The 5-Minute STD Case Study Primary Syphilis? Or? Recent Presentations at the Denver Metro Health Clinic
Case 44 year-old Hispanic male Penile ulceration for 2 weeks Started as a blister that “popped” Pt has been applying the contents of antibiotic capsules (tetracycline?) on the lesion for > 1 week
Case – Sexual History Monogamous relationship since 6 months Last sex 20 days ago Vaginal sex only Partner does not have symptoms No male partners No history of STIs No other risk behaviors
Case: Physical Examination Large (1.5 cm) ulceration sulcus coronarius Yellow adherent discharge Lesion is moderately painful and bleeds easily after rubbing off discharge No lymphadenopathy
Which of the following positive tests would prove this to be a case of primary syphilis? Dark field examination RPR TPPA FTA-abs
Case Darkfield exam: not available Stat RPR: positive 1:1 HIV rapid: NR
What is the differential diagnosis? Primary syphilis Genital herpes Toxic reaction to topically applied antibiotics Trauma with secondary infection All of the above
How to treat the patient? LAB 2.4 MU i.m. once LAB 2.4 MU i.m. once a week for 3 weeks Azithromycin 2 g single oral dose Doxycycline 100 mg bid for 14 days
Case – Follow up (19 days after initial visit) Lesion almost completely healed (decrease in size from 15 mm to 2 mm) Reference lab results: RPR: positive 1:1 TPPA: NR Disease intervention specialist reports: Pt reported 6 partners in past 3 months All have been brought to treatment None of the partners tested positive for syphilis
Questions What did this patient have? Was he treated appropriately? What, if anything, should have been done differently?
Disclaimer Copyright all clinical photos: Dr. Kees Rietmeijer, STD Control Program, Denver Public Health Department Individual slides can be used for educational purposes with reference to source and/or inclusion of the DMHC logo Questions are addressed in similarly-titled PDF available on STD Prevention Online For comments on this case please contact author: kees@rietmeijer.us