Primary Syphilis
This painless, indurated ulcer is typical of the chancre of primary syphilis. This patient also had a positive RPR in a titer of 1:32.
A 17-year-old woman noted a gradually increasing, asymptomatic “sore” on her lower lip.
Key point: The patient was sure that this was merely a chancre sore, but became alarmed when the lesion failed to resolve after several weeks. This painless, indurated ulcer is typical of the chancre of primary syphilis. She also had palpably enlarged submental and submaxillary lymph nodes and a positive RPR in a titer of 1:32. She admitted to multiple episodes of oro-genital contact with different partners within the past 3 months; this led to an extra-genital chancre.
Treatment: Primary syphilis was treated with intramuscular benzathine penicillin (2.4 milion units).
Note: Aside from referral to the county health department for contact tracing, the patient was also offered, but refused, HIV testing.
Common Side Effects of Antiretroviral Therapy in HIV Infection
February 7th 2013What are some of the more common side effects of antiretroviral therapy, and what can the primary care physician do to help manage these effects? In this podcast, infectious disease expert Rodger MacArthur, MD, offers insights and points readers to updated comprehensive guidelines.
