Relapse of gonorrhoea after treatment with penicillin or streptomycin.

Abstract

A study was made of over 2000 men with gonococcal urethritis treated with penicillin and of almost 2000 men with gonococcal urethritis treated with streptomycin. Eleven point four percent of men treated with 600,000 units of aqueous procaine penicillin relapsed. The relapse rate after treatment with 1 or 2 intramuscular injections of 1 gm. of streptomycin was 19.1%. Wide variations were noted in the proportion of patients who relapsed following treatment with either drug. There was no regular seasonal variation, nor did the relapse rate increase or decrease at the time of introduction of a new batch of the antibiotic. Success or failure of treatment did not influence the results of treatment of a subsequent reinfection, nor did any racial or age group show increased liability to post treatment relapse. The failure rate with procaine penicillin in men who were not cured with streptomycin was 3 times greater than the failure rate in unselected patients. Eighty-four to 91% of the sex partners of patients who relapsed following treatment also failed of cure when given the identical drug in the identical dosage. Although in homosexually transmitted gonorrhea treated with 1 to 2 g of streptomycin the failure rates of proctitis and of urethritis were similar, when 600,000 units of procaine penicillin were used the the failure rate in proctitis was twice as great as in urethritis. In some homosexual pairs 600,000 units of procaine penicillin cured the gonococcal urethritis of the "active" partner but failed to cure the gonococcal proctitis of the "passive" partner. However when streptomycin was used both partners were either cured or both relapsed. The presence of penlcillinase producing organisms in the rectum may explain this finding. In more than half of the women with gonorrhea who were not cured by penicillin the diagnosis of relapse was made by culture only.