Review Question - QID 103000

The patient is asymptomatic for syphilis but experienced a painless chancre of primary syphilis and has a positive VDRL and FTA-ABS test which is concerning for latent syphilis. The first-line treatment is penicillin.

Primary syphilis typically presents as a painless chancre at the site of the infection and resolves within several weeks regardless of treatment. Secondary syphilis may occur if not treated and presents approximately 6-8 weeks following the primary infection and is a maculopapular rash involving the trunk, face, and extremities (including the palms and soles). Tertiary syphilis can present with dorsal column involvement and Argyll-Robertson pupils as well as other systemic findings such as aortitis. Latent syphilis is asymptomatic and results from untreated primary and secondary syphilis and will be positive by serologic testing. Any patient with primary, secondary, tertiary, or latent syphilis should be treated with penicillin if they are not allergic.

Incorrect Answers:
Answer 1: Acyclovir is the treatment of herpes simplex virus which presents with vesicular skin lesions and ulcers that can be painful.

Answer 2: Azithromycin and ceftriaxone is the appropriate treatment of urethritis/cervicitis secondary to Neisseria gonorrhoeae and Chlamydia trachomatis which presents with pain and urethral/cervical discharge.

Answer 3: Doxycycline can be used to treat primary and secondary syphilis if there is anaphylaxis to penicillin but is not the preferred first-line agent.

Answer 4: No treatment indicated would be appropriate for a viral exanthema (aside from herpes infections) such as coxsackievirus which presents with pustular skin lesions that resolve on their own.

Bullet Summary:
The treatment of latent syphilis is penicillin.