Guide to adequate treatment of gonorrhoea complicated by Staphylococcus albus.

Gonorrhoea has always been considered of less interest and importance than syphilis, and because easily treated has received little attention. In the past 10 years physicians have reported cure rates of 95 to 98 per cent. in large series of patients with a single, conservative intra-muscular dose of penicillin (Fiumara, Appel, Hill, and Mescon, 1959; Norgaard, 1956). Recent textbooks and Armed Forces medical manuals likewise recommend this regimen on the basis of the marked susceptibility of N. gonorrhoeae to penicillin. However, during the past 6 years there have been increasing reports in the medical literature of failures with previously effective and greater doses of penicillin (Willcox, 1962; Reyn, Korner, and Bentzon, 1958; Epstein, 1959; Thayer, Field, Magnuson, and Garson, 1957; Sabath and Kivlahan, 1961; Barile, Van Zee, and Yaguchi, 1959). This has led to a concept of emergence of "resistant" strains. Several investigators have documented this changing pattern of penicillin sensitivity of strains of gonococci in the United States, Europe, and the Far East (Barile and others, 1959; McCarthy, Wallmark, and Finland, 1961). Other authors have taken exception to this concept as the sole explanation and have pointed out that other factors foster these high failure rates (Sabath and Kivlahan, 1961; McCarthy and others, 1961; Gangarosa and Cary, 1960; Svihus, Lucero, Mikolajczyk, and Carter, 1961; Sanders, Pelczar, and Hoefling, 1962; Gentele, Lagerholm, and Lodin, 1960; Kjellander and Finland, 1963a; Personal communications with U.S. medical personnel in the Far East). In Korea, failure rates are said to run between 10 and 30 per cent. with penicillin dosages ten to thirty times greater than those effective in the past (300,000 U. to 600,000 U. procaine penicillin G intramuscularly: Epstein, 1959; Sabath and Kivlahan, 1961; Sanders and others, 1962; Personal communications with U.S. medical personnel in the Far East). The present study was undertaken to investigate the factors responsible for the high failure rate, and to find methods to insure adequate therapy in the least possible time.