A physician is obliged to let a woman who innocently is about to marry a "cured" gonorrheic know of the man's condition, as in a case of supposedly cured syphilis. Taber Johnson, Noble, and other authorities, say no one can tell when a gonorrheic is absolutely cured.
In women infection of the cervix uteri occurs in about 80 per cent. of the cases of acute gonorrhea, and in 95 per cent. of all chronic cases. The infection may extend up into the uterus at the menstrual period or just after parturition. In the cervix, owing to the histologic formation, the disease tends to chronicity, but the inflammation within the uterus is much more likely to subside naturally. Chronic gonorrhea of the endometrium is usually accompanied by tubular infection. The infection of the uterus may be superficial or it may extend down into the underlying myometrium.
The inflammation extends from the endometrium to the Fallopian tubes and beyond, causing salpingitis, pyosalpinx, hydrosalpinx, tuboövarian abscess, tuboövarian cysts, and pelvic peritonitis. The most frequent form of tubal gonorrhea is pyosalpinx, or pus tube.
In the acute stage of tubal infection the tubes become elongated and swollen, and the mucous surfaces within are covered with a seropurulent exudate. This condition is called salpinx or salpingitis. When the condition advances so far that the external abdominal ostium of the tube is closed, a pyosalpinx forms. The pyosalpinx may be quite large. A hydrosalpinx is like a pyosalpinx, with both tubal ends sealed, except that its content is a serous or watery fluid. When infected material escapes through the distal end of the tube, perioöphoritis develops, and the ovary becomes adherent to the tube and other adnexa. More commonly only the surface of the ovary is affected, but frequently the infection gets into the body of the ovary and causes oöphoritis. The ovary then swells and there is a tendency to the formation of retention and other cysts, or an abscess of the ovary. A tuboövarian cyst is a hydrosalpinx in communication with an ovarian retention cyst, and a tuboövarian abscess is a like formation.
Gonorrhea, especially in women, is likely to be very chronic. Emil Noeggerath, who in 1872 published a book[164] which changed the medical doctrine on the disease, said of women, "Once infected, always infected." Norris[165] reports a case where the gonococcus was latent in a man for twenty years, and he then infected his wife and wished to divorce her until he found that he himself was at fault. Sax[166] reported an infection after fourteen years; MacMunn,[167] one after fifteen years. These are exceptional durations in the male for virulence, though not for continuance of the diplococcus.