Penicillin Failures in Gonorrhoea: Responses to Procaine Benzyl Penicillin G and to Ampicillin.

There is considerable evidence of increasing failure rates following the treatment of gonorrhoea with penicillin (Mead, Moon, and Bean, 1960; Willcox, 1961; Sabath and Kivlahan, 1961). Doses and preparations of penicillin sufficient a decade ago have become no longer so in many areas. The reasons for failure are manifold and complex. They include re-infection, which is probably common but extremely difficult to prove, misdiagnosis (other Neisseria and Mimeae being mistaken for the gonococcus in failing cases), and failure of the penicillin to reach the focus of infection in adequate amounts. The latter can arise from inadequate or faulty penicillin preparations, inadequate absorption or too rapid elimination of penicillin from a "walledoff" focus of infection-particularly in the femaleand also, theoretically, from antagonism to penicillin of penicillinase produced by commensal organisms or by immunological phenomena in the host. The reason most generally suspected has been a lessened sensitivity of the gonococcus to antibiotics, although it is likely that a number of factors act in concert. The gonococcus has a wide range of sensitivity to penicillin but there is some considerable evidence, not only in Great Britain (CradockWatson, Shooter, and Nicol, 1958; Curtis and Wilkinson, 1958) but also on the continent of Europe (Reyn, Korner, and Bentzon, 1961; Roiron, Rasetti-Nicod, and Durel, 1961; Gjessing, 1962; Rockl, 1962) and in the U.S.A. (Thayer, Field, Perry, Martin, and Garson, 1961), of an increasing number of circulating strains less sensitive to penicillin and also of a widening of their range of sensitivity. Moreover, there is also good indication (Cradock-Watson and others, 1958; Curtis and Wilkinson, 1958; Gjessing and Odegaard, 1962) that