Treatment of venereal disease in the penicillin-allergic patient: administration of penicillin following testing with major and minor determinants.

We describe the administration of penicillin for venereal disease in three penicillin-allergic patients for whom alternative antibiotics were not considered suitable. Each patient was skin test negative to the major penicillin determinant benzylpenicilloyl-polylysine and a minor determinant mixture of potassium penicillin, benzylpenicilloate and benzylpenicilloyl-n-propylamine provided by the National Institute of Allergy and Infectious Diseases. Therapeutic doses of penicillin were administered without anaphylaxis, but one patient developed serum sickness on day five following benzylpenicillin. The skin testing results were determined within 30 minutes such that penicillin or its derivatives could be administered safely and rapidly to seriously ill patients, i.e. disseminated gonococcemia. When treating neurosyphilis or disseminated gonococcal infection for which non-penicillin therapy is unacceptable, use of the current skin test reagents provides a level of safety in avoiding anaphylaxis not previously attainable.