In some cases the tenesmus, or ineffectual straining, is most distressing, and the sufferer has a constant desire to urinate without relief being obtained. Sometimes he sits on the commode almost constantly, passing a few drops of bloody urine now and then, and bathed in a profuse sweat, while at other times, and in other cases, there is incontinence of urine, or a condition in which he cannot retain his urine from constantly dribbling away.
Frequent pollutions are often induced in this condition, causing relapse after relapse, so that the disease may last for weeks, or months, or indefinitely. Such a patient is very liable to be sterile. In men who have hypertrophy of the prostate, or a stricture from an old attack of gonorrhoea, posterior urethritis is a most distressing and sometimes alarming and dangerous complication, the combination of acute and chronic disorders leading to general blood poisoning and an ascending gonorrhoea which attacks the kidneys. Repeated infections of gonorrhoea are more dangerous than a single attack; for then there is liable to be a subacute form, lasting indefinitely and becoming aggravated, as it continues, by various sequelae and complications which may lead to a fatal termination.
Gonorrhoeal rheumatism and involvement of the heart, by endocarditis or pericarditis, are very liable to cause permanent impairment of health and even death; while sterility may follow upon inflammation of the testicles, epididymes and seminal vesicles, and further grievous damage is not infrequently caused by abscesses of the prostate, peritonitis, bladder and kidney complications, and affections of the eyes. The prognosis in each case, of course, depends on the conduct and prudence of the patient as well as the skill in treatment. When one considers that the sexual appetite, in some of these cases, is uncontrollably strong and passionate, and that the patient is degenerated by evil ways of living and thinking, he can readily see that the physician must be guarded in the expression of his opinion as to the chances of a recovery which approaches a cure.
If proper care and treatment are employed, a provisional cure may often, under favorable circumstances, be looked for in a month or two.
The Treatment of Acute Gonorrhoea. A clearer conception of the gonorrhceal process can be obtained by an insight into the general line of treatment than by any other way. Bemember that gonorrhoea, as a rule, remains a local disease, but that the gonococci in the urethra elaborate certain poisonous chemical substances ptomaines which sometimes produce a general constitutional effect of septicaemia, or blood-poisoning, and that sometimes the gonococci themselves enter the circulation and are carried in the blood stream to the heart, the eyes, the brain and the large joints, where they produce disastrous results.
The absolute diagnosis of gonorrhoea can be made only when the physician has demonstrated the presence of gonococci in the mucus or pus discharge by microscopical examination; though of course one can be practically certain of the character of the disease from the information gained by clinical experience.
After cohabitation with a suspicious woman, a man is liable to be worried and anxious and unable to enjoy a single moment's peace of mind. As a rule, therefore, patients present themselves early for treatment, and certainly as soon as the discharge is well developed.
There is hardly any disease for which so many methods of treatment have been tried as for gonorrhoea; and since uninformed men have fallen into the habit of considering it a trifling ailment, the druggist probably treats more cases in the early stages than the physician, though the latter is bound to receive their visits soon, usually after irreparable damage has been done.