[National Library of Medicine, HF 0372. This transfer made: 12/29/05. Length: 00:08:15.]

[Penicillin and Venereal Disease]

[Presented by the U. S. Public Health Service in cooperation with State and Local Health Departments]

[This is a portion of the motion picture Penicillin in Medicine and Surgery produced by Grant, Flory & Williams and distributed by E. R. Squibb & Sons]

[ Narrator: ] The United States Public Health Service has had a major role in determining the value of penicillin in the treatment of venereal disease. Much of this work has been done under the direction of Dr. J.R. Heller, Jr.

[ Dr. J.R. Heller: ] More than 200,000 new infections of syphilis are acquired in this country each year. All are actually or potentially highly infectious.

If these patients could be found and treated before they have a chance to spread their infections there would soon be a marked reduction of syphilis.

Increasing alertness and diagnosis is important as a first step in bringing this about. Early diagnosis not only aids in reducing syphilis. but also it is important in improving the outlook for cure of the individual patient.

[ Narrator: ] One or more of these cases too often unnoticed or unlooked for may be present in the physician's waiting room. Physicians should examine the genitalia, the skin, and the mucosa for lesions of early syphilis.

They should employ both dark field microscopic examinations and blood serologic tests. Look for such symptoms as early penile lesions, the lip chancre, and the noticeable gumma.

Other manifestations are the sore throat, any mucosa lesions which do not heal in 10 days, any unexplained loss of hair.

General malaise, loss of weight, fever, or macular and maculopapular and group follicular eruptions.

The clinician may occasionally be surprised to find among his patients long-neglected cases. such as this example of advanced syphilis.

The early latent stage often passes unrecognized. There are probably scores of latent syphilis cases passing through your office each year.

Blood and spinal fluid tests are the principle diagnostic procedures available in the early latent stage of syphilis.

This applies also to the late latent stage with an increased probability of positive spinal fluid findings. For example, the colloidal gold test for paresis appears in this manner.

And is usually indicated by this type of curve. [Chart reading Spinal Fluid Dilutions in 0.4% Sodium Chloride Controls is shown,]

While the test for a [?] reaction responds in this manner.

Let us look at some typical latent manifestations of syphilis. .

Penile lesion

Aneurysm.

Charcot's joint.

Ocular nerve palsy and optic atrophy.

Syphilis of the central nervous system.

Paresis or tabes.

On the basis of present evidence, penicillin appears to have great value in the treatment of syphilis in virtually all stages and manifestations.

This lesion, which we saw earlier, has been treated with penicillin. Treatment was on a schedule of 40,000 units every 3 hours which will total 2 million 400,000 units in seven and one half days.

The healing of this lesion was accompanied by a serologic reversal which occurred over a five-week period. We cannot always expect such ideal results, however.

The more obstinate cases may require prolonged therapy and attention. Serologic reversal may require many weeks or months and in some rare cases even clinical symptoms may recur.

No final statement can be made at this time regarding the place penicillin will eventually occupy in the treatment of syphilis.

Developments are occurring are so rapidly that it is not feasible to recommend here precise dosages and methods of administration, but it is important to keep abreast of progress in the field.

Your professional societies and journals, your health departments, and the United States Public Health Service are all reliable sources of information.

Against gonorrhea the advent of penicillin presents a strong and efficient weapon. Here we can be more definite in our suggestions.

Under penicillin therapy, the gonorrhea patient is completely ambulatory. Toxic reactions are almost unknown. Discomfort and pain are slight.

Fortunately the gonococcus is highly susceptible to penicillin, and control is apparent almost at once.

The patient from whom this specimen was taken received four intramuscular doses of 50,000 units of penicillin in aqueous solution at three-hour intervals. Total 200,000 units.

Within 24 hours, the smear should be negative. Complications such as epididymitis, arthritis, and endocarditis require larger and prolonged dosage.

As an alternative procedure, a single dose of 300,000 units of penicillin in oil and wax has proved effective in gonorrhea with a minimum of inconvenience to the patient.

[Warning: A maximum penicillin dosage for gonorrhea may inhibit the normal development of clinical and serologic symptoms of a concomitant syphilis infection.]

[A blood specimen for serologic testing should be taken before therapy is begun.]

[Each gonorrhea patient should be strongly urged to report for serologic and other tests for syphilis at suitable intervals for 3 to 6 months after completing the treatment for gonorrhea.]

[ Dr. John R. Heller, Jr.: ] Whatever the future may hold for penicillin therapy, we physicians already have in our hands weapons, which with proper medical usage should enable us to reduce materially  the amount of venereal disease in the United States.

[The End]