Treatment of ano-rectal gonorrhoea with ampicillin.

It has been observed that there is a high incidence of treatment failure in cases of ano-rectal gonorrhoea treated by the time-honoured standard methods. At this hospital urethral gonorrhoea has responded well for many years to one injection only of 1-2 m.u. procaine penicillin given intramuscularly; but similar treatment for an ano-rectal infection with gonococci has given very poor results. Treatment of the latter by daily injections of procaine penicillin for even 4 to 5 days was also often unsatisfactory, but when tetracycline, ampicillin, or 'Septrin' (trimethoprim plus sulphamethoxazole) was given for the same period, the success rate appeared to be higher. A possible reason for this is that, in a rectal infection, some of the gonococcal pus becomes caught up in the faeces and remains there to re-infect the rectal mucosa when the serum penicillin level falls below a bacteriocidal or bacteriostatic level. This would happen 15 to 18 hrs after a single injection of procaine penicillin and would leave a gap of 6 to 9 hrs in which the rectum could be re-infected from the faeces even if a further injection were given 24 hrs after the first one. However, if a continuous bacteriostatic or bacteriocidal level is kept up for several days by giving tetracyline, ampicillin, or 'Septrin' by mouth 6-hrly, there is a good chance that the infected faeces may have been passed out of the body before the blood level has dropped sufficiently for the mucous membrane to be re-infected.