17-year-old female, comes to the physician's office to discuss a private issue.

Instructions:

-Take a focused history.

-Ask physical examination findings and from examiner

-Explain the preliminary differential diagnoses and initial workup plan to the patient.

Use this marking scheme: https://next.amboss.com/us/article/7K043S

Diagnostic investigations
Dark ground microscopy of the chancre fluid – shows motile spring-shaped bacteria in primary
syphilis.

Syphilis PCR from a swab taken from an ulcerated lesion.

Treponemal-specific serology remains positive throughout life:

 Treponemal enzyme immunoassay (EIA)

 T.pallidum haemagglutination test (TPHA)
 T. pallidum particle agglutination test (TPPA)

Cardiolipin serology tests are used as an indicator to measure disease activity, disease staging and
treatment efficacy. These include:

 Rapid Plasma Reagin (RPR)

 Venereal Disease Research Laboratory (VDRL)

It can take up to 12 weeks from exposure for laboratory tests to show a positive Syphilis result.
Tests should, therefore, be repeated at 12 weeks post-exposure, and if considered high-risk at 6
weeks as well.

Management
Treatment is with Benzathene benzylpenicillin IM injection, however, the dose depends on the
nature of the infection, whether the infection is congenitally acquired, and whether the individual
is pregnant. Prednisolone is given alongside antibiotics in cases of neurosyphilis.

Primary, secondary and early latent syphilis: Benzathine benzylpenicillin 2.4 million units IM

injection as a single dose

Late latent, cardiovascular and gummatous syphilis: Benzathine benzylpenicillin 2.4 million

units IM injection weekly for three weeks (three doses)

A full STI screen including blood tests should be performed if not already done. Contact tracing
and partner notification need to be offered. Patients should be followed up with a clinical review
and repeat serology testing at 3, 6 and 12 months.

How to differentiate early vs late latent?

Early latent is infection occur within 12 months from exposure, late latent >12month after exposure.