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SYPHILIS:

CASE ANALYSIS
30 RENDON, MAEGHAN C.
5ACLPH
PATIENT CASE:
 A 39-year-old man presented to the emergency
department reporting several weeks of generalized weakness,
headache, nausea, and migratory arthralgia. The patient had
exclusively had sex with men, had participated in condomless
anal insertive and receptive intercourse, and had been in a
monogamous relationship during the past 6 months. The
patient is known to be allergic to penicillin.
 Physical examination revealed a painful ulcerated plaque on
the upper lip, a macular rash with three crater-like scarred
painless lesions (considered to be healing chancres) on the
glans, a nonpruritic hyperkeratotic maculopapular palmar
rash and bilateral submandibular lymphadenopathy. No
alopecia, gummas, neurologic deficits or ocular or
cardiovascular abnormalities were noted.
 Ulcerated plaque on the upper lip. Results
of laboratory testing included a positive
reactive syphilis immunoglobulin G (IgG)
enzyme immunoassay and a positive rapid
plasma reagin (RPR) test (titer 1:256).
Human immunodeficiency virus (HIV)
testing was negative and serologic testing
demonstrated prior immunization to
hepatitis B virus. Given the clinical
presentation and laboratory findings,
secondary syphilis was the considered
diagnosis.
 The patient was prescribed with
benzathine penicillin G 2.4 million units
intramuscularly.
 Patient is diagnosed with syphilis
 Patient presents with weakness,
headache, nausea, and migratory
athralygia
 Patient is present with a painful
ulcerated plaque on the upper lip,
macular rash with three crater-like
scarred painless lesions on the
glans, a nonpruritic hyperkeratotic
maculopapular palmar rash and a
bilaterial submandibular
lymphadenopathy
Address symptoms of the patient
i.e. generalized weakness,
headache, nausea, migratory
arthralgia
Arrest damage done by the
infection by treating syphilis
R
 Existing
 Patient was prescribed with
benzathine penicillin G 2.4 million
units IM
 Recommendation
 Suggest the physician to change drug
because penicillin is contraindicated
to the patient. Patient is known to be
allergic to penicillin.
 Doxycycline 100 mg orally twice daily
for 14 days or Tetracycline (500 mg
four times daily for 14 days)
Non treponemal test : VDRL Test
(Venereal Disease Research
Laboratory Test) or RPR Test
(Rapid Reagin Test)
Treponemal test: immunoblots,
and rapid treponemal assays
can be used to test levels of
antigen specific for syphilis
Wrong drug of choice for the
patient
Patient medication allergy-
patient is allergic to the
prescribed drug which is
benzathine penicillin G 2.4
million units
No drug-drug interaction; other
medications of the patient is not
stated
Patient is allergic to the drug
benzathine penicillin G 2.4
million units; prescribed drug is
contraindicated to the patient.
There is a more suitable drug of
choice for the patient.
Doxycycline 100 mg orally twice
daily for 14 days or Tetracycline
(500 mg four times daily for 14
days) patient.
 Subjective: Patient reports several
weeks of generalized weakness,
headache, nausea, and migratory
arthralgia
 Objective: Results of laboratory testing
included a positive reactive syphilis
immunoglobulin G (IgG) enzyme
immunoassay and a positive rapid
plasma reagin (RPR) test (titer 1:256).
Human immunodeficiency virus (HIV)
testing was negative and serologic
testing demonstrated prior immunization
to hepatitis B virus.
 Medication: benzathine penicillin G 2.4
million units
Patient is allergic to penicillin.
Short Term Goal: Arrest the
patient’s signs and symptoms of
syphilis
Long Term Goal: Cure the
patient’s infection i.e. syphilis.
R
 Suggest the physician to change drug because
penicillin is contraindicated to the patient.
Patient is known to be allergic to penicillin.
 Doxycycline 100 mg orally twice daily for 14
days or Tetracycline (500 mg four times daily for
14 days)
 Patient should abstain from sexual contact with
new par tner s until the syphilis sores are
completely healed.
 Patients with syphilis must notify their sex
par tner s so that they can also be tested and
receive treatment if necessar y.
 Prevent sexually transmitted diseases like
syphilis by using protection like condoms or
dental dams when having sexual intercourse.
Avoid sharing of sex toys and sharing of
needlesi.e. syphilis.
M
 Non treponemal test : VDRL Test (Venereal
Disease Research Laborator y Test) or RPR Test
(Rapid Reagin Test). Treponemal
test: immunoblots, and rapid treponemal
assays can be used to test levels of antigen
specific for syphilis. Tests can be done to
monitor the ef fectiveness of the treatment.
 Clinical and serologic evaluation should be
per formed at 6 and 1 2 months af ter treatment;
more frequent evaluation might be prudent if
follow -up is uncer tain or if repeat infection is a
concern. Serologic response should be
compared with the titer at the time of
treatment. However, assessing serologic
response to treatment can be dif ficult, and
definitive criteria for cure or failure have not
been well established. In addition,
nontreponemal test titers might decline more
slowly for per sons previously treated for syphilis
REFERENCES

 https://www.aphl.org/AboutAPHL/publications/Documents/ID
_Suggested_Syphilis_Reporting_Lang_122015.pdf#search=su
ggested%20syphilis%20reporting%20language
 https://www.cdc.gov/std/syphilis/treatment.htm
 https://www.healthline.com/health/std/syphilis#prevention
 https://www.cdc.gov/std/syphilis/stdfact -syphilis-
detailed.htm

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