Sexually Transmitted Infections
The case study chosen for this week’s discussion will be Case Study #1: Case Study 1:? A 19-year-old Asian American female comes into the clinic for a well-woman checkup. She states that about three weeks ago she had a non-tender sore on her labia that resolved without treatment. Her gynecologic exam is normal but she has maculopapular lesions on her trunk, neck, palms, and soles of her feet. The remainder of her exam was unremarkable. Differential Diagnosis The differential diagnosis included for this patient are secondary syphilis, pityriasis rosea (a benign condition that resolves over 6 to 8 weeks), and a viral exanthema.
Secondary syphilis is by far the most likely diagnosis. In primary syphilis the an ulcer or chancre will appear at the site of inoculation and can isolate spirochetes from the lesions. The lesions heal in 3-12 weeks. Secondary syphilis the likely diagnosis for this patient begin 2-10 weeks after the primary lesion(chancre) which the patient has widespread mucocutaneous lesions that spread to skin, liver, joints, muscle, lymph nodes and brain. Systematic symptoms include rash, mucocutaneous lesions in mouth/throat and is highly infectious, lymphadenopathy.
Treatment Penicillin is the most effective therapy for all stages of syphilis. Doxycycline hyclate or tetracycline are alternative treatments for patients with a demonstrated allergy to penicillin. Pregnant patients who are allergic to penicillin should be desensitized, if necessary, and treated with penicillin. The patient should be instructed on safe sex and if she becomes pregnant inform her provider so that the baby can be treated. The patient should finish all treatment and all partners should be bought in for treatment as well