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In women, gonorrhea may begin in either the urethra or the cervix, or both. The vulva and vagina are relatively insusceptible to infection until later in the course of the disease. In most cases the urethra is first infected, and the cervix may later be involved. If the cervix is infected first, the urethra is fairly certain to be infected later by bacteria carried downward through the vagina from the cervix. From the urethra the spread of infection into the glands of Skene is a common occurrence, and the glands of Bartholin are also commonly involved. Abscesses may develop in either of these glands, and, especially in the case of the glands of Bartholin, become large and painful, requiring surgical treatment. Once the cervix is infected, the body of the uterus, the uterine tubes, and the ovaries may be infected in turn, although several years may pass before all these parts are involved. Infection of the lining of the abdominal cavity (peritonitis), a very serious complication, may occur. Spread of the infection into the bladder and to the ureters and kidneys is quite rare, although the bladder frequently becomes infected with other organisms during gonorrhea. Symptoms vary with the location and acuteness of the infection. In all cases pus will be visible at the vulva coming from the urethra or cervix, or both. If the urethra is infected, there will be frequent urination with more or less burning. When the cervix and body of the uterus are involved, there may be pain in the back and painful feeling of downward pressure in the pelvis. In infection of the tubes, there is more or less severe lower abdominal pain, sometimes accompanied by chills, fever, headache, and general malaise. Peritonitis may cause adhesions which produce severe pain at times.
Gonorrheal infection is often found in little girls, and here the infection is usually limited to the vulva and the vagina. This infection—juvenile gonorrheal vaginitis—is extremely contagious and is dreaded in infants' and children's institutions because of its rapid spread and the difficulties involved in its control or cure.