Ernst Epstein

Genital Herpes and Erythema Multiforme

To the Editor.— Dr Corey, in his scholarly review of the diagnosis and treatment of genital herpes (1982; 248:1041), did not mention erythema multiforme under his list of complications of recurrent genital herpes infection. Erythema multiforme caused by herpes is uncommon, and— in my experience—physicians are usually unaware of this association. Unlike herpes, this complication is treatable; it responds dramatically to corticoids administered for systemic effects. Once the association between recurrent herpes simplex and erythema multiforme is recognized, future misery can be avoided by a one- to two-week course of corticoids administered for systemic effects started at the first sign of erythema multiforme.

TREATMENT OF GONORRHEA

To the Editor:— Dr. Goodmans letter raises several points which I would like to answer. I have questioned dozens of military physicians in Korea and Japan, and everyone who had personal experience in treating gonorrhea commented on the problem of penicillin treatment failures. Curtis and Wilkinson ( Brit. J. Ven. Dis. 34: 70-82 [June] 1958) document their experience with the bacteriology of penicillin failures in gonorrhea. Their studies, as well as the discussion appended to the paper, indicate that penicillin-resistant cases of gonorrhea are being encountered in Britain. Bernstein, of the 406th Medical General Laboratory at Camp Zama, Japan has intensively investigated the bacteriology of penicillin treatment failures. Using rigid laboratory criteria he proved that these were indeed Neisseria gonorrhoeae infections and that the in vitro penicillin sensitivity of these strains was definitely, although moderately, elevated. By measuring in vivo penicillin blood levels, Bernstein showed that the usual penicillin schedules failed