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SHORT COMMUNICATION
Year : 1991  |  Volume : 57  |  Issue : 1  |  Page : 49

Ampicillin treatment for Gonorrhoea : Its effects on incubating syphilis



Correspondence Address:
K Pavithran


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How to cite this article:
Pavithran K. Ampicillin treatment for Gonorrhoea : Its effects on incubating syphilis. Indian J Dermatol Venereol Leprol 1991;57:49

How to cite this URL:
Pavithran K. Ampicillin treatment for Gonorrhoea : Its effects on incubating syphilis. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 May 26];57:49. Available from: http://www.ijdvl.com/text.asp?1991/57/1/49/3623


Penicillin still remains the drug of choice in the treatment of gonorrhoea in most countries. If the patient prefers oral treatment the usually recommended drug is ampicillin which is ad­ministered as a single dose of 3.5 g along with 1 g of probenecid. [1] Sometimes both gonorrhoea and syphilis may be acquired from a single source. In such cases, due to short incubation period, the manifestations of gonorrhoea may appear first, Whether treat­ment of gonorrhoea in such cases with the rec­ommended doses of penicillin will mask coex­isting incubating syphilis has been a matter of great concern among venereologists. It is gen­erally believed that the currently recommended schedule of ampicillin 3.5 g alongwith 1 g of probenecid will abort incubating syphilis which may occur in as many as 3% of patients with gonorrhoea. [2]

Two unmarried men aged 25 and 30 de­veloped dysuria and mucopurulent urethral discharge. 7 days following sexual intercourse with prostitutes. There were no associated genital ulcers, lymphadenopathy and skin rash. Gram staining of the urethral discharge from both patients revealed numerous, gram-nega­tive, reneform, intracellular diplococci, and their blood VDRL was negative. Each of them was treated with cap. ampicillin 3.5 gm along with 1 gm probenecid administered orally as a single dose. The signs and symptoms of urethritis subsided completely, 6 days following this treatment. But at 10 and 16 weeks respec­tively, following treatment for gonorrhoea, both of them developed genital ulcers, clinically quite suggestive of syphilitic chancres. Both of them strongly denied history of sexual `exposure' following the last treatment for urethritis. Dark­field microscopy of the serum from the ulcers showed many Treponema pallida, and blood VDRL was reactive 1:16 and 1:8 respectively.

The ulcers healed completely following treat­ment with benzathine penicillin and after one month the VDRL had fallen to 1:2 in the first case and had become negative in the second case.

The dosage of penicillin recommended to cure syphilis increases as the number of Treponema pallida increases. [3] During the in­cubation period of syphilis, the number of spirochaetes is not enormous. So when 3.5 g of ampicillin is used to treat acute gonorrhoea, any co-existing incubating syphilis is likely to be aborted. The above regime of ampicillin resulted in complete cure of gonorrhoea in our patients. But both of them developed syphilitic chancres, at - 10 weeks and 16 weeks respec­tively after getting treatment of gonorrhoea. In the abseme of history of a fresh 'exposure' it appears that the dose of ampicillin failed to abort incubating syphilis in them. Further, in the second case, it actually prolonged the incu­bation period of syphilis. This report empha­sizes the need for follow-up for a longer time when gonorrhoea patients are treated with ampicillin. They should be watched for devel­oping syphilitic chancres at a later time.

 
  References Top

1.Willcox RR and Willcox JR Pocket Consultant Venereology, Maruzen Asian Edition, Grant Mc Intyre Ltd, London,1982, p.76.  Back to cited text no. 1    
2.Schroeter AL, Turner RH, Lucas JB et al : Therapy for incubating syphilis : effectiveness of gonorrhoea treatment, J A M A, 1971 218 : 711-713.  Back to cited text no. 2    
3.Magnussen HJ and Eagle H : The relationship and suppression of experimental early syphilis by small dose of penicillin compared to those used in the treatment of gonorrhoea, Amer J Syphilol Gonorrh Vener Dis 1945; 29 : 587-596.  Back to cited text no. 3    




 

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