Syphilis

HISTORY:

‍Symptoms of syphilisGenital ulcerSkin rash for ‍ ‍hoursdays

‍genital ulcer

‍skin rash including palms and soles

‍mucous membrane lesions

‍fever, up to ‍°, over ‍ ‍hoursdays

‍swollen lymph nodes

‍sore throat

‍patchy hair loss

‍headaches

‍weight loss

‍muscle aches

‍fatigue

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash



ASSESSMENT:

‍Syphilis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍creatinine, ‍LFTs, ‍CRP, ‍HIV, ‍RPR, ‍FTA-ABS, ‍HBsAg, ‍anti-HBs, ‍anti-HBc, ‍anti-HCV, ‍syphilis IgM

- Lumbar puncture

- Chest X-ray

- ‍Penicillin G (advised that may experience fever and muscle aches in the 24 hrs following injection)

- ‍Acetaminophen

- ‍Ibuprofen

- Sexual partners notification and screening treatment (last 12 months)

- Sexual partners treatment (last 3 months)

- Abstinence until treatment completed and symptoms resolved

- Counseling on safe sex practices

- Notification to public health

- Repeat Syphilis RPR in 3, 6, and 12 months

- Referral to infectious disease specialist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop