Arthritis and venereal urethritis.

The clinical course of arthritis associated with venereal urethritis was clearly defined before 1900. Brodie (1818, 1836), Fournier (1868-69), and Launois (1899) published excellent descriptions of the disease, noting the predilection of the arthritis for the joints of the lower extremities, the relapsing course, and the frequency of complications affecting the eyes. Launois gave an accurate account of an attack of keratodermia blennorrhagica occurring during severe arthritis, and investigation of the accompanying urethritis in this case failed to reveal the gonococcus. Fiessinger and Leroy (1916) and Reiter (1916) described the syndrome of urethritis, arthritis, and conjunctivitis following bacillary dysentery, and in the same year Waelsch (1916) observed a similar triad of symptoms in his investigation of 44 cases of abacterial urethritis of venereal origin. Hollander (1946) reported 53 patients with " non-specific " urethritis in whom arthritis developed; 32 of the patients had conjunctivitis, 26 circinate balanitis, and six keratodermia blennorrhagica. Harkness (1949, 1950), from a review of 125 patients, discussed at length the problem of " nonspecific " urethritis and its complications. He was the first to state authoritatively that the usual clinical pattern ofjoint disease associated with a gonorrhoeal urethral discharge was identical with that following " non-specific " urethritis. In other words the arthritis following gonorrhoea was not a " true gonococcal arthritis" in the majority of cases. Harkness substantiated this contention with evidence derived from chemotherapy. The gonococcus is extremely sensitive to penicillin, and penicillin-resistant gonococci are rarely found; yet penicillin given for gonorrhoeal urethritis did not prevent the development of arthritis, nor did penicillin have any effect on the course of the arthritis when it was already present at the beginning of treatment. Levy (1950) su-pported this hypothesis from his experience of infective arthritis in Army personnel treated at