There is reason to believe that our troubles in treating gonorrhea are due at least partly to negligence and delay: we might have scotched it if we had acted more quickly. Now it looks as though syphilis, in which we have faced pretty much the same set of problems except penicillin resistance, is capable of following gonorrhea into the same predicament.

But if penicillin resistance of the spirochete is what killed the Johns Hopkins baby, it is the only case of such resistance reported thus far for early syphilis. It is obviously important to treat syphilis in its early stages. It would be vastly better to prevent it outright. The problem, for this and other reasons to be seen in later chapters, is sure to get worse before it can get better. One of the further complications is an apparently increasing prevalence of early latent syphilis, possibly resulting from inadequate treatment. In the words of the reporters of this increase, Pereira and Volley, "the ominous prospect of a widespread resurgence of the disease in its tertiary form looms ahead."

As we turn now from syphilis to gonorrhea, we meet the problem of penicillin resistance head on. While penicillin dosage has been increased for treatment of syphilis, the increase has been made not because of a change in the spirochetes but rather to be sure that the initial treatment would be sufficient to prevent relapse. But the gonococcus has been changing in its resistance to drugs from the start, first to sulfonamides and more slowly to penicillin and other antibiotics. The resistance of gonococci to sulfonamides developed rapidly. As many as 10 per cent were resistant from the start, and by 1943 cure rates were as low as 25 per cent among troops in Italy. A year later resistant strains of gonococci were even more common. The sulfonamides, moreover, were not always well tolerated, and reactions were sometimes severe. Penicillin, introduced in 1944, was therefore "providential," and in adequate dosage was found uniformly effective for more than a decade. But by the late 1950s penicillin resistance of the gonococcus was being reported all over the world.

Yet resistance has developed slowly and in stages, so that increasing dosage could usually overcome it; and even today, in most parts of the world, penicillin in high dosage is preferred to any other antibiotic, although a wide range of other antibiotics is also effective. (see PENICILLIN RESISTANCE IN THE TREATMENT OF VD PART II)