I have been looking at a death certificate from the 1940s that shows cause of death as "advanced stages of gonorrhea." How does gonorrhea cause death? I've read about the symptoms, treatment and prevention, but I did not see any information on what happens when it goes untreated, and what happens to the body.

Faye

I must say that I have never seen any patient die from gonorrhea, but I have treated a few who have come close. In most people, gonorrhea is a self-limited illness, even without therapy. Males typically develop pain and discharge from the penis. Women can develop several forms of the disease. The most common is infection of the cervix, which often results in no symptoms at all. When there are symptoms, there is vaginal itching, discharge and occasionally pain. Both males and females can also have gonorrheal infections of the rectum or throat (from anal or oral sex with an infected partner).

Less commonly, the bacterium Neisseria gonorrhea can enter the bloodstream. When this occurs, the infection can affect the skin and joints, although the patient is not all that ill. In such cases, people commonly develop a rash consisting of a few vesicles (small fluid-filled blisters) or pustules (pus-containing skin lesions), usually on the hands and/or feet. In the beginning of this illness, people often have fever and pain and swelling in multiple joints. Tendons and the tissues around them also can become inflamed. Later, a single joint may become significantly affected, while the remainder of the joints improve. This illness responds dramatically to antibiotics and can even resolve without any treatment.

Gonorrhea can have serious complications, sometimes in the absence of the more typical genital infections. The most common complication, pelvic inflammatory disease (PID), occurs in women. In PID, the bacteria infect the fallopian tubes that lead from the ovaries to the uterus and other structures of the reproductive system, resulting in fever and severe pelvic pain. The most important complication is future infertility. In rare cases, gonorrhea bacteria can cause meningitis (inflammation of the membranes covering the brain and spinal cord). (A related bacterium, Neisseria meningitidis, is the cause of meningococcal meningitis.)

What the unfortunate person on the death certificate may have had was endocarditis, infection of the heart valve. While rare today -- I have seen two cases -- this infection was more common in the days before antibiotics. As with the far more common form of endocarditis due to staph (Staphylococcus aureus) bacteria, the patient usually has a relatively rapid onset of fever and destruction of the heart valve. This results in heart failure and sometimes strokes and other problems (caused when debris consisting of clot and organisms travels in the bloodstream and lodges in a blood vessel). This infection is always fatal without treatment, and penicillin was not available for general use until the late 1940s. Even with treatment, death was common in the early days of antibiotics. Gonococcal endocarditis still can be fatal, though recovery is expected if treatment is begun promptly.