Managing gonorrhoea in a world without antibiotics

On 6th June the World Health Organization (WHO) put out an alert regarding drug-resistant gonorrhoea (http://www.who.int/mediacentre/news/notes/2012/gonorrhoea_20120606/en/ ) simultaneously with the publication of a Global Action Plan (http://whqlibdoc.who.int/publications/2012/9789241503501_eng.pdf).  The last year or so has seen the emergence of strains of the infection that are resistant to cephalosporins, the antibiotics of last resort.  The plan includes: increased awareness of correct use of antibiotics; systematic monitoring and reporting of treatment failure; improved surveillance; research into new treatment regimens.  But the brute fact remains that with no new drugs even on the horizon, we face a future in which there will increasingly be no effective treatment for Neisseria gonorrhoea.

This may raise in some minds the questions of how we ever coped in the days before antibiotics.

If you have ever wondered what the venereological world was like before the 1940s, the STI journal archive contains a wealth of material.  Contrasted assessments of the various treatment regimes for gonorrhoea current in the 1920s and their drawbacks can be found in papers by Prof.  Jadassohn, 1926 (http://sti.bmj.com/content/2/6/152.full.pdf+html?sid=cb748843-f7a4-40c9-99aa-b50a4d6faeea) and F.W.F. Purcell, 1931 (http://sti.bmj.com/content/7/3/187.full.pdf+html?sid=cb748843-f7a4-40c9-99aa-b50a4d6faeea).  I would particularly recommend a paper by L.W. Harrison in commemoration of venereologist Albert Neisser (http://sti.bmj.com/content/31/2/65.full.pdf+html?sid=8635f797-ed0e-4f71-a264-72f060bf8461).  Harrison profits from the occasion to reminisce at length on his own venereological career going back to experiences in charge of a clinic during World War I; he offers frank opinions of the treatments used at different periods by himself and others, and what he felt these owed to Neisser.

Use of injections of silver nitrate via urinary meatus go back to the nineteenth century and continue until the 1940s. The late C19th also saw the employment of an eye-watering range of injected “astringents” from potassium permanganate to hot water and sulphurous acid (Harrison).  These treatment regimens partly give way in the early C20th to the use of silver nitrate and a range of organic silver compounds (protargol, ichthargan, albargin etc.) – a change that Harrison attributes to the influence of Neisser.  A wide range of treatments, however, continue to be described in the literature (see above).  Occasional doubts are voiced as to the effectiveness of organic silver compounds, as compared with silver nitrate (http://sti.bmj.com/content/1/4/245.full.pdf+html?sid=cb748843-f7a4-40c9-99aa-b50a4d6faeea).

 

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