During this prodromal stage sensitive patients usually exhibit symptoms of depression of spirits, lassitude, and loss of appetite, chiefly on account of anxiety of mind and fear of impending gonorrhoea.
After the prodromal symptoms have lasted from two to eight days, there then comes the acute, or florid stage, which is accompanied by the classical symptoms of heat, pain, redness and swelling "calor, dolor, rubor, et tumor". The drop or two of grayish fluid which was first noticed at the meatus now increases in amount and becomes converted into a milky or creamy pus. At first the redness is confined to the margins at the orifice of the urethra; but this soon spreads until often the whole glans penis, or head of the organ, and sometimes even the whole penis, is enormously swollen and exceedingly painful.
Patients with a tight or long foreskin are liable to suffer more, since the tissues which compose this structure are of such a nature that they are liable to swell to an enormous degree and to retain the irritating pus secretion beneath them. In some cases the foreskin is so much swollen that it cannot be drawn back, and then the surgeon is compelled to slit it up in order to liberate the pent up secretion.
Very early in the acute stage, as a rule, the lymphatic glands in the groins become swollen and tender, and one can often trace, from the glans penis to the groins, the red and swollen lymphatic vessels which convey the poison to them.
The discharge at about the beginning of the second week becomes thick, creamy, profuse, purulent, and often blood tinged. It pours out so freely from the urethra day and night, in the form of large, heavy drops, that it soils the genitals and clothing of the patient and necessitates the wearing of a protective dressing over the penis.
Gonorrhoea begins in the anterior part of the urethra, but in from eighty to ninety per cent of cases travels down the canal until almost its whole length is in an intense state of inflammation. In this event, i.e., when the inflammation has spread down the urinary passage, even the substance of the penis, as well as the urethra, will be acutely inflamed and swollen, and the patient then finds himself in the undignified position of having an absorbing interest in his genital apparatus to the exclusion of all else.
It is important to understand that the urethra is a tube or rather a potential tube, for its walls lie in apposition when not distended by urine with a calibre of about the size of an ordinary lead pencil, extending a distance of eight or nine inches from the bladder to the exterior, and serving as a passage, or conduit, for the urine and semen. So it is evident that the result of a severe inflammatory swelling of its walls, and of the surrounding tissues, will be to narrow very materially the calibre of this tube.
Urination, consequently, is now a matter of acute pain and even agony, giving a sensation as though a red hot iron had been passed down the urethra, or as if the urine were scalding the canal. This is due partly to the increased acidity of the urine, but chiefly to the forcible distention of the inflamed and supxrarating canal. In such a case the patient exerts every effort to pass his water slowly, and to effect this he holds his breath, relaxes the abdominal muscles, and sometimes even tries to stop the stream of urine. Often there is a spasm of the compressor urethrce muscle, so that strangury, or an inability to pass urine, is caused, which condition may require relief by the passage of a catheter. Owing to the swelling of the urethral mucous membrane and the resulting narrowing of the canal, the stream of urine becomes very thin, escaping in drops, or in a twisted, sputtering and weak manner, while sometimes it dribbles away drop by drop involuntarily.