Year : 2007 | Volume
: 28 | Issue : 1 | Page : 51--52
Abstracts from yester years
Anitha Iyer, Yogesh Marfatia
Department of Skin and VD, Medical College and SSG Hospital, Vadodara, India
Department of Skin and V.D., Medical College and SSG Hospital, Vadodara
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Iyer A, Marfatia Y. Abstracts from yester years.Indian J Sex Transm Dis 2007;28:51-52
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Iyer A, Marfatia Y. Abstracts from yester years. Indian J Sex Transm Dis [serial online] 2007 [cited 2022 Aug 18 ];28:51-52
Available from: https://www.ijstd.org/text.asp?2007/28/1/51/35716
Anti-chancroidal drugs tested by the hetero inoculation of bubo fluid from the treated donor
In this study, the person with the bubo was first treated with the drugs to be tested and then the bubo fluid was injected into others to ascertain whether it had lost its virulence or not. The virulence of the bubo fluid was first injected intradermally into the forearm of volunteers to test its virulence; and later on after treatment had been given, further specimens of bubo fluid were injected into others in order to ascertain whether the fluid had lost its virulence.
All donors had clinical soft sore with unilateral or bilateral chancroidal buboes. The specimens were taken from undermined edge of the lesion. The recipients were all African Negroes with VDs, usually syphilis often combined with soft sore.
In case of treatment with sulphathiazole (1 gm 4 times daily) one person was inoculated 24 hours after the donor had begun to be treated, four at 48 hours and three at 72 hours. All had negative results. Sulfonamide drugs proved particularly effective. Steptomycin (0.5 gm twice daily for 3 days) was given and then inoculation was carried out. A 'take' was produced in none. Thus streptomycin was found to be very effective. Treatment with chloramphenicol (250 mg three times daily) also proved effective.
In case of Aureomycin, when the donor was injected with his own fluid a bump developed which proceeded to ulceration. But further specimens inoculated at 48, 72, 96 and 120 hours fail to produce a take. Thus aureomycin has a definite beneficial action against chancroid but not as marked as streptomycin or sulfonamide. Neo Arsephenamine proved to be inferior to others because inspite of vigorous treatment, the fluid showed no sign of losing its virulence. In two small scale investigations, donors were given single shot treatments with procaine penicillin with 2% aluminium monostearate. Penicillin has some definite action against chancroid when given in a dose which produces and sustains an adequate blood level. If a high level is not sustained, then the action of the drug is not adequate. Aureomycin and chloramphenicol taken orally are known to influence syphilis, gonorrhoea, granuloma inguinale and possibly also lymphogranuloma venereum, non specific urethritis and herpes simplex. As they will also prevent soft sores, these all purpose oral antibiotics have great prophylactic possibilities.
R. R. Willcox. British Journal of Venereal Diseases 1950;(26):131-5.
Editor - Many of these drugs are now obsolete, but current Centre for Disease Control (CDC) guidelines in non-HIV patients suggest streptomycin among aminoglycoside group as effective therapy. Chloramphenicol can also be used selectively, taking into account its side effects.
The contemporary male defaulter
The material selected for the study has been taken principally from the records of the male venereal diseases clinic at Edinburgh from January 1948 to March 1950. The principal deductions are made from the behavior of male patients with early (primary and secondary) syphilis who were diagnosed and whose treatment started between January 1, 1948, and December 31, 1949. They were all prescribed a course of penicillin ranging from 5-12 MU, together with one or two unit courses of arsenic and bismuth. This was given a few days after the first injection of penicillin. A rest of 4 weeks was given between two courses. Action was taken whenever a patient was 2 or 3 days overdue for penicillin and 7-10 days overdue in the arsenic or bismuth course - in the form of a stereotype letter followed by, if this failed, a more personal letter. Other approaches were through the patient's wife, his doctor or in some cases by a personal visitation. When a defaulting patient returned, he was specially interviewed and the importance of continuation of treatment stressed. No action was taken when patients defaulted after one unit course. Total of 161 patients were included. A defaulter in this analysis meant a patient who never completed his prescribed treatment.
Of the 161 patients, 4 failed to complete the penicillin course; and 25, the unit course with a default rate of 17%. The total default rate up to the end of treatment was 25. It was observed that the default rate at the end of first course was same in both primary and secondary syphilis. The admission to hospital also did not significantly influence the default rate. The default rate was higher in separated or divorced men. Maximum default occurred in the 20-24 age group and decreased with increasing age. The few patients under the age of 20 did not default. Default rate was higher in drivers and laborers.
Thus it is doubtful if expending much effort to trace the defaulter is worth it when default occurs at a later stage in the treatment. Also, a defaulter should be given a second concentrated course of penicillin if he returns, in order to produce the best therapeutic effect. A defaulter should be traced with the purpose of tracing and treatment of the consort and any others who might be infected. But adoption of cynical pessimism is to be condemned, and the highest professional and ethical standards should be maintained even though it has been found in this study that defaulters are little amenable to personal or other influences.
Gordon OH. British Journal of Venereal Diseases 1950; (26):164-171.
Editor - This default is a problem in the present decade also; and hence single-dose therapy, along with counseling, is to be preferred as in syndromic approach.