Declaring cure in women with gonorrhoea.

Sir, Ofloxacin is a new quinolone antibacterial compound for the oral treatment of systemic infections. It has rapid bactericidal activity against a wide range of Gram positive and Gram negative, aerobic, and anaerobic bacteria, including emerging pathogens (such as methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa, Proteus rettgeri, and Serratia spp).' It is active against Neisseria gonorrhoeae and other common urogenital pathogens (Ureaplasma urealyticum, Chlamydia trachomatis, Gardnerella vaginalis, and Mycoplasma hominis).2-5 Ofloxacin possesses good pharmacokinetics in man, with a mean peak serum concentration of 3.8 mg/A and a half life of about six hours after a single 300 mg oral dose.6 We report the results of animal experiments carried out to assess whether ofloxacin, used to treat urogenital infection, can delay or mask the development of simultaneously acquired incubating syphilis. We infected intratesticularly 26 rabbits (weighing 3-35 kg)with 2ml of a suspension of 2 x 107 ml of Nichols strain treponemes.7 Three days later, we treated 10 of the rabbits with 100 mg/kg ofloxacin (Glaxo), given as single daily oral dose, for three consecutive days. Nine rabbits were given procaine penicillin G, and seven were left untreated. After a single dose of ofloxacin the mean peak serum concentration was 29.5 mg/l, about eight times that obtained in man after a single therapeutic oral dose of 300 mg.6 At the end of the experiments, three rabbits were injected intratesticularly with treponemes obtained from rabbits treated previously with ofloxacin. These rabbits were left untreated and observed during the following days. Seven days after inoculation all the ofloxacin treated rabbits, as well as those untreated, developed syphilitic orchitis. Increasing Treponemapallidum haemagglutination assay (TPHA)titres appeared five to 10 days later in the ofloxacin treated and in the untreated rabbits . Treponemes were detected in the testes of the rabbit that were killed 30 days after infec tion. Serological tests for syphilis in the penicillin treated rabbits gave negative results. The three rabbits infected with treponemes obtained from rabbits previously treated with ofloxacin developed syphilitic orchitis and serological reactivity. The results of this study show that ofloxacin does not cure incubating syphilis in the rabbit. Therefore , ofloxacin seems to have no effect on Treponema pallidum in experimental syphilis. If these results are confirmed in man, ofloxacin could be used to treat gonorrhoea and other urogenital infec tions without any risk of delayinig or masking the development of simultaneously incubating syphilis.