By attention to all the rules of hygiene and by proper treatment, acute anterior urethritis uncomplicated clap may, under the most fortunate circumstances, be recovered from in from six to eight weeks, but such an event is the exception and not the rule.
After the acute stage has lasted from one to three months, it passes into the declining stage, which may drag along for many long months more, or even for years.
In the declining stage there is not usually much pain, the chief symptom being a more or less copious discharge which soils the patient's shirt and bed linen, but all through this declining stage the recovery is apt to be interrupted by severe relapses, especially if he take active exercise, become constipated, catch cold, or indulge in excesses in Ventre et in Baccho.
These relapses are regarded by many patients as fresh attacks of gonorrhoea, and it is to these that one refers when he says that he heeds a case of clap as little as a bad cold; and from these relapses quacks and charlatans make a great reputation, for the discharge is readily checked by slightly astringent injections. If, however, the urethra were to be examined by the urethroscope in the hands of an expert, areas of inflammatory tissue would be seen in the deeper parts, although there might be no external discharge whatever.
In reality, in these cases, the patient never has recovered, but healing is taking place with relapses whose intensity grows gradually less and less severe with each succeeding attack. One is more apt to suffer set backs if he be of a weak constitution, if he have previously suffered from syphilis, if he have pollutions, if he indulge in coitus, or in alcoholics, or take too active exercise, or spicy food, or if he be constipated. Should he be so unfortunate as to acquire any other simultaneous illness, he will also very probably suffer a relapse. Of course, many cases of acute gonorrhoea vary a good deal in the intensity and in the duration of the different stages from the preceding typical description; for instance, sometimes the period of incubation and the prodromal stage last longer and are less severe, while in other instances all the symptoms develop more rapidly and are intensified, so as to be even more severe than what has been depicted.
Sometimes the amount of pus poured out is small in amount and there is not much discomfort, so that an unobservant patient might miss the fact that he had an attack of gonorrhoea, while in other cases, there may be, in addition to the worst symptoms already described, involuntary pollutions, gonorrhceal rheumatism, gonorrhceal ophthalmia or conjunctivitis, or gonorrhoeal inflammation of the brain or heart, ending fatally. Remember that even the mildest case of clap may result disastrously by spreading to the deep, or posterior portion of the urethra, causing any of these complications, or stricture, prostatitis and sterility. It is erroneous to suppose that gonorrhoea limits itself to the anterior urethra. The whole extent of the urethra becomes involved in the large majority of instances.
All the symptoms heretofore described have been quite apparent to the patient, but, in order to follow the course of the disease accurately and scientifically, it is necessary for the physician to make frequent microscopical examinations of the discharges and of the urine.
During the height of the attack the microscope reveals pus corpuscles and gonococci in enormous numbers, and the treatment will be largely directed by their persistence 01 decline. By degrees the pus cells and gcnococci become less numerous; but the latter are very liable to recrudesce, or crop up afresh with renewed activity, months after their apparent disappearance.
In the early stages there will be noticed in the urine numerous little rice like bodies, resembling fluffy threads or balls; these are called "clap-threads" (Tripperfaden by the Germans), and consist of pus and exfoliated epithelial cells held together by mucus, for which the careful physician must look with his microscope, day by day, until they have entirely disappeared.