Gonorrhoea treated by a combination of probenecid and sodium penicillin G.

In an area with a high incidence of gonorrhoea, where strains of Neisseria gonorrhoeae having a reduced sensitivity to penicillin in vitro are common, there is an urgent need for effective routine therapy. Furthermore, when local conditions are such that diagnosis and therapy are in the hands of personnel with a limited training, treatment must be both simple and easy to administer. When the form of treatment to be described was introduced into Greenland in 1964 (Lomholt and Berg, 1966), it had to fulfil these requirements. The incidence of gonorrhoea was greater than 100 cases per 1,000 population. The treatment previously used had failed in 27 per cent. (B0ggild, 1965), and 86 per cent. of the strains of Neisseria gonorrhoeae tested had shown a reduced sensitivity to penicillin in vitro. The daily management of gonorrhoea among the two-fifths of the population living outside the towns, or rather villages, was mostly in the hands of midwives with limited medical training. The reason for combining the quick-acting sodium penicillin G with probenecid is that the latter inhibits renal excretion and so maintains therapeutic penicillin concentrations long enough to fight the gonorrhoeal infection. The therapeutic regime introduced was as follows: Probenecid, 1 g. (i.e. 4 tablets of 250 mg.) was administered by mouth. 15-30 min. later 5 million units sodium penicillin G in 8 ml. of a 0 5 per cent. lignocaine solution were injected intramuscularly. This combination gives an initial penicillinaemia of up to 200 units/ml.; at the end of 8 hours the average blood level is 5 units/ml., and at the end of 24 hours 0 03-0-10 unit/ml. (Schmidt and Roholt, 1965). Curtis and Wilkinson (1958) suggested a blood level above 1 unit/ml. maintained for 24 hours as the sine qua non for an ideal treatment of gonorrhoea. The results of our studies indicate that a penicillin level of this magnitude is not needed for longer than