The FP suspected that the patient had syphilis, herpes, or both. The FP performed a herpes culture and sent the patient for serologic testing for syphilis and HIV. The rapid plasma reagin (RPR) test came back positive at 1:16 and the confirmatory treponemal test was positive, as well. The herpes culture and HIV tests were negative. The final diagnosis was primary syphilis and the patient was treated with 2.4 million units of benzathine penicillin IM.
It was fortunate that in this case, the presence of multiple ulcers did not dissuade the clinician from considering syphilis in the differential diagnosis.
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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