Syphilis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍symptoms suggestive of syphilisgenital ulcerskin rash

Symptoms include:

‍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, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍muscle aches

‍fatigue



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍unprotected sex

‍multiple sexual partners

‍sexual partner with a history of syphilis

no history of: ‍syphilis, ‍sexually transmitted infections, ‍HIV, ‍immunodeficiency





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Syphilis ‍likelysuspectedpossible

DDx: syphilis, gonorrhea, chlamydia, HIV, herpes simplex virus infection, chancroid, lymphogranuloma venereum, granuloma inguinale, hepatitis B and C, HPV, molluscum contagiosum, genital warts, scabies, balanitis, vulvitis, contact dermatitis, lichen planus, lichen sclerosus, psoriasis





PLAN:

Investigations:

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

- Lumbar puncture

- Chest X-ray

Treatments:

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

- ‍Doxycycline

- ‍Ceftriaxone

- ‍Azithromycin

- ‍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

Further care:

- 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

- Referral to ER if severe headache, vision changes, or other signs of neurosyphilis occur