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Clinical Manifestations and Sequelae (continued)
Genital Infection in Women
Cervicitis and
urethritis
are associated with gonococcal infection in women. However, approximately 50% of
infected women are asymptomatic.
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Symptoms of cervicitis may vary from a nonspecific vaginal discharge to more specific symptoms including intermenstrual bleeding, dysuria, lower abdominal pain, and
dyspareunia. Clinically, the cervix may show mucopurulent or purulent cervical discharge and easily induced cervical bleeding.
The incubation period in women is unclear, but symptoms usually occur within 10 days of exposure.
Forty to sixty percent of women with cervical gonococcal infection also have
urethral infection (urethritis). Dysuria may be present, but more commonly women
are asymptomatic.
Complications in Women
There are several complications associated with gonorrhea in women. Accessory
gland infections, often unilateral, may involve the
Bartholin’s glands or
Skene's
glands. Occlusion of the ducts of these glands may result in abscess formation.
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Pelvic inflammatory disease (PID) occurs when infection ascends to
the endometrium or fallopian tubes or both.
PID symptoms may include lower abdominal pain, discharge, dyspareunia, intermenstrual
bleeding, and fever but PID may also be asymptomatic. During a pelvic exam, uterine or adnexal tenderness and cervical
motion tenderness may be noted. Evidence of cervicitis may be present as well. The long-term sequelae of untreated PID can
include chronic pelvic pain, tubal infertility, and
ectopic pregnancy.
Perihepatitis (Fitz-Hugh-Curtis Syndrome) is an inflammation of the liver capsule and adjacent peritoneum. It is associated with PID. Historically, perihepatitis was attributed only to gonococcal infection, but now it is often associated with chlamydial infection as well. It is characterized by right upper quadrant pain, and may be accompanied by abnormal liver function tests.
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