Treatment resistant syphilis; short review and report of a case.

During four centuries of mercurial treatment of syphilis there has been little documentary evidence of the concept of treatment-resistance in syphilis. Mercury, on account of its feeble treponemicidal action, did not interfere to any significant extent with the natural course of infection, and the question of resistance to treatment did not arise. In the decade following the introduction of the organic arsenical compounds, Ehrlich's concept of " therapia sterilisans magna" dominated the field, but Ehrlich himself foresaw the problem of drug-fastness in chemotherapy and, recognizing inadequate dosage as its most frequent cause, emphasized the dangers of under-treatment at several international conferences. From 1920 to 1940 many reports on treatment-resistant syphilis werepublished byGerman and French workers. Beerman (1936) lists 430 references. Most of these reports discuss resistance to arsenical therapy and some to bismuth. Silberstein (1924) classified treatment-resistance in primary and secondary syphilis as follows: