PENICILLIN THERAPY OF LATE CONGENITAL SYPHILIS

Abstract

Though no valid comparisons can be made until more patients have been treated and followed for a longer time, it seems to us that penicillin used alone is at least as effective as any other single agent for the treatment of late congenital syphilis. To what extent treatment or time alone contribute to improvements cannot yet be stated. Most of the clinical and serologic indications of healing developed rather slowly; in only a few patients with the most superficial lesions were there objective signs of improvement during therapy.

The treatment schedules we employed are similar to those previously recommended for infants. At present we advise a total dosage comprising at least 100,000 units commercial penicillin per kilogram body weight, divided into 100 equal intramuscular injections and given at two to three hour intervals around the clock for eight or more days. Therapeutic reactions, entirely febrile in nature, have all been transient and benign. There were no deaths. We believe that the simplicity, safety and convenience of these plans make them preferable to the more costly, hazardous, and time-consuming older methods; further-more, they effectively curtail the appallingly high delinquency rates formerly prevailing.

Results were significantly better for children treated under six years of age than they were for older children, and also for those who had normal spinal fluid before treatment; they were suggestively but not significantly better among those for whom the larger dosage schedules were used. Outcome was significantly worse in those who had received previous treatment of any sort. There were just three relapse—two defined only serologically, and one by a questionable recurrence of interstitial keratitis.

About a quarter of those with latent congenital syphilis have become seronegative. The poorest results ensued for patients with clinical neurosyphilis; two children from this group continued to exhibit definite deterioration. For interstitial keratitis, results were most gratifying in two patients treated within a month of onset. Seventy-two per cent of all patients with late congenital syphilis so far treated with penicillin and followed for more than two months are clinically well and have negative serologic reactions or progressively declining titers.