1. The 5-Minute STD Case Study Primary Syphilis? Or?
Recent Presentations at the Denver Metro Health Clinic

2. 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

4. 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

5. 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

7. Which of the following positive tests would prove this to be a case of primary syphilis?
Dark field examination
RPR
TPPA
FTA-abs

8. Case Darkfield exam: not available Stat RPR: positive 1:1
HIV rapid: NR

9. What is the differential diagnosis?
Primary syphilis
Genital herpes
Toxic reaction to topically applied antibiotics
Trauma with secondary infection
All of the above

10. 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

11. 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

12. Questions What did this patient have? Was he treated appropriately?
What, if anything, should have been done differently?

13. 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: