TREATMENT OF EARLY SYPHILIS WITH PENICILLIN*t

Since the last International Congress of Dermatology was held in London in 1952 the use of penicillin alone in the treatment of early syphilis has become even more firmly established throughout the world. European specialists, however, have been somewhat slower to abandon the older, albeit well tried, methods employing arsenic and bismuth than experts in other areas. In January, 1953, a World Health Organization survey of the schemes of treatment in use in the venereal diseases clinics of the world showed that drugs other than penicillin were at that time being used in 347 per cent. of these establishments. While all the North American clinics included in the survey relied on penicillin alone, arsenic and bismuth (usually in addition to penicillin) were still in use in 47 8 per cent. of the clinics of Europe (Willcox, 1954). Though penicillin alone in a total dosage of 2-4 mega units had been used throughout the British Army and the Royal Air Force for the treatment of primary and secondary syphilis since 1944, in the civil clinics it was at first the common practice to follow a course of 24 to 4 mega units penicillin with ten weekly injections of neoarsphenamine and bismuth. This routine was followed at St. Mary's Hospital during the years 1946-47 and McElligott, Jefferiss, and Willcox (1948) made a preliminary report on 275 patients with early syphilis treated with 2 4 to 4 mega units penicillin over a period of 7k to 121 days plus a course of neoarsphenamine and bismuth lasting from 6 to 10 weeks. 54 per cent. of the patients had been followed for 12 to 18 months or over, and there were ten failures, four of which were considered as being due to reinfection. Toxic effects from the arsenical drugs were not negligible and in ten cases they were severe. This led to the discontinuance of arsenic and, from 1947 to 1950, the short intensive course of penicillin was followed by not more than ten intramuscular injections of an aqueous suspension of bismuth oxychloride, usually given twice weekly. Jefferiss, Willcox and McElligott (1951) reviewed a total of 744 cases of primary and secondary syphilis treated at St. Mary's Hospital in 1946-48. All of these patients had had an 8-day course of penicillin (maximum total dosage 4 8 mega units), 561 receiving a single course of a maximum of ten injections of neoarsphenamine and bismuth, and 183 a maximum of ten injections of bismuth only. Up to the time of review 32 patients had needed re-treatment, ten of whom were considered to have been re-infected Since then no further cases of serological, clinical, or neurological relapse have been noted in this series, which supports the widely-held opinion that relapses, when they occur, usually do so within the first year of post-treatment observation.