Transcript Slide 1 - STD Prevention Online

A Man with a Faint Rash
The 5-Minute STI Clinical Case Study
Case History
• 30 year-old gay man complaining of a faint, nonitching rash for >4 weeks
• Took left-over amoxicillin for sore throat about 1
month ago – however, pt. does not have a prior
history of penicillin allergy
• No neurological symptoms or other physical
complaints
Case History -Continued
• Sexual and STI History
– 2 partners in past 6 months:
• One steady partner
• One occasional partner (about 3 months ago)
– Protected receptive and insertive anal sex with steady
partner only
– Unprotected oral sex with steady and occasional
partners
– No history of genital/rectal sores
– Rectal gonorrhea and chlamydia > 1 year ago
– History of primary syphilis – treated 4 years ago with
2.4 MU LAB
– Most recent RPR: NR (14 months ago; this clinic
– HIV: negative (14 months ago; this clinic)
Physical Exam
• Faint erythematous macular rash trunk
and extremities
• Soles of feet involved, but palms of hands
are not
• No excoriations or scratch marks noted
• No penile or anal lesions observed
• Neurological exam: normal
Question 1
What laboratory test would be the least
useful in this case?
a)
b)
c)
d)
e)
Qualitative (stat) RPR
Quantitative RPR
Treponemal test (TPPA or FTA-abs)
HIV rapid test
HIV viral load
Stat Lab Results
• Qualitative RPR reactive: ++++
• HIV Rapid Test: Positive
Question 2
Based on our knowledge so far, what is the
most likely diagnosis?
a)
b)
c)
d)
Acute HIV Infection
Drug rash
Secondary syphilis
Scabies
Question 3
You decide to treat the patient for secondary
syphilis – what do the CDC treatment
guidelines recommend:
a) LAB 2.4 MU i.m. now and refer to HIV care
b) LAB 2.4 MU i.m. now and once a week for 2
subsequent weeks + refer to HIV care
c) Patient should undergo LP before treatment is
initiated
d) Refer to HIV care as treatment will depend on
HIV viral load and CD4 count
Question 4
Regarding the patient’s follow up – which is
a CDC recommendation?
a) Patient should return for follow-up at 1 and 2
weeks for additional treatment
b) Serological follow-up should be more
frequent than in HIV negative patients
c) Follow-up should include a neurological
work-up and LP to exclude neurosyphilis
Disclaimer
• Copyright case study and clinical photos:
– Dr. Kees Rietmeijer, STD Control Program,
Denver Public Health Department
• Individual slides can be used for
educational purposes with reference to
source and/or inclusion of the DMHC logo