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| FIGURE 1 | FIGURE 2 |
The family physician (FP) recognized the nonpainful ulcer (FIGURE 1) and rash (FIGURE 2) as a combination of primary and secondary syphilis. Rapid plasma reagin (RPR) and human immunodeficiency virus (HIV) tests were drawn; the patient was treated immediately with IM benzathine penicillin.
The RPR came back as 1:128 and the ulcer was healed within 1 week. Her HIV test was negative and the physician recommended that she also have a Pap smear with screening for gonorrhea and chlamydia. The patient was told that she should inform her boyfriend of the diagnosis and encourage him to get evaluated and treated as soon as possible. The result was also reported to the Health Department.
The Centers for Disease Control and Prevention’s (CDC) recommended treatment for primary, secondary, and early latent syphilis is benzathine penicillin G, 2.4 million units IM. For patients who have a penicillin allergy, doxycycline 100 mg twice daily for 14 days is recommended.
Patients should be evaluated clinically and serologically at 6 and 12 months after therapy. Failure of nontreponemal test titers to decline 4-fold within 6 to 12 months of therapy may be indicative of treatment failure. Further evaluation should be performed, including a repeat HIV test. For further information on the management of syphilis, see the CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010 at: http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#syphilis
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Syphilis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:924-928
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