Probenecid in the treatment of neurosyphilis in men who have sex with men: a commentary

Probenecid is a uricosuric drug, which inhibits the renal excretion of procaine penicillin via inhibition of the organic anion transporter (OAT-1) system in the proximal renal tubule producing higher plasma and cerebrospinal fluid (CSF) penicillin levels.1 2 Oral probenecid is recommended to be used with intramuscular procaine penicillin for the treatment of neurosyphilis. Rates of syphilis and neurosyphilis have increased significantly over the past 20 years particularly in men who have sex with men (MSM). There are several issues for clinicians to consider when prescribing probenecid to MSM with neurosyphilis. First, there are global supply chain issues with probenecid (and procaine penicillin). Second, there is a risk that the probenecid may be inadvertently omitted because of prescriber error. Third is patient adherence, as probenecid needs to be taken four times a day for the duration of the procaine penicillin (10–14 days) to be effective. Fourth,...
Source: Sexually Transmitted Infections - Category: Sexual Medicine Authors: Tags: Research letter Source Type: research