Recommended treatment of syphilis and gonorrhea ADVISORY COMMITTEE ON VENEREAL DISEASE CONTROL,* HEALTH AND WELFARE CANADA *Dr. D. SEVERS, chief medical health officer, medical services division, Department of Health,
sociales, Quebec; Di. R. PERSAD, senior medical consultant in VD, Ontario Ministry of Health;
Newfoundland; DR. BURTON D. HOwArr,
DR. J. SCATLIFF, director of venereal disease
assistant deputy minister, Department of Health, field epidemiologist, communicable disease section, Department of Public Health, Nova Scotia; DR. C. DEVADASON, director, venereal disease control, Department of Health, New BrunswIck; DR G. TARJAN, directeur, division des maladies v6n6riennes, minisalre des Affaires Prince
Edward
Island;
DR.
A .E.
POINTER,
control, Manitoba Ministry of Health & Social division of venereal disease control, Department of Health, Saskatchewan; DR. J. BROWN, director, division of social hygiene, Department of Social Services and Community Health, Alberta; DR. H.K. KENNEDY, director, division of venereal disease control, Ministry of Health, British Development;
DR.
W.G.
DAVIDSON,
director,
Columbia; MR. JOE ATKINSON, officer in charge of venereal disease control, Northwest Territories; MRS. ANNE GRAUWILER, infectious disease control officer, Yukon region _______________________________________
Reprint requests to: Dr. A.G. Jessamine, Medical officer, Bureau of epidemiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Tunney's Pasture, Ottawa, Ont. Ki A 0L2
Table I-Recommended treatment of syphilis Drug
Stage of syphilis
Preferred Benzathine penicillin G* or Aqueous procaine penicillin G*
Early (primary, secondary or latent for less than 1 year) Other Tetracycline hydrochloridet or Erythromycint
Latent (of more than 1 year's duration)1:
Benzathine penicillin G or Aqueous procaine penicillin G
Dosage Single intramuscular dose of 2.4 million units Intramuscular administration of 600 000 units daily for 8 days; total, 4.8 million units Oral administration of 500 mg four times a day for 15 days Same dosage as for tetracycline Intramuscular administration of 2.4 million units weekly for 3 successive weeks; total, 7.2 million units Intramuscular administration of 600000 units daily for 15 days
*Single..dose treatment is preferred because it provides effective treatment in a single visit. tThese drugs are preferably reserved for patients allergic to penicillin. .The optimum treatment schedules for syphilis of more than 1 year's duration (latent, neurosyphilis, cardiovascular syphilis, congenital syphilis and syphilis in pregnancy) have been less well established than schedules for early syphilis. When such cases are suspected, consultation with an appropriate specialist is recommended.
Table Il-Recommended treatment of gonorrhea Type of gonorrhea
Drug* Preferred Aqueous procaine penicillin Gt
Uncomplicated
Complicated (salpingitis or disseminated gonococcal infection
or Ampicillini Other Tetracycline hydrochloride.:
Dosage Intramuscular administration of 5 million units plus 1 g of probenecid Oral administration of 3.5 g plus 1 g of probenecid Initial "stat" dose of 1.5 g, then 0.5 g four times a day; total, 9.5 g Same dosage as for tetracycline
or Erythromycinl Restricted Intramuscular administration of 2 g Spectinomycin§ Will require prolonged treatment (up to 10 days). Hospitalization may be necessary, and consultation is recommended.
*Benzathine penicillin G (Bicillin) or oral administration of penicillin should not be used in the treatment of gonorrhea. .Single-dose injectable or oral medication is preferred. .Other tetracyclines may be used, but all are preferably reserved for patients allergic to penicillin. §Use should be restricted to cases of penicillin or ampicillin treatment failure, or when penicillinase-producing organisms have been found.
Traitement recommande pour Ia syphilis et Ia blennorragie Columbia; Ma. Joa ATKINSON, officer in charge of venereal disease control, Northwest Territories; MRS.
ANNE GRAUWILER,
infectious disease
control officer, Yukon region Les demandes de tires . part doivent etre adressees au Dr. A.G. Jessamine, Medical officer, Bureau of epidemiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Tunney's Pasture, Ottawa, Ont. KIA 0L2
Tableau 1-Traitement recommand6 pour Ia syphilis Stade de Ia syphilis
Medicament
Posologie
Pr4f&entiel
Benzathine-p6nicilline G* ou Procaine-p6nicilline G aqueuse* Pricoce (primaire, seco.ndaire ou latente d'une dui.6e inf6rieure . 1 an)
Dose unique intramusculaire de 2.4 millions d'unit6s Administration intramusculaire de 600 000 unit6s tous les jours pendant 8 jours; 4.8 millions d'unit6s au total
AutTe Chlorhydrate de t6tracyclinet ou Erythromycinet Benzathine-p6nicilline G
Administration orale de 500 mg quatre fois par jour pendant 15 jours Mime posologie que pour Ia t6tracycline Administration intramusculaire de 2.4 millions d'unit.s chaque semaine pendant 3 semaines cons6cutives; 7.2 millions au Latente (duree sup6rieure . ou total 1an). Procaine-p6nicilline G aqueuse Administration intramusculaire de 600 000 unit6s tous les jours pendant 15 jours *LPadministration d'une dose unique est pr6f6rable car elle fournit un traitment efficace en une seule visite. tCes m6dicaments sont r6serv6s de pr6f6rence au traitement des patients allergiques i Ia p6nicilline. Les sch.mas optimaux de traitement pour Ia syphilis d'une dur.e sup6rieure . 1 an (latente, neurosyphilis, syphilis cardiovasculaire, syphilis cong6nitale et syphilis en cours de grossesse) ont et6 moms bien d6finis que ceux pour Ia syphilis pr6coce. Lorsqu'on croit itre en presence d'un tel cas, il est recommand6 de I'adresser . un sp.cialiste.
Tableau Il-Traitement recommand6 pour Ia blennorragie Genre de blennorragie M6dicament*
Posologie
Pr.f.rentiel
Procaine-p6nicilline G aqueuse. ou Ampicillinet Sans complication
Autre Chlorhydrate de t6tracycline1. ou Erythromycine.
Administration intramusculaire deS millions d'unit6s plus 1 g de prob6necide Administration orale de 3.5 g plus 1 gde prob6n6cide Dose d'attaque de 1.5 g suivi de 0.5 g quatre fois par jour; 9.5 g au total Mime posologie que pour Ia t6tracycline
Restreint
Administration intramusculaire de 2 g Spectinomycine§ N6cessite un traitement prolong6 (jusqu'. 10 jours). II peut itre n6cessaire Avec complication (salpingite ou infection gonococcique d'hospitaliser le patient et il est recommand6 de l'adresser . un sp.cialiste. diss6minee) *La benzathine-p6nicilline G (Bicilline) ou l'administration oralede Ia p6nicilline ne doit pas itre utilis6e pour le traitement de Ia blennorragie. tIl est preferable d'administrer une dose unique injectable ou orale. 10n peut utiliser d'autres t6tracyclines, mais toutes sontde pr6f6rence reserv6es au traitementdes sujets allergiques a Ia p6nicilline. §Ne doit itre utilisie que dans les cas oO le traitement . Ia p.nicilline ou . l'ampicilline se r6v.le un .chec, ou lorsqu'on trouve des organismes produisant de Ia p.nicillinase. CMA JOURNAL/AUGUST 6, 1977/VOL. 117
251
sociales, Quebec; Di. R. PERSAD, senior medical consultant in VD, Ontario Ministry of Health;
Newfoundland; DR. BURTON D. HOwArr,
DR. J. SCATLIFF, director of venereal disease
assistant deputy minister, Department of Health, field epidemiologist, communicable disease section, Department of Public Health, Nova Scotia; DR. C. DEVADASON, director, venereal disease control, Department of Health, New BrunswIck; DR G. TARJAN, directeur, division des maladies v6n6riennes, minisalre des Affaires Prince
Edward
Island;
DR.
A .E.
POINTER,
control, Manitoba Ministry of Health & Social division of venereal disease control, Department of Health, Saskatchewan; DR. J. BROWN, director, division of social hygiene, Department of Social Services and Community Health, Alberta; DR. H.K. KENNEDY, director, division of venereal disease control, Ministry of Health, British Development;
DR.
W.G.
DAVIDSON,
director,
Columbia; MR. JOE ATKINSON, officer in charge of venereal disease control, Northwest Territories; MRS. ANNE GRAUWILER, infectious disease control officer, Yukon region _______________________________________
Reprint requests to: Dr. A.G. Jessamine, Medical officer, Bureau of epidemiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Tunney's Pasture, Ottawa, Ont. Ki A 0L2
Table I-Recommended treatment of syphilis Drug
Stage of syphilis
Preferred Benzathine penicillin G* or Aqueous procaine penicillin G*
Early (primary, secondary or latent for less than 1 year) Other Tetracycline hydrochloridet or Erythromycint
Latent (of more than 1 year's duration)1:
Benzathine penicillin G or Aqueous procaine penicillin G
Dosage Single intramuscular dose of 2.4 million units Intramuscular administration of 600 000 units daily for 8 days; total, 4.8 million units Oral administration of 500 mg four times a day for 15 days Same dosage as for tetracycline Intramuscular administration of 2.4 million units weekly for 3 successive weeks; total, 7.2 million units Intramuscular administration of 600000 units daily for 15 days
*Single..dose treatment is preferred because it provides effective treatment in a single visit. tThese drugs are preferably reserved for patients allergic to penicillin. .The optimum treatment schedules for syphilis of more than 1 year's duration (latent, neurosyphilis, cardiovascular syphilis, congenital syphilis and syphilis in pregnancy) have been less well established than schedules for early syphilis. When such cases are suspected, consultation with an appropriate specialist is recommended.
Table Il-Recommended treatment of gonorrhea Type of gonorrhea
Drug* Preferred Aqueous procaine penicillin Gt
Uncomplicated
Complicated (salpingitis or disseminated gonococcal infection
or Ampicillini Other Tetracycline hydrochloride.:
Dosage Intramuscular administration of 5 million units plus 1 g of probenecid Oral administration of 3.5 g plus 1 g of probenecid Initial "stat" dose of 1.5 g, then 0.5 g four times a day; total, 9.5 g Same dosage as for tetracycline
or Erythromycinl Restricted Intramuscular administration of 2 g Spectinomycin§ Will require prolonged treatment (up to 10 days). Hospitalization may be necessary, and consultation is recommended.
*Benzathine penicillin G (Bicillin) or oral administration of penicillin should not be used in the treatment of gonorrhea. .Single-dose injectable or oral medication is preferred. .Other tetracyclines may be used, but all are preferably reserved for patients allergic to penicillin. §Use should be restricted to cases of penicillin or ampicillin treatment failure, or when penicillinase-producing organisms have been found.
Traitement recommande pour Ia syphilis et Ia blennorragie Columbia; Ma. Joa ATKINSON, officer in charge of venereal disease control, Northwest Territories; MRS.
ANNE GRAUWILER,
infectious disease
control officer, Yukon region Les demandes de tires . part doivent etre adressees au Dr. A.G. Jessamine, Medical officer, Bureau of epidemiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Tunney's Pasture, Ottawa, Ont. KIA 0L2
Tableau 1-Traitement recommand6 pour Ia syphilis Stade de Ia syphilis
Medicament
Posologie
Pr4f&entiel
Benzathine-p6nicilline G* ou Procaine-p6nicilline G aqueuse* Pricoce (primaire, seco.ndaire ou latente d'une dui.6e inf6rieure . 1 an)
Dose unique intramusculaire de 2.4 millions d'unit6s Administration intramusculaire de 600 000 unit6s tous les jours pendant 8 jours; 4.8 millions d'unit6s au total
AutTe Chlorhydrate de t6tracyclinet ou Erythromycinet Benzathine-p6nicilline G
Administration orale de 500 mg quatre fois par jour pendant 15 jours Mime posologie que pour Ia t6tracycline Administration intramusculaire de 2.4 millions d'unit.s chaque semaine pendant 3 semaines cons6cutives; 7.2 millions au Latente (duree sup6rieure . ou total 1an). Procaine-p6nicilline G aqueuse Administration intramusculaire de 600 000 unit6s tous les jours pendant 15 jours *LPadministration d'une dose unique est pr6f6rable car elle fournit un traitment efficace en une seule visite. tCes m6dicaments sont r6serv6s de pr6f6rence au traitement des patients allergiques i Ia p6nicilline. Les sch.mas optimaux de traitement pour Ia syphilis d'une dur.e sup6rieure . 1 an (latente, neurosyphilis, syphilis cardiovasculaire, syphilis cong6nitale et syphilis en cours de grossesse) ont et6 moms bien d6finis que ceux pour Ia syphilis pr6coce. Lorsqu'on croit itre en presence d'un tel cas, il est recommand6 de I'adresser . un sp.cialiste.
Tableau Il-Traitement recommand6 pour Ia blennorragie Genre de blennorragie M6dicament*
Posologie
Pr.f.rentiel
Procaine-p6nicilline G aqueuse. ou Ampicillinet Sans complication
Autre Chlorhydrate de t6tracycline1. ou Erythromycine.
Administration intramusculaire deS millions d'unit6s plus 1 g de prob6necide Administration orale de 3.5 g plus 1 gde prob6n6cide Dose d'attaque de 1.5 g suivi de 0.5 g quatre fois par jour; 9.5 g au total Mime posologie que pour Ia t6tracycline
Restreint
Administration intramusculaire de 2 g Spectinomycine§ N6cessite un traitement prolong6 (jusqu'. 10 jours). II peut itre n6cessaire Avec complication (salpingite ou infection gonococcique d'hospitaliser le patient et il est recommand6 de l'adresser . un sp.cialiste. diss6minee) *La benzathine-p6nicilline G (Bicilline) ou l'administration oralede Ia p6nicilline ne doit pas itre utilis6e pour le traitement de Ia blennorragie. tIl est preferable d'administrer une dose unique injectable ou orale. 10n peut utiliser d'autres t6tracyclines, mais toutes sontde pr6f6rence reserv6es au traitementdes sujets allergiques a Ia p6nicilline. §Ne doit itre utilisie que dans les cas oO le traitement . Ia p.nicilline ou . l'ampicilline se r6v.le un .chec, ou lorsqu'on trouve des organismes produisant de Ia p.nicillinase. CMA JOURNAL/AUGUST 6, 1977/VOL. 117
251
