Treatment of gonorrhoea with cotrimoxazole, procaine penicillin alone, and procaine penicillin plus probenecid.

Successful treatment of gonorrhoea with cotri-moxazole* has now been reported by several workers who gave one tablet four times a day for 5 days, observed a failure rate of 38 per cent. of the 86 men followed. They claimed that in 45 per cent. of the failures a carrier state resulted which was detected by routine examination of Gram-stained smears in all cases after treatment; cultures were not taken to prove the identity of the organism. They went so far as to say that the use of this drug combination was not justified in the routine treatment of gonorrhoea. The present trial was undertaken to see if the findings of Wright and Grimble (1970) could be confirmed, but routine cultures as well as smears were employed both at the patient's initial attendance and at follow-up visits. Gonococcal isolates were confirmed by fermentation tests. As the results of routine treatment with single intramuscular injections of 1-2 mega units procaine penicillin had given less satisfactory results recently, the opportunity was taken to assess the effect of adding probenecid to this regime. Material and methods 376 men suffering from acute gonococcal urethritis were allocated to five different treatment groups in random fashion. Habitual defaulters and those unable to attend for regular follow-up were excluded. Initial cultures were positive in approximately 90 per cent. of the patients. Three different methods of giving the same daily dosage of cotrimoxazole were used to see if this would influence the response. Thus Carroll and Nicol (1970) gave their patients four tablets in a single dose daily for 5 days, but Wright and Grimble gave one tablet four times daily for *Bactrim-Roche and Septrin-Burroughs Wellcome. Each tablet contains 400 mg. sulphamethoxazole and 80 mg. trimethoprim. 5 days. Furthermore, the manufacturers recommend that a daily dosage of four tablets be given as two tablets twice daily. TREATMENT SCHEDULES These were as follows: (1) Four tablets of cotrimoxazole in a single dose daily for 5 days (50 patients). The first dose was given in the clinic at the time of diagnosis, the second when the patient was seen again the next day, and the remaining three doses were given to the patient to take at home each morning. (2) One tablet of cotrimoxazole four times daily for 5 days (51 patients). (3) Two tablets of cotrimoxazole twice daily for 5 days (54 patients). (4) 12 m.u. procaine penicillin intramuscularly (110 …