Reports concerning pathological findings in acute gonorrhea are very rare. In this paper, histopathological studies were performed in thirty-five acute gonorrhea patients with biopsy of tissue taken from all parts of the urethra employing Dr. Sato's urethroscope. Among these patients twenty-seven were of clinically proved primary infection and the others of relapsing cases. They all complained of purulent discharges, pains on urination and so forth. In all these cases gonococci was demonstrated positively.
The results obtained are as follows:
Histopathologically gonorrhea is classified in the following three groups.
(1) Cases of local dissemination (typical acute inflammation)
(2) Cases of early stadium having a tendency to extend its inflammation.
(3) Cases of relapsing acute gonorrhea,
(1) Cases of Local Dissemination
Every patient in mature stadium of acute gonorrheal urethritis showed almost similar extent of inflammatory changes on the epithelium of urethra, sub-epithelial tissue, epithelium of paraurethral duct and connective tissue around paraurethral duct.
Inflammatory changes seen in these are as follows:
(a) epithelial cells of the urethra and of the paraurethral duct were found to be expanded. Vacuole formation was seen in the protoplasm. Intracellular spaces were widely dilated. The cells were irregular in arrangement, sometimes desquamating or regenerating. In parts where more than several epithelia were seen accumulated, neutrophil leucocytes were often found between these epithelia. It was also noticed that the epithelial layer of the urethra generally became thinner, and according to the author's opinion, this histologic change occurred owing to the mechanical irritation exerted on this layer by urination.
(b) All infiltrations were formed under the mucosa of the urethra and also the same infiltrations of similar degree were noticed around the area of paraurethral duct, extending to the removed tissue stump.
(c) The infiltrated cells consisted mostly of lymphoid cells and neutrophil leucocytes. In all cases, also the plasma cells were increased in number. Often various other cells were also found, but each of them was small in number.
(d) Capillary vessels under the epithelial mucosa were dilated and filled with blood cells and the same changes were seen in most of the other blood vessles. Many of the lymphatic vessels and ducts were also found to be dilated to a great extent.
(e) The connective and the elastic tissues were found decreased in size and number in parts where the infiltration of cells was largely found. Hawever, they were seen thickened in irregular lumps in parts where the cells were not so thickly infiltrated.
(2) Cases of Early Stadium Having Tendency to Extend its Inflammation
In many cases of this group, inflammation occured at the epithelia of the urethra and between the connective tissues located just under the urethra, gradually extending deeper and finally inflaming the paraurethal duct and its surrounding area. On the other hand, the inflammation extended itself by invading the epithelial layer of the neighboring urethra.
(3) Cases of Relapsing Acute Gonorrha
The author was successful in tracing the recurring area in most cases of the relapsing acute gonorrhea. In these cases, inflammation was often seen at one of the paraurethral ducts from which part the surrounding area was noticed to be infected. The same two ways of inflammatory extension was found in this group as in the second group.

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