Treatment of Early Syphilis with Penicillin Alone.

To-day few clinicians doubt the efficacy of penicillin as the sole curative agent in the treatment of syphilis, and the wide range of arsenical and bismuth preparations at one time available have virtually disappeared from the pharmaceutical market. The first few sailors to be given penicillin for syphilis were treated by Mahoney, Arnold, and Harris (1943), which event was followed by numerous reports of phenomenal success on a wider scale (e.g. Sternberg and Leifer, 1947; and see Moore 1947). The difficulty created by the less successful results which were due to the varying amounts of the G fraction present in the earlier amorphous penicillins (U.S. Public Health Service, 1946) was successfully resolved by the isolation and production of crystalline (benzyl) penicillin G and by the introduction of repository preparations: penicillin in oil-beeswax (Romansky and Rittman, 1945), procaine penicillin (Buckwalter and Dickison, 1948), and procaine penicillin in oil with aluminium monostearate (PAM) and benzathine penicillin. The success of penicillin in the treatment of syphilis has since continued uninterrupted, and to-day there is no sign that T. pallidum is less sensitive to the antibiotic; allergic reactions, although occasionally troublesome in individual cases, offer no major obstacle to the routine treatment of the disease provided proper precautions are taken (W.H.O., 1960). Acceptance of penicillin alone for the treatment of a chronic and serious disease like syphilis was much slower in Europe than in other parts of the world. In many centres for some years a course of old style neo-arsphenamine and bismuth was given in addition to penicillin. Then, as severe toxic reactions continued to occur with the arsenical compounds, these were omitted, and for a time treatment with penicillin was followed by a course of bismuth injections.