Problems in the Diagnosis and Treatment of Gonorrhea

Recent Difficulties in the Treatment of Gonorrhoea with Penicillin

“…Others have referred to a ' threat of penicillin resistance ' (Laird and Morton 1959) or to a 'lessened sensitivity' (Willcox 1958). It is generally agreed, however, that there are increasing frequent reports of more or less resistant strains (Enfors 1960 ;Garson and Barton 1960 ;1960a). It was noted early that different strains of gonococci differed widely in their susceptibility to penicillin (Cohn and Seijo 1944) and that resistance could be increased by repeated sub-culture in a penicillin environment (Bahn et al 1945 ;Mills 1949).…”

“…Others have referred to a ‘threat of penicillin resistance’ (Laird and Morton 1959) or to a ‘lessened sensitivity’ (Willcox 1958). It is generally agreed, however, that there are increasing frequent reports of more or less resistant strains (Enfors 1960 ; Garson and Barton 1960 ; 1960 a ).…”

“…Hirsh et al (1960), for example, noted that in the USA changes in susceptibility to penicillin were still relatively small. Nevertheless Garson and Barton (1960 – see also Brown 1959) – reported that the minimal in vitro concentration to inhibit certain strains was as high as 0.333 units per ml. and more and more natural strains required 0.1 to 0.2 units per ml.…”

“…With their use ‘ping pong’ infections may thus be reduced if there is a delay in the consort seeking advice. Long‐acting penicillins have been recommended as a deterrent to auto‐infection from the host (Garson and Barton 1960). Moreover, by the longer duration of serum level provided, they are more likely to cure simultaneously acquired incubating syphilis.…”

Treatment of Gonorrhoea with Penicillin Preparations

“…At first excellent results could be obtained in gonorrhoea even with small doses of 300,000 units (O'Brien and Smith 1952). The powers of larger doses completely to abort simultaneously acquired syphilis, and especially to prevent early reinfection with gonorrhoea, has led to its widespread use in the USA in doses of 1.2 to 2.4 mega units for the treatment of both patients with gonorrhoea and their contacts (Takos et al 1957 ; Hookings and Graves 1957 ; Schamberg et al 1958 ; Garson and Barton 1960), although PAM is often used in combination (Hookings and Graves 1957 ; Takos et al 1957).…”