The optimal and alternative antimicrobial regimens to treat neurosyphilis in human immunodeficiency virus (HIV) infected patients remain controversial. Little is known concerning the efficacy of ceftriaxone. A 75-year-old heterosexual man visited an outpatient clinic due to incidentally detected positive serum Venereal disease research laboratory (VDRL) and Fluorescent treponemal antibody absorbed tests in routine preoperative checkup. Because of benzathine penicillin was unavailable to use, 4-week regimen with doxycycline was started. After 2 weeks doxycycline treatment, a severe headache suddenly occurred. Cerebrospinal fluid (CSF) analysis showed mild lymphocyte-dominant pleocytosis, increased protein, and weakly reactive VDRL test. ELISA for HIV antibody and Western blot assay revealed he is infected with HIV. Initial CD4+ T cell count was 220/mm3 and the load of HIV RNA was 5,200 copies/mL. The most probable diagnosis was deemed to be neurosyphilis, considering the possibilities of Jarisch-Herxheimer reaction or doxycycline-induced pseudotumor cerebri. In the absence of procaine penicillin G in our hospital, intravenous ceftriaxone was administered and highly active antiretroviral therapy was started. After 14days of treatment, the patient no longer had a headache and the CSF profile was improved. Additional follow-up CSF analysis was done 3months after treatment. CSF pleocytosis and protein level were decreased and the CSF VDRL was converted to negative. Ceftriaxone may be a good alternative in the treatment of neurosyphilis in HIV infected patient.
Aged ; Ambulatory Care Facilities ; Antiretroviral Therapy, Highly Active ; Blotting, Western ; Ceftriaxone ; Cell Count ; Doxycycline ; Enzyme-Linked Immunosorbent Assay ; Ethylenediamines ; Follow-Up Studies ; Headache ; Heterosexuality ; HIV ; Humans ; Leukocytosis ; Neurosyphilis ; Penicillin G Benzathine ; Penicillin G Procaine ; Pseudotumor Cerebri ; RNA ; Sexually Transmitted Diseases

We reported previously that, combined with l. 0 gm of probenecid, sodium penicillin G. 4, 0 m.u.i.m. was slightly less effective than procaine penicillin G. 4. 8 m.u. i.m. in the treatment of uncomplicated male gonorrhea. We now present the effect of double dose of sodium penicillin G. in the treatment of uncomplicated gonorrhea. The subjects were 262 male patients with uncomplicated gonoccccal urethritis at the VD clinic of Choong Ku Public Health Center in Seoul during 5 months period from January to May 198l. The following criteria were used to identify gonococcal infection - Gram negative intracellular diplococci in urethral smear and/or oxidase positive typical colony formation on Thayer-Martin media composed of Gram negative diplococci. They were given 4.0 m.u. sodium penicillin G. i.m. proceeded 15 to 30 min. by 1. 0 gm. probenecid p.o.. Four hours later, same amount of sodium peniciIlin G. i.m. was repeated. Concornitant eomparison of procaine penicillin G. was not done because of recent una,vailability of the drug in Korea. To avoid pain, the drug is dissolved in 6 ml of normal saline plus 2 ml of 2% lidacaine. One hundred eighty five patients were able to be followed 3 to 7 days after the treatment. There were .24 (13%) failures and 17 (10. 6%) postgonococcal urethritis. During this study, l4 strains of PPNG (Penicillinase Producing Keisseria Gonarrhoeae) were detected with chromogenic cephalosporin slide method. There were 10 (5. 8%) failures among 171 patients with urethritis caused by non-PPNG.
Gonorrhea* ; Humans ; Korea ; Male* ; Oxidoreductases ; Penicillin G Procaine ; Penicillin G* ; Probenecid ; Public Health ; Seoul ; Sodium* ; Urethritis

No abstract available.
Doxycycline ; Humans ; Penicillin G Benzathine ; Syphilis

A case of lymphocytoma cutis, the circumscribed form in 9 year-old girl is reported. This is seldom conclusive without histological examinatien for a wide variety of conditions has to be considered. The circumscribed form usually responds rapidly to radiotherapy, although recurrence is possible and good results from the use of procaine penicillin especially in the disseminated form. In this case, I experienced good results from CO, slush and topical application of 0.25 % fluocortolone 3 times a day without recurrence in 3 months after treatment.
Child ; Female ; Fluocortolone ; Humans ; Penicillin G Procaine ; Pseudolymphoma* ; Radiotherapy ; Recurrence

Although the penicillin is still the first choice of drug in the treatment of gonorrhea in most areas of the world, Neisseria gonorrhoea has become increasingly less sensitive to penicillin preparations. The proportion of such strains also varies from region to region. Sodium penicillin G. is a short acting preparation which enables to attain quick high blood level. The reason for combining the quick acting sodium penicillin G. with probenecid is that latter inhibits renal excretion of penicillin and maintains effective serum penicillin levela long enough to extinguish gonococcal infections. The subjects were 265 male patients with uncomplicated gonococcal urethritis at the VD clinic of Cboong Ku Public Health Center in Seoul during 5 months period from September 1980 to January 1981. The following criteria is used to identify gonococcal infection Gram negative intracellular diplococci in urethral smear and/or oxidase positive typical colony formation on Thayer-Martin media composed of Gram negative diplococci. The 265 patients were divided in two groups(A and B group). They were administered an oral dose of 1.0 gm. probenecid and, 15 to 30 min. later, 4.0 m.u. of sodium penicillin G. i.m. in A-group(152) and 4.8 m.u. procaine penicillin G. i.m. in B-group(113). Only those who were able to be followed up 3 to 7 days after treatment were contained for final analysis(A-group:108, B-group:88), A-group showed 22 failures(20.4%), and B-group 9 failures(10.2%). A significant difference is found between the two groups(P<0.05). Incidence of postgonococcal urethritis was 6(7.0%) in A-group and 5(6.3%) in B-group(P>0.05). We suggest a repeated injection 3 to 4 hours later or increased amonuts of sodium penicillin G. might give better result in the treatment of uncomplicated gonorrhea.
Gonorrhea* ; Humans ; Incidence ; Male* ; Neisseria ; Oxidoreductases ; Penicillin G Procaine ; Penicillin G* ; Penicillins ; Probenecid ; Public Health ; Seoul ; Sodium* ; Urethritis

The authors has recently experienced a case of Argyll-Robertson pupil in neurosyphilis patient. Characteristic ophthalmological findings in this case are incomplete ptosis of right lid, bilateral loss of pupillay reflex, mydriasis of right eye, and miosis of left eye. The authors administered Benzathine penicilline intramuscularly during 4 weeks of admission, but dissociated pupil was not improved.
Humans ; Miosis ; Mydriasis ; Neurosyphilis ; Penicillin G Benzathine ; Pupil* ; Reflex

Lues maligna (malignant syphilis), also called noduloulcerative syphilis, is a kind of cutaneous secondary syphilis, which presents virulent clinical features and is frequently associated with an immunosuppressed state. Though there are many possible debilitative diseases, it has recently been more frequently presented in the human immunodeficiency virus (HIV)-infected patients. Other causes are diabetes and chronic alcoholism. Prompt diagnosis and early treatment can result in a desirable recovery and prevent spread of the disease. We report two cases of lues maligna associated with the underlying diseases of HIV-infection and diabetes. The skin lesions in these cases showed favorable results after treatment with benzathine penicillin.
Alcoholism ; Diagnosis ; HIV ; Humans ; Penicillin G Benzathine ; Skin ; Syphilis

We report one case of 1 month old male with early congenital syphilis Who represented the characteristic clinical features and laboratory findings including darkfield examindtion and quantitative VDRL test. The histopathologic findings of the patients skin biopsy specimen showed extravasation of erythrocytes and perivascular infiltration of plasma cells were found. in addition to the previous described findings by Fraser. He was managed by daily injection of 200,000 units of aqueous procaine penicillin for 8 days and then three injections of 150,000 units of PA.M at two days intervals with excellent effect
Biopsy ; Erythrocytes ; Humans ; Infant, Newborn ; Male ; Penicillin G Procaine ; Plasma Cells ; Skin ; Syphilis, Congenital*

Penicillin is still the first choice of drug in the treatment of gonorrhea. The ever lowering sensitivity of Neisseria gonorrhoeae to penicillin and the emergence of PPNG (Penicillinase Producing Neisseria Gonorrhoeae) in the Far East and other parts of the world neceessitate reapprisal of treatrnent schedules with penicillin for gonococcal infections. In Korea, no authentical study in this regard has been done recently. The presence of intracellular gram r.egative diplococci in urethral smear as weIl as the presence of oxidase positive typical, round, convex, smooth, glistening, tratmslucent, greyish colonies of 0.5 to 2mm in diameter a 24 hours composed of grarn negative diplococci are used for presump'ive evidence of gonococccal infection 224 male patients with acnte uncomplicated gonococal infections were treated one of following regimens. Regimen A: 4.8mega unit combicillin (3.6mega unit procaine penicillin+l.2 mega unit sodium penicillin) i.m.. preceded by 1gm probenecid p.o., Regirnen B: 4.8 mega unit procaine penicillin i.m. preceded by 1gm probenecid P.O. Regimen A showed 14 failures(11.3% arnong 124. Regimen B showed 19 failures (19%) among 100 It is suggested that in Korea sesnsitivity to penicillin of Yeisseria gonorrhoeae is quite low.
Appointments and Schedules ; Far East ; Gonorrhea ; Humans ; Korea ; Male ; Neisseria ; Neisseria gonorrhoeae ; Oxidoreductases ; Penicillin G Procaine ; Penicillins* ; Probenecid ; Procaine ; Sodium

Five hundred seventeen male patients with gonococcal urethritis at the VD clinic of Chocng-ku Public Health Center between Feb. 27 and Oct. 27, 1984 the were source cf this study. Forty-five of seventynine patients who had practiced cunnilingus were actual subjects of this study. Aeiss.ria gonorrhoeae were cultured from the pharynx of five patients: one was found to be PPNG. All 5 pharyngeal gonorrhea patients were asymptornatic and their throat appeared to be normal, except injection of the pharynx in one patient. Two patients infected by non-PPNG were administered an oral dose of 1. 0 gm probenecid plus 2 5 gm talampicillin and 2. Ogm Kanamycin sulfate, IM and one patient infected by non-PPNG was administred an oral dose of l. Ogm probenecid and, 3i) minutes later, 6. 0 m.u. fortified procaine penicillin G IM. One gatient infected by PPNG was administered an oral dose of 1, 0 gm probenecid and 30 minutes later, 1 vial of sulbactam sodium/ampicillin sodium, IM. All four pharyngeal gonorrgeal patients were cured, One patient was lost from further evaluation, We consider it important to have pharyngeal cultures done on all gonorrheal patients, at least on those who admit having had orogenital contact in recent episode, because pharyngeal gonococci may be the source of disseminated gonococcal disease and in rare circumstances, the source of mfection for sexual partners, and single lose spectinomycin and orally administered penciillin regimens that are effective against anogenital gonorrhea, had been known to have high rates of failure when used in the pharyngeal gonrorhea.
Gonorrhea* ; Humans ; Kanamycin ; Male ; Penicillin G Procaine ; Pharynx ; Probenecid ; Public Health ; Sexual Behavior ; Sexual Partners ; Sodium ; Spectinomycin ; Sulbactam ; Talampicillin ; Urethritis