An Evaluation of the Therapeutic Effectiveness of Vibramycin (Doxycycline) in Early Syphilis

Kim, Young Pio; Park, Seock Don

Abstract

The year 1943 saw the introduction, by Mahoney and his associates, of penicillin treatment for syphilis. That period was an epic turning point in many respects, not least of which was the commencement of the antibiotic era in venereology. Frorn that point on, there were no antibiotics as effective, as cheap,or as low in toxicity as penir.illin, despite the discovery of a number of ather. a.ntibiotics. Also, na signs of resistance by Treponema pallidum t,o the antibiotic have yet been noted, although this possibility ha.a not bcen evaluated adequately. Sirice then Benzathine penicillin G, a long acting l3epo-penicillin, (discovered by Seifter, et al, in 1951), has been uti.lized for treating ayphilis. Aft.er the discovery of penicillin, syphilis began to decline. However, during the r.niddle 1950s the incidence of syphilis began to increa se throughout the world. In the 1960's, this rate of increase became quite pronounced. Thus, the present trend. is to treat most syphi]is with Benzathine penicillin Ci. However, occasional adverse reacf.ions, (e.g. hypersensitivity, anaphyIactic shack, phobia of injections and other untoward effects), sometimes render treatment with Renzathine Fenicillin G irnpossible. In such cases, treatment consists of the oral administration of Vibramycin' (Doxycycline to compensate for the defects of the penicillin. Although the previous alternatives have tra,ditionally been Tetracycline and Erythromyr,in, by utiIizing Vibramycin, we are a.41e to repozt the results comparing the effectiveness of Vibramycin with the effectiveness of Renza.cillin. The results focus on clini.cal irnprcivement and serological tests. Thirty five patients were treateif, with Vibramycin, but despite our requests, only ten patients participated in the foliowup study. among these ten patients, three patients were hypersensitive to penicillin. Forty nine patients were treated with Benzacillin, among which only thirteen patients responded to our follow-up studies. All members of the Benzacillin group were skin tested for penicillin hypersensitivity before treatment was initiated. The Vibramycin treatment regirnen was the oral administration of 200mg twice on the first day, and from the second day to the fourteenth day, 100mg twice daily. Three million units of Benzacillin were given .intra;nuscularly in weekly intervals for three weeks. The therapeutic results obtained were as follows: 1) The Vibramycin group showed remarkable clinical irnprovernent en the third day of treatment, with clinical manifestations completely disappearing en the following days- Lymphangitis dorsalis penis, sixth day of treatment; headache ninth day' maculopapulo-squamous syphilids, eleventh day; condyloma lata, fourteenth day' primary chancre, tenth day after finishing treatrnent. However, regional lymphadenopathies persisted for over four and a half months. 2) In most patients, serological follow-up studies, (VDRL slide test, and Wasserrnann complement fixation test), revealed declining titers one month after concluding treatment. These titers continued to decline in the following months. One case of sero-relapse, howe ver, was shown in both the Vibramycin group and the Benzacillin group. R) No cases of side effects were observed in either treatrnent group. 4) It is concluded from this study that nine of ten patients (90%) in the Uibramycin group, and twelve of thirteen patients (92. 3 %) in the Benzacillin group showed serological improvement. Thus, in those instances where penicillin is contraindicated, (e.g. hypersensitivity, anaphylactic shock, etc.), Vibramycin (Doxycycline) appears to be one of the most valuable treatment alternatives available.

An Evaluation of the Therapeutic Effectiveness of Vibramycin (Doxycycline) in Early Syphilis

Abstract

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