Syphilis Medical Question:
A 46 year old male comes to the physician with an ulcer on his genital. On physical examination you note that the ulcer is non-tender, with a raised border and a smooth base. There is bilateral inguinal adenopathy. The rest of the exam is unremarkable. Dark field microscopy of a specimen from the ulcer base reveals spirochetes. Which of the additional screening studies should be performed on this patient?
A ) VDRL
B ) Proctosigmoidoscopy
C ) FTA-ABS
D ) HIV antibodies by ELISA
E ) Serum prostate specific antigen
F ) No further screening is required
–USMLEWORLD,LLC QBank ver 2009.02
Correct answer is D. This patient’s clinical picture is consistent with primary syphilis. Dark field microscopy is especially useful in diagnosing primary syphilis and visualization of the spirochetes (as in this case) confirms the diagnosis. This patient’s syphilis infection suggests that he may be involved in high-risk sexual activity, also putting him at risk of HIV exposure. After proper counseling, HIV screening using ELISA should be offered.