Preliminary report on spectinomycin HCl in the treatment of gonorrhoea in homosexual men.

Homosexuality plays an important role in the diagnosis, treatment, and epidemiology of venereal diseases. Jefferiss (1966) found that 89 (15 per cent.) of 604 males with gonorrhoea seen at St. Mary's Hospital in London admitted homosexual contact. Ekstr6m (1970) found that 12 per cent. of 100 males aged 14 to 19 years who reported for treatment of venereal disease in Copenhagen had engaged in homosexual relations, most of them with more than ten different partners. In the same study, only 3-5 per cent. of the females of the same age group considered themselves to be homosexuals, and most of these were prostitutes. Racz (1970) found Hungarian male homosexuals to be more promiscuous than heterosexual males. In the United States, Webster (1970) found that male-to-male contacts accounted for 25-4 per cent. of cases of venereal diseases in men in 1968, whereas, female-to-female contacts accounted for only 1 6 per cent. of cases in women for the same year. He pointed out that male homosexuals represented a high-risk group for venereal disease in the United States, but there have been relatively few studies of gonorrhoea in the homosexual. Fluker and Hewitt (1970) evaluated kanamycin and procaine penicillin in the treatment of a large number of cases of gonococcal proctitis in males. Diagnosis was based on the finding of typical intracellular Gram-negative diplococci in rectal smears; the same method was used for follow-up. Treatment failure was observed in 27 per cent. of those who received 1-8 m.u. procaine penicillin and 16 per cent. of those who received 2 g. kanamycin. By contrast, 35 cases of urethral gonorrhoea were treated with 2 g. kanamycin and the treatment failure rate was only 3 per cent. Scott and Stone (1966) found rectal gonorrhoea in 36 (44 per cent.) of 82 passive homosexual males known to be gonorrhoea contacts. They felt that a higher dosage of penicillin was required to treat gonococcal proctitis than gonococcal urethritis. Sparling, Yobs, Billings, and Hackney (1966) found spectinomycin sulphate (Actinospectacin) to be effective in the treatment of rectal gonorrhoea in women at a dose of 3 g. in a single injection. Aqueous procaine penicillin G, 2 4 m.u., was equivalent to the 3-g. dose of spectinomycin sulphate, each drug curing about 90 per cent. of the patients. In the interest of evaluating alternative antibiotics in the treatment of gonococcal proctitis in the homosexual, we conducted a study with spectinomycin hydrochloride* (Trobicin), a new antibiotic produced by the fermentation of Streptomyces spectabilis. The substitution of a hydrochloride salt for the original sulphate salt has made the antibiotic more suitable for injection because of its greater solubility.