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57
TREATMENT OF GONORRHffiA WITH TWO GRAMMES
OF TERRAMYCIN IN UNEQUAL DIVIDED DOSES OVER
TWENTY-FOUR HOURS
BY
R. R. WILLCOX, M.D.
(St. Mary's Hospital, London)
(Lately Adviser in Venereal Diseases to the War Office)
THIS is the fourth of a series of reports on the treatment of acute gonorrhrea
with 2 grammes of terramycin. The first (1) referred to the results obtained
by a single mass dose of 2 g., and the same amount in two doses each of 1 g.
given six hours apart; the second to those of 2 g. given in eight six-hourly
doses over 48 hours (2); and the third to 2 g. given in four doses of 500 mg.
over 24 hours (3). The present paper concerns 45 cases of uncomplicated
gonorrhrea treated with an initial dose of 1 g. followed by four doses of 250 mg.
given on four occasions during the ensuing 24 hours, all doses being administered
orally.
THE CASES
Forty-four of the patients were male and one was female, 32 were single
and 13 were married. The average age was 30.4 years (extremes 20-55). Twenty
persons had no previous experience of venereal disorders, but 25 patients had
had no less than 41 previous venereal episodes (32 of gonorrhrea, 6 of syphilis
and 3· of non-specific urethritis). Six of the males were negroes from West
Africa or the West Indies, of whom two denied having had previous venereal
disease, while four had five attacks of gonorrhrea and one of syphilis between
them.
Of the 44 males, 34 had noted a discharge 1-3 days before seeking advice,
7 for 4-7 days, and 3 for two weeks. Some dysuria was present in the majority.
The Wassermann and Kahn reactions were both negative in 40 patients, 4
showed initially a negative Wassermann but a hypersensitive Kahn, and one
gave strongly· positive readings to both tests. The gonococcal complement
fixation test was performed in 35 cases, being negative in 31 and positive only
in 4.
THE RESULTS
Eight patients did not attend again after treatment. Of the 37 followed,
35 were observed for 4-7 days, 26 for 8-14 days, 22 for 15-28 days and 14 for
longer than this time.· The status of 31 patients (83.8 per cent.) was entirely
satisfactory at the times seen. There was only one definite failure in which
gonococci recurred in the smear at 16 days. This patient denied other exposure
and was treated with penicillin. There were, however, five patients who subsequentiy developed non-specific discharges in which gonococci were not found.
These were considered to be infections with non-specific urethritis unconnected
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58
Treatment of Gonorrhcea
with the gonorrhrea. Two of these, noted at 4 and 8 days respectively from
treatment, were given a further 2 g. of terramycin as before and remained subsequently well following 35 and 45 days respectively of observation. It is
possible that these two cases were retreated unnecessarily. One patient
developed a non-specific urethritis at 26 days and was retreated with sulphadiazine, and another, who was apparently well at 57 days, attended with a nonspecific discharge at 96 days which may well have arisen from a second exposure.
One other patient showing a non-specific discharge at 26 days had bilateral
swollen ankles and a sedimentation rate of 10 mm. in one hour. He was considered to be suffering from Reiter's syndrome and was treated with penicillin.
As the incubation period of non-specific urethritis is longer than that of
gonorrhrea, the presence of a non-specific discharge following the apparent cure
of gonorrhrea does not necessarily imply that further sexual contact has taken
place as the two diseases may be acquired simultaneously. It is interesting to
note that terramycin, which is curative in established non-specific urethritis,
failed as a prophylactic in these cases.
The treatment was generally free from side-effects, although two patients
developed the ano-rectal syndrome of burning and pruritus which has already
been described (4).
The results are summarized in the table.
TABLE I.-STATUS AT LAST EXAMINATION OR AT FAILURE
Days
0
1-3
4--7
8-14
15-21
22-28
29-35
36-42
64--70
85-91
92-98
99-105
106-112
120--126
140-147
Followed
8
2
9
4
4
4
1
2
1
1
1
5
1
1
1
Total
Followed
Failures
G.C. plus
45
37
35
26
22
18
14
13
Non-specific
Urethritis
1
1
2
11
10
9
8
3
2
45
1
1 (2.7%)
5 (13.5%)
SUMMARY
Of 45 patients with uncomplicated gonorrhrea treated with 2 g. of terramycin
given orally in an initial dose of 1 g. plus four doses each of 250 mg. during the
ensuing 24 hours, and followed for varying periods up to 146 days, there was
only one gonococcus-positive failure requiring retreatment. In addition,
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R. R. Willcox
59
there were five cases (13.5 per cent.) showing non-gonococcal discharges, one
of which had Reiter's syndrome, which were considered to be infections of nonspecific urethritis.
REFERENCES
Brit. med. J., ii, 527-9.
South African med. J., 26, 688-9.
WILLCOX,
Med. J. Aust., i, 260-l.
WILLCOX,
Lancet, ii, 154-6.
The terramycin used in this study was kindly provided by Charles Pfizer and Co.
Inc. of Brooklyn, New York.
(1)
(2)
(3)
(4)
WILLCOX,
WILL COX,
R.
R.
R.
R.
R. (1951).
R. (1952).
R. (1953).
R. (1951).
FURTHER WANDERINGS OF THE YACHT
"MARCUS AURELIUS' ,
BY
Colonel R. V. FRANKLIN
I T took a bit of persuading my boss "The Admiral" that a good long leave
was vital to my well-being, especially as I had spent most of the early summer
divided between an exciting "Exercise" in B.A. O. R. and an equally good one
on Salisbury Plain. However, as always, virtue was rewarded, and on Saturday,
9th August, thinking in terms of blue water and sunshine, my son Barn, recently
returned from his C.C.F. camp, and myself drove from Catterick to Cairnryan in
Wigtownshire and boarded my 1S-ton sloop Marcus Aurelius with the prospect
of a whole twenty-eight days aboard ahead of us.
Our plans were that next day Gin, my wife, Tooks, my thirteen-year-old
daughter, Jack, a bachelor doctor and Gin's brother, and my good friend Jonath
Jones of the R.A.S.C. should join us aboard and then we should then make a
fair course for Ireland. To accommodate the crew comfortably (sic) aboard,
the children shared the fo'c'sle, Barn sleeping on a mattress on the sail locker.
Jonath and Jack shared the owner's cabin aft with its two comfortable bunks,
and the skipper and his wife occupied the saloon settees. A seventh member
of the crew, Coco, the dachshund, took up little room in the bottom of the clothes
locker. It rained and it blew from the wrong direction, so departure was
inadvisable. We shopped at Stranraer and walked over the hills, where I
discovered the Garrison Mess of which I was made an honorary member and
was able to quench the thirsts of the crew. We also discovered a garage at
1s. 6d. a night for our cars quite near the steamer pier. The steamer leaves
twice daily, takes two hours to get to Larne, and the cost is about 13s. with an
Army concession voucher.
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Treatment of Gonorrhoea
with Two Grammes of
Terramycin in Unequal
Divide Doses Over
Twenty-Four Hours
R. R. Willcox
J R Army Med Corps 1954 100: 57-59
doi: 10.1136/jramc-100-01-08
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