Gonorrhoea appears differently in the two sexes. In the male it generally manifests itself after several hours or a few days by a pricking sensation in the end of the penis. The urine burns as it passes out, and is later followed by a thin, fluid secretion, which gradually turns purulent. This pus may at first be scanty, or it may be very profuse. Urination becomes more and more painful, as does also erection. The latter condition is often accom panied by considerable swelling of the meatus of the urethra, at times of the entire organ, or of the glans and foreskin. These painful inflammations become more severe and persist at a certain height until the third week ; then the discharge again becomes gradually mucopurulent, then mucoid, and soon disappears entirely. In an uninterrupted cure, the disease is con quered usually in six to eight weeks. If the disease, as often happens, is insidious, there remains a scant secretion of mucus for weeks, months, and even years. These lasting mucous discharges may be contagious, hut are not always so. This point can be decided by the physician only after repeated microscopical examinations of the discharges or of the " threads," found especially in the morning urine. A material delay in the cure, and a change of prognosis regarding the issue, is conditioned by a number of possible accidents. The most usual complications are : Inflam mation of the epididymis (see EPIDIDYMITIS) ; inflammation of one or both testicles, at times causing the affected testicles to become functionless (see OucHITIS) ; inflammation of the lymphatic glands and the lymph channels (see ; inflammation of the prostate (see PRosTArms) ; and inflammation of the neck of the bladder or of the bladder itself (see CYSTITIS.
Late consequences of an insidious gonorrhoea are contractions of the urethra (see STRICTURE) and, in rare cases, the spread of the infection to internal organs. Inflammation of the iris and gonorrheal rheumatism may be mentioned as possible results of such infection. The results may be very dangerous, conditioned by the importance of the organ affected. In all cases, any additional disease which may occur will cause considerable delay in the cure.
In the female there are fewer urinary symptoms, unless by chance the disease invades the urethra. The discharge (at first scanty, but gradually increasing in quantity) is usually regarded as a harmless leucorrhcea : and not until the disease has progressed upward to the internal sexual parts does a copious mucous discharge appear. Usually the disease progresses from the womb to the tubes and ovaries. Then collections of pus take place in the tubes, with limited peritoneal exudations and adhesions ; and these in turn cause lasting inflammatory conditions which can be cured only by operation. The insignificance of the early symptoms, and the absolute ignorance of many women of the possibility of such a disease, readily explain the delay in treatment ; and it generally requires some persuasion to influence a girl or a woman to submit to an examination. Whenever
symptoms of a mucous or purulent discharge from the vagina, difficulty in urination, or pains in the abdomen, occur shortly after marriage, it is advis able that a thorough examination be made, and that attention be paid to the possibility of gonorrhcea being present. The husband should be examined also, especially if he had suffered from gonorrhcea before marriage. The sooner the treatment is begun (of both parties, if necessary), the more lasting will be the results obtained.
With women, as with men, complications are common. Cystitis, vaginitis, and cervical erosions are not unusual. In women the contagious inflammation frequently comes in contact with the vaginal discharge, spreads to the anus, and causes gonorrhcea of the rectum. In such cases evacuation of the bowels becomes exceedingly painful.
The eye is always endangered by contact with gonorrhceal discharge. The purulent inflammation which results is always very severe, and may lead to total destruction of the eye. See EYE, DISEASES OF. It is there fore necessary that persons suffering from gonorrhoea should wash the hands most scrupulously after treating the parts (injections, etc.), and avoid every possibility of the eye coming in contact with the discharge (from soiled linen or bandages).
Contagion is produced most frequently by sexual intercourse. There are, however, cases of non-sexual contagion. Sponges, soiled wash, and towels may convey a gonorrhcea to little girls.
As to the treatment, it may be said that, after the first twelve to twenty four hours, washing out the anterior urethra with bactericidal remedies (to be done only by a physician) is at times efficacious in preventing an out break of the disease. Later this treatment is of no value, and the condition must then be handled according to the severity of the inflammation. Thera peutic treatment lies entirely in the hands of the physician ; it is very unwise to try the remedies used by another person, for there is no one cure for all cases, and medical treatment is conditioned by the symptoms in each case.
It is imperative that a patient suffering from gonorrhcea should adopt a sensible mode of life, and avoid bodily exertion, sexual excitement, and alcoholic drinks. Carelessness in this regard is just as wrong as prejudice against medical treatment (particularly injections), for the latter naturally aids the progress of the cure. The fear that the suppression of the urethral discharge caused by the injections may lead to internal diseases, must be rejected, as it is based upon wrong impressions. I t goes without saying that quacks should not be allowed to treat such a serious disease. Such persons generally regard the patient as an object of profit rather than someone needing careful treatment. Young men are ruined for life by quacks. Some quacks have been known to cause gonorrhcea to last for a long time.