An 18 year old male comes into the clinic complaining of a headache, a sore throat, myalgia, nausea, and other flu-like symptoms. The doctor immediately notices that he man has a generalized disseminated skin rash that covers his skin, including his palms and soles of his feet. The history reveals that the man has been sexually active with multiple partners in the last year. When prompted, the patient admits that the had a painless chancre on his penis about six months ago, but it had cleared up on its own. Penicillin was prescribed and the doctor recommends that the patient contact all of his sexual partners to encourage them to come to the clinic for treatment. What does the man have? Group of answer choices A. Gonorrhea B. Syphilis C. Genital herpes D. Chlamydia
The correct answer and explanation is:
Correct Answer: B. Syphilis
The clinical presentation strongly suggests secondary syphilis, a stage of the sexually transmitted infection caused by the bacterium Treponema pallidum. Syphilis progresses in distinct stages, each with characteristic signs and symptoms. The history and clinical findings of this patient match this progression precisely.
The patient reports having had a painless chancre on his penis about six months ago, which is typical of primary syphilis. This initial lesion often appears at the site of infection and resolves on its own after a few weeks. This is followed by a latent period, and then the onset of secondary syphilis, which is what the patient is currently experiencing.
Secondary syphilis is marked by systemic symptoms such as fever, headache, sore throat, muscle aches (myalgia), and nausea, which resemble flu-like symptoms. A hallmark of this stage is a generalized maculopapular rash, often involving the palms of the hands and soles of the feet, which is uncommon in most other illnesses. This skin manifestation is highly suggestive of syphilis and serves as a critical diagnostic clue.
The doctor appropriately prescribes penicillin, which remains the treatment of choice for all stages of syphilis. It is also crucial to notify and treat all recent sexual partners to prevent reinfection and further spread of the disease. Without treatment, syphilis can progress to a latent stage and eventually to tertiary syphilis, which can result in severe complications involving the heart, brain, and other organs.
The other options do not match the full clinical picture. Gonorrhea and chlamydia typically present with genitourinary symptoms like urethral discharge or burning, not systemic symptoms or rash. Genital herpes is characterized by painful vesicular lesions, not a painless chancre or systemic rash. Thus, syphilis is the most accurate diagnosis.