Up Above

Immune System


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 Relevant Investigations

1. Dark field microscopy

clear

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

2. Rapid Plasma Reagin

check

The Rapid Plasma Reagin test is strongly reactive.

3. TPPA

check

The Treponema pallidum Particle Agglutination assay is reactive.

4. Biopsy of ulcer

clear

A biopsy will be arranged next week.

Step 3: Select Appropriate Management

1. Metronidazole

clear

2. Penicillin

check

3. Acyclovir

clear

4. Topical Corticosteroids

clear