The best method of diagnosing a chronic gonococcal urethritis is to give a large dose of a potent gonococcal vaccine, and if there are gonococci latent, the injection will quickly stir them up, with the result that within forty-eight hours the patient will either have had an increase in the urethral secretions on rising or even profuse discharge. The further administration of vaccines may cure such a case, especially if the prostate or the seminal vesicles are affected. Many a case of urethritis is kept up by a stricture, and no treatment short of gradual dilatation or urethrotomy will effect a cure. A urinary fistula may result, but it will almost invariably close of its own accord in time, and operative interference is seldom called for. Many a case of acute prostatitis will resolve by merely putting the patient to bed and inserting a psychophore per rectum, through which runs a stream of cold water.
Resolution is rapid and a fistula is extremely rare.
Gonococcal Cystitis so rarely occurs, and when it does the infection becomes so quickly superseded by the bacillus coli that the treatment does not differ from that which is described elsewhere. Epididymitis, on the other hand, is an extremely common complication, and, as when bilateral it is a frequent cause of sterility, may call for special and energetic treatment. Then treat in the usual way with lotions, etc. The epididymis reaches its normal size in one to three days, and only occasionally is a second injection necessary. Paraphimosis occurs mechanically and is not due to the patient having drawn back his foreskin and being afterwards unable to draw it forwards again.