances of vulvovaginitis of young girls living in institutions, and occasional accidental eye infections in adults are transmitted by direct sexual contact. Gonorrhea is worldwide in distribution and very common, though the incidence is not precisely known because of self-treatment, undiagnosed cases, and defective reporting. The World Health Organization reports that a general decline has been followed by a worldwide increase since the mid-1950s. The increase was attributed in part to the growing resistance of N. gonorrhoeae to penicillin. In the United States it was estimated in the late 20th century that some 2 million cases occurred each year, only about 30 to 40 percent being reported. The mortality from gonorrhea is negligible, but its indirect effects on the population by its not infrequent sterilization of both sexes are incalculable. The incubation period of gonorrhea is usually three to five days (range two to ten days). The first symptoms in the male are a burning sensation upon urination and a purulent urethral discharge that may be profuse or may be so meagre as to go unnoticed. In the absence of treatment, the infection usually extends deeper, to involve the upper urethra, the neck of the bladder, and the prostate gland. Urgency and frequency of urination and, occasionally, blood in the urine may follow. Spontaneous recovery may occur within a few months to a year. The initial symptoms in the female in most instances are so mild as to go unnoticed. Slight vaginal discharge with burning may occur. The disease is not usually suspected by either patient or physician until complications arise or a sexual partner is infected. Abscess of a vulvovaginal (Bartholin) gland occurs rarely as an early complication. Many women recover spontaneously from gonorrheal infections that extend no farther than the cervix (mouth of the uterus). In many, however, there is extension through the uterus to the fallopian tubes and ovaries. Fever usually accompanies these extensions to the pelvic organs, and lower abdominal pain is a prominent symptom. Pelvic abscess or peritonitis may result. The symptoms can be confused with those of appendicitis. Healing occurs without resort to surgery in most cases, often with some physical disability and sterility. In immature girls the infection is usually confined to the vagina. In both male and female, arthritis is the most common extragenital manifestation of gonorrhea. The process usually settles in one or two joints and may result in permanent disability in the absence of treatment. Involvement of the tendon sheaths in the region of the affected joint or joints is not uncommon. Other, very rare, complications of gonorrhea are iritis, endocarditis, meningitis, and skin lesions. Penicillin or tetracycline are the antibiotics usually used in treatment, one injection usually being sufficient to cure uncomplicated gonorrhea. Strains of gonococci that are resistant to penicillin or tetracycline are on the increase, however, and spectinomycin or cefoxitin are increasingly used as alternative drugs in eliminating these bacteria. The administration of the smaller amounts of penicillin and most other antibiotics sufficient to cure gonorrhea may mask the early manifestations of coexisting syphilis and delay its diagnosis. An integral part of the treatment of gonorrhea, therefore, is the so-called serologic follow-up-a blood test for syphilis at least once a month for four months.