Those who treated their first case of syphilis with bismuth compounds and arsenicals can best appreciate the strides made in the treatment of syphilis in the last quarter of a century.

Over 20 years ago, Dr. John Mahoney working in the Venereal Disease Research Laboratory reported to the world the first cures of syphilis with penicillin. Much has happened to the World but not to syphilis since that momentous discovery. The causal treponeme has not developed any measurable resistance to the product of Fleming’s antibacterial fungus and penicillin remains the best and most effective treatment of syphilis.

If the physicians of the Renaissance who watched this disease sweep Europe were alive today they would be most skeptical if they were told that there is a drug that with one injection will cure the “great pox” in its early stages. Even Ehrlich with his magic bullet, arsphenamine or 606, would have been astounded at penicillin’s lack of toxicity as compared to his chemotherapeutic agent and would have had to acknowledge penicillin’s more potent spirocheticidal action.

Following Mahoney’s work with penicillin, the broad spectrum antibiotics were also found effective in the treatment of syphilis. However, these oral preparations are not preferred to penicillin for the following reasons:

1. Less spirocheticidal action (some are only static in action).
2. Absorption is highly variable.
3. Patient cooperation is not always obtained.
4. Follow-up studies still leave some doubt as to efficacy of treatment, especially when minimal doses are used in pregnancy and in obese individuals.
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