Therapy for nonvenereal treponematoses: review of the efficacy of penicillin and consideration of alternatives.

Penicillin therapy has been a crucial element in public health programs for control of nonvenereal treponematoses. The recommendations made by the World Health Organization on penicillin therapy and the literature substantiating the effectiveness of penicillin therapy are reviewed. In mass public health programs, the recommended penicillin regimen can confidently be used. Although penicillin is the drug of choice for all treponemal infections, some individuals will be allergic to this drug. For these persons tetracyclines are the most thoroughly evaluated alternative antimicrobial agent and seem highly effective. However, further comparative evaluations of various tetracycline regimens are needed if tetracyclines are required by more than the occasional individual. The long-acting tetracyclines may be particularly appropriate in minimizing problems of compliance.