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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 Oct 20];57:49. Available from:

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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