Causes or Factors which Convert an Acute Attach into Chronic Gonorrhoea.
1. There is a natural tendency for gonorrhoea to remain indefinitely latent or dormant, because the gonococci bury themselves deeply in the tissues, where they can with difficulty be reached by medicinal applications.
2. Too active or too mild treatment on the part of the physician, along with infractions of hygienic and dietetic rules on the part of the patient, such as:
(a) the patient, considering himself cured as soon as the discharge is checked, thinks that he will economize by stopping treatment, though there yet remain pus cells, clap threads and gonococci in the urine;
(b) he is intemperate in his eating and drinking;
(c) he does not refrain from active exercise if a wage earner, he must work;
(d) he gratifies his ardent sexual desires by fornication or masturbation. The ordinary clap patient concentrates his mind and attention on sexual matters, and, if he cannot fornicate, will compromise by associating with lewd and loose women whom he can at least hug and kiss, thereby promoting congestion of the already inflamed tissues by sexual excitement;
(e) some have peculiar idiosyncrasies or diatheses which favor the development of the chronic form, e.g., syphilis, or the gouty or rheumatic diathesis, or any debilitating disease.
3. Relapses or rapidly recurring fresh infections of gonorrhoea favor the acquirement of the chronic type. After a period of treatment of six or eight weeks' duration, during which the patient has been continent, he thinks that he must now reward himself by a spree, either of drinking or of venery; then comes on a relapse which is treated and disappears. Similar conduct brings on relapse after relapse, each one of less intensity and suffering, but continually conducing to the firm implantation of the gonococci in the tissues, with a resulting serious and permanent damage to important structures. It is thus seen that there are many influences which favor
an attack of gonorrhoea becoming chronic, and no patient can for a moment assure himself that he will escape this misfortune.
Can gonorrhoea last for a long time? Indeed it can.
"In very many cases of posterior urethritis, there being no visible discharge, and the patients complaining of no symptoms referable to the deep urethra, the affection remains dormant, latent and unrecognized. Thus the cases may drag on for one or more, and even five, ten, and twenty years without giving any indication of lurking trouble. In some of these cases an exacerbation occurs, and then the patient realizes that he has had an uncured gonorrhoea".
Can a patient have repeated attacks of gonorrhoea?
1. One attack, after its complete cure, furnishes absolutely no immunity.
2. An acute attack may be contracted while yet suffering from chronic gonorrhoea.
3. A fresh attack requires two or three days for its incubation or development, while a mere relapse of an old case shows its symptoms at once. The cause of chronic gonorrhoea is of course the gonococcus. These gonococci may remain latent for almost indefinite periods of time in certain parts of the genital area, and become enfeebled in power, but not inert; and men who suffer from chronic gonorrhoea infect their wives with a chronic, and sometimes with an acute gonorrhoea, perhaps months or years after they have supposed themselves cured.
Symptoms of Chronic Gonorrhoea. Many a man is suffering with chronic gonorrhoea without being aware of it, since there is not always, by any means, an external discharge from the meatus.
When there is chronic gonorrhoea in the anterior urethra there is apt to be a thin, watery discharge, which later on becomes thick, tenacious, and yellowish, gluing together the lips of the meatus, and constantly staining the linen. To this form the term "gleet" is appropriate. Dietetic or sexual intemperance renders the patient liable to an acute recrudescence of the morbid process, so that he often thinks that he has contracted a fresh case of gonorrhoea.