A comprehensive treatment for gonococcal and non-gonococcal urethritis.

Urethritis, either gonococcal or non-specific, is the commonest form of venereal disease. Lees (1951) suggested that of all cases of urethritis probably 50 per cent. are gonococcal, and Harkness (1950) stated that at least 70 per cent. of all his venereal disease patients suffered from non-gonococcal urethritis. Microscopic examination ofsmears of the urethral discharge is standard practice in venereal disease clinics before treatment of the condition, but many cases are treated empirically, on the mistaken assumption that all cases of purulent urethral discharge in the male are cases of gonorrhoea. This applies particularly to seamen employed in vessels which do not carry a doctor. The Penicillin (Merchant Ships) Act, 1951, so amended the Penicillin Act, 1947, that where a ship does not carry a duly qualified medical practitioner as part of her complement the master, or a person authorized by the master, may administer penicillin subject to the instructions contained in " The Ship Captain's Medical Guide " (Ministry of War Transport, 1946). Amendment No. 4 of this Guide instructs the master that the urethral discharge of gonorrhoea will be eliminated in 3 to 4 days following a single injection of 200,000 units penicillin in aqueous suspension (150,000 units procaine penicillin + 50,000 units crystalline penicillin), that a discharge which persists after such treatment is probably not due to the gonococcus, and that the injection of penicillin must on no account be Tepeated, a course of sulphathiazole, four tablets thrice daily for 4 days, being advised. The injunction against the further injection of penicillin is almost invariably ignored where there is a persistent urethral discharge, as is the advice to procure a specimen of the discharge on a glass slide for subsequent examination at a shore clinic. The result is that doses are given of up to 1 2 and 2-0 mega-units of penicillin, with no effect on the persistent urethritis, but perhaps delaying