Therapy for Nonvenereal Treponematoses: Review of the Efficacy of Penicillin and Consideration of Alternatives

Penicillin therapy has been a crucial element in public health programs for control of nonvenereal treponematoses. The recommendations made by the World Health Organization on penicillin therapy and the literature substantiating the effectiveness of penicillin therapy are reviewed. In mass public health programs, the recommended penicillin regimen can confidently be used. Although penicillin is the drug of choice for all treponemal infections, some individuals will be allergic to this drug. For these persons tetracyclines are the most thoroughly evaluated alternative antimicrobial agent and seem highly effective. However, further comparative evaluations of various tetracycline regimens are needed if tetracyclines are required by more than the occasional individual. The long-acting tetracyclines may be particularly appropriate in minimizing problems of compliance. Penicillin was established as an effective treatment for treponematoses in the 1940s. Subsequent laboratory experiments, controlled clinical trials, and public health programs all underscored the effectiveness of penicillin in the therapy for nonvenereal treponemal infections. On the basis of these observations, various expert groups have recommended penicillin as the drug of choice for the treatment of treponematoses [1-4]. In this article these recommendations are reviewed and supporting information on penicillin from both control programs and clinical trials is examined. Allergy to penicillin may be more common today than in the 1950s and 1960s, since it is possible that populations suffering from nonvenereal treponematoses have had more exposure to penicillin today than during the era before mass treatment campaigns. Therapeutic alternatives for penicillin-allergic individuals with nonvenereal treponematoses have not been recommended. Information related to the effectiveness of potential alternatives is reviewed, and agents for further consideration and possible study are proposed.