PNEUMONIA, MENINGITIS AND GONORRHEA 327 



the discharge changes to a more or less viscous serum. The 

 gonococci occasionally invade the urinary bladder, pro- 

 ducing an acute cystitis. They may also pass along the vas 

 deferens to the seminal vesicles and finally to the epi- 

 didymis, causing epididymitis and orchitis. The disease is 

 peculiarly difficult to treat because after the first occurrence 

 of urethritis, the organism frequently invades the neighbor- 

 ing glands, such as the prostate, and local applications of 

 disinfectants do not reach them. In a considerable per- 

 centage of cases, therefore, the disease becomes chronic. In 

 metastatic infection from cases showing prostatitis or vesi- 

 culitis, the organisms may localize in the joints producing 

 gonorrheal rheumatism. More rarely there may be involve- 

 ment of the heart valves. 



In the female gonorrhea is usually primarily a vaginitis 

 followed by involvement of the uterus and not infrequently 

 of the Fallopian tubes. The acute inflammation here may 

 give rise to the condition known as "pus tubes " (pyosalpin- 

 gitis) in which there is danger of the tubes bursting and 

 producing peritonitis. The urethra is frequently also 

 involved in the disease. 



Because of its wide distribution, the variety of the symp- 

 toms and the seriousness of the after effects, such as rheu- 

 matism, sterility, pyosalpingitis requiring surgical inter- 

 vention, etc., the disease probably is to be regarded as the 

 most important of the venereal infections. 



Bacteriological Diagnosis. As noted above, the dis- 

 ease may frequently be recognized by the identification of 

 the Gram-negative, coffee-bean-shaped diplococci present in 

 the pus. The complement fixation test has also been used 

 to detect the presence of the organism where there are no 

 apparent or evident symptoms of the disease, particularly 

 in determining when a cure has been effected. 



Immunity. Gonorrhea is a disease from which spon- 

 taneous cure occurs but slowly, the individual frequently 



