Treatment of gonorrhoea with trimethoprim-sulphamethoxazole in Uganda.

Penicillin is still satisfactory as the main treatment for gonorrhoea in Uganda, but there is evidence that its usefulness is declining. In 1961, there was a treatment failure rate of only 4 per cent. with a single dose of 0-3 mega units penicillin aluminium mono-stearate (PAM) (Kibukamusoke, 1965); four times that dose-1V2 mega units-gave a failure' rate of 17-9 per cent. in 1966 (Arya, unpublished) and of 32 per cent. in 1968 (Arya and Phillips, 1970). This last survey also showed that 80 per cent. of strains of gonococci from the Kampala area had diminished sensitivity to penicillin-and' tetracycline, and were resistant to streptomycin. Although cure rates as high as 91 per cent. can still be achieved with larger doses of medium-acting penicillins, e.g. procaine penicillin 2-4 mega units (as found in the present study), it is reasonable to predict that this state of affairs will not continue indefinitely. There is, therefore, a need for alternatives, not only to keep-up with the continuing increase of gonococcal resistance Ato antibiotics but also because of the increasing ..number of patients who are allergic to penicillin (Brit. med;J., 1968): 5 to 7 per cent. of Makerere students now show evidence of penicillin. hyper-sensitivity. In Kampala, tetracycline is 'still "an effective alternative to penicillin (Arya and Phillips, 1970) but it has the following disadvantages: (i) Strains partially resistant to penicillin usually have reduced sensitivity to tetracycline; (ii) Tetracycline is more expensive tha-penicillin ; (iii) Several doses are needed and the patient may not take all of them, but many save the remainder for use before or after the next exposure re to risk of infection or to share with friends (Arya and Bennett, 1968). Such nmisuse may contribute to the diminishing sensitivity of gonococci to this antibiotic. For these and possibly other reasons, evaluation of-other drugs must continue. Trimethoprim used 'in combination with sulphamethoxazole has given promising results (Csonka and Knight, 1967), and because this population has a fairly high incidence of gonorrhoea (Arya and Bennett, 1967) and a good record of cooperation in follow-up examinations, it was decided to carry out an evaluation of this form of treatment. Material and methods Patients 109 male college students suffered 154 attacks of acute urethritis, gonococcal and-non-gonococcal; between January 1 and, May 31, 1969; eighty had urethritis once, nineteen twice, five thrice, four four times, and one five times. Of the 154 attacks, 141 were seen …