Kanamycin in the treatment of rectal gonorrhoea.

The rate of treatment failure in cases of rectal gonorrhoea has been the source of considerable concern in recent years and it was therefore decided to investigate the value of kanamycin for this condition. As pointed out by Jefferiss (1966), the true incidence of gonorrhoea in passive homosexuals is undoubtedly greater than the figures of proven infections would suggest, as there are many cases in which the diagnosis is strongly suspected on historical or clinical grounds but bacteriological proof is lacking. In view of the fact that diagnosis may be difficult, it is all the more important that the treatment of those cases which are identified should be as efficient as possible. The treatment of rectal infections with gonorrhoea by means of penicillin carries with it a much greater risk of failure than the use of corresponding doses of penicillin in urethral infections. Using a dosage of 600,000 units of procaine penicillin, Scott and Stone (1966) reported thirteen (43 per cent.) cases of treatment failure in 36 patients treated and Evans (1966) reported seventeen (20-5 per cent.) in 83 patients. These figures suggest that either a considerably larger dosage of penicillin should be used to treat rectal gonorrhoea or an alternative drug should be used. In general, treatment schedules which are relatively short and can be administered under the surveillance of the clinic staff are desirable. Homosexuals, particularly, need to be encouraged to attend a clinic in the first instance (Fluker, 1966) and it is doubly desirable that the treatment schedules employed for them should cause as little distress as possible. The necessity for administering the therapy under supervision is made obvious by the findings of Anderson (1966), who showed that over 30 per cent. of a series of patients attending a Venereal Disease Clinic had misused tablets given for a previous infection or had taken tablets prescribed for a sexual partner. For this reason, treatment by means of an injection is clearly preferable.