The seven-year itch.

Case 1, a white male aged 42, was first seen in July, 1943, suffering from secondary syphilis. He was admitted to hospital and was treated with twice weekly injections of N.A.B. and bismuth (total 4 5 g. and 1 2 g. respectively); 4 months later he had become sero-negative but he was given a second course of injections in November/December, 1943 (Mapharside 0-5 g. and bismuth 1-2 g.). Further S.T.S. in January and April, 1944, were also negative. A third course of injections was administered in April/May, 1944 (Mapharside 0-48 g. and bismuth 1 2 g.). Blood tests in August, 1944, and February, 1945, were negative. He was, nevertheless, given a fourth course of treatment in February/March, 1945 (Mapharside 0 48 g. and bismuth 1 2 g.). Blood tests in July, 1945, and January, 1946, were negative, and after this last visit the patient failed to attend. He was next seen in October, 1950, when, following extra-marital exposure, he became worried about some 'small seborrhoeic patches on the anterior abdominal wall and thorax'. The Wassermann reaction and Meinicke test proved to be strongly positive and this was confirmed on repetition. There were no clinical signs of cardiovascular or neurosyphilis and the cerebrospinal fluid was completely normal. He was treated with weekly injections of P.A.M. 600,000 units and Bisoxyl 0.1 g. (total 8 4 mega units and 1 *4 g. respectively). By March, 1951, he had become seronegative and regular 3-monthly blood tests between that date and December, 1952, were consistently negative. At this point he lapsed from observation once more but he attended again in February, 1955, with a nonspecific urethritis. A routine Wassermann reaction was negative. He was next seen in December, 1957, when he presented with a typical macular secondary syphilide. There was a history of exposure to possible infection 3 weeks and 5 weeks previously, but no history of primary lesion and no penile scar. The Wassermann reaction was positive 1/128, and the Meinicke test strongly positive. He was treated with P.A.M. 600,000 units