Syphilis, Primary

Up Above

Step 1: View clinicals

A 32 year old man presents with a painless oral ulcer for one week. Further questioning reveals that he had unprotected orogenital sex with two separate partners during the preceding month. He is otherwise well, with an unremarkable medical history.


Step 2: Order all relevant investigations

Dark field microscopy

You remember that dark field microscopy of oral lesions is not recommended.

Rapid Plasma Reagin

The Rapid Plasma Reagin test is strongly reactive.

TPPA

The Treponema pallidum Particle Agglutination assay is reactive.

Biopsy of ulcer

A biopsy will be arranged next week.


Step 3: Select appropriate management

Metronidazole
Penicillin
Acyclovir
Topical Corticosteroids


Score: ★★☆