ACCEPTABILITY AND COMPLIANCE WITH DAILY INJECTIONS OF PROCAINE PENICILLIN IN THE OUTPATIENT TREATMENT OF SYPHILIS-TREPONEMAL INFECTION

Background: In the United Kingdom, it is recommended that syphilis sho uld be treated with intramuscular daily procaine penicillin with or wi thout oral probenecid for 8 to 21 days, However, it has been argued th at this regimen would be unacceptable to patients in terms of daily at tendance and volume of drug administered, resulting in poor compliance . Goal: To assess the acceptability of and compliance with daily proca ine penicillin for 10 to 17 days in patients attending an East London Genito-Urinary Medicine Clinic with a diagnosis of syphilis-treponemal infection. Study Design: The notes of 210 consecutive patients attend ing with syphilis-treponemal infection who had been offered treatment with daily procaine penicillin, with or without oral probenecid for 10 to 17 days, were reviewed retrospectively. Results: Of 210 patients w ho were offered daily procaine penicillin, 42 (20%) declined and were given oral doxycycline, amoxicillin, or depot penicillin injections, O f 168 patients who accepted daily procaine penicillin, depending on th e stage of infection, 90 (54%) had 1.8 g of daily procaine penicillin together with oral probenecid 500 mg every 6 hours for 17 days (high-d ose regimen), 57 (34%) had 0.6 g of daily procaine penicillin for 10 t o,17 days (low-dose regimen), and 21 (12%) had mixed-dose regimens ran ging from 0.5 to 2.4 g. Of the 90 who had high-dose regimen, 76 (84%) complied with treatment compared with 50 (88%) of 57 who had low-dose regimen, All 21 patients who had mixed-dose regimens complied fully. C onclusions: Daily procaine penicillin is a well-accepted out-patient r egimen with excellent compliance (88% overall) and minimal side effect s, Because the high-dose regimen has been shown to achieve treponemici dal levels of penicillin in the cerebrospinal fluid, it is recommended for patients with neurosyphilis or those in whom neurosyphilis cannot be excluded, It also could be considered for patients with concomitan t human immunodeficiency virus infection in view of the possible progr ession to neurosyphilis in those treated with depot penicillin.