Manifestations of Syphilis Bernard M. Karnath, MD Choose the single best answer to each question. 1. A 25-year-old man presents with a 2-day history of a painless ulcer located on his glans penis. The ulcer is 0.5 cm in diameter. The patient admits to recent unprotected intercourse 3 weeks ago with an unknown partner. Dark field microscopy confirms the diagnosis of syphilis. The patient is allergic to penicillin. What is the best treatment option for this patient? One dose of azithromycin 1 g orally One dose of ceftriaxone 250 mg intramuscularly Doxycycline 100 mg orally twice daily for 14 days Levofloxacin 250 mg orally once daily for 7 days Click here to compare your answer. 2. A 30-year-old man presents with a 3-day history of a painful ulcer located on the dorsum of his penis. The ulcer is 1 cm in diameter. The patient also has tender bilateral inguinal lymphadenopathy. The patient admits to recent unprotected intercourse 3 weeks ago with a prostitute. Dark field microscopy and rapid plasma reagent testing are negative. What is this patient’s most likely diagnosis? Chancroid Granuloma inguinale Lymphogranuloma venereum Gonorrhea Click here to compare your answer. Questions 3 and 5 refer to the following case: A 30-year-old woman presents with a 1-week history of a generalized rash, fever, malaise, myalgias, and generalized lymphadenopathy. Her past medical history is significant for HIV diagnosed 5 years ago. Her most recent CD4+ count from 4 months ago is 350 cells/mm3. The rash involves the palms of the hands and the soles of the feet. Rapid plasma reagent testing is reactive at 1:64 dilutions. The patient has no known drug allergies. 3. What is the next step in the management of this patient? Begin treatment with doxycycline 100 mg orally twice daily for 14 days Begin treatment with levofloxacin 250 mg orally once daily for 7 days Lumbar puncture Dark field microscopy of the skin lesions Click here to compare your answer. 4. The fluorescent treponemal antibody absorption (FTA-ABS) is positive. Lumbar puncture is performed and the VDRL-CSF is positive. What is the next step in the management of this patient? Initiate intravenous (IV) levofloxacin 500 mg daily for 14 days Initiate IV ceftriaxone 1 g every 12 hours for 10 days Initiate doxycycline 100 mg orally twice daily for 14 days Initiate IV penicillin G 2 to 4 million units every 4 hours for 14 days Click here to compare your answer. 5. Approximately 2 hours after beginning treatment, the patient complains of chills and rigors. What do you recommend? Stop treatment Continue present treatment Consult an allergist for desensitization Draw 2 sets of blood cultures Click here to compare your answer. Click here to read more about Manifestations of Syphilis (Requires Adobe Acrobat Reader) Check our archives to test your knowledge in other clinical signs: If you do not already have Acrobat Reader, simply click on the icon below, scroll down to the "Get the Free Acrobat Reader" heading and follow the instructions to install the program. Acrobat enables you to convert any document into an Adobe Portable Document Format (PDF) file for easy viewing. Download Adobe Acrobat Reader   Hospital Physician     JCOM     Seminars in Medical Practice Hospital Physician Board Review Manuals About TWC    Subscribe    Contact TWC    Home    Search   Site Map Copyright © 2009, Turner White Communications Updated 2/05/09 • nvf