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New England Training Curriculum in
Sexually Transmitted Infections

A CME-based series of online case studies

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Case 7

An 18-year-old male with no past medical history presents to the clinic reporting a four-day history of pruritis and erythema of the glans of the penis. He is not circumcised and has never been sexually active.

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QUESTION 1: What is the most likely diagnosis?*
- A: Candidiasis
- B: Trichomoniasis
- C: Bacterial Vaginosis
- D: Herpes Simplex Virus (HSV)
- E: Syphilis

Question 2: What is true about the epidemiology of syphilis?*
- A: Syphilis does not increase the risk of HIV acquisition
- B: Syphilis is more common in females than males in the United States
- C: African American/Black populations have lower rates of syphilis than White populations
- D: Gay, bisexual and other men who have sex with men (MSM) account for the majority of new syphilis infections in the United States

Question 3: Which of the following is false regarding syphilis?*
- A: Syphilis can be transmitted through oral sex
- B: A maculopapular rash or rash on the palms of the hands and soles of the feet can be a manifestation of secondary syphilis
- C: Individuals with primary syphilis always develop the symptoms of secondary syphilis
- D: During the latent phase, syphilis transmission is rare
- E: Neurosyphilis can occur at any stage of syphilis infection

Question 4: Which one of the following is the most appropriate treatment in this patient?*
- A: Amoxicillin 1 g every 8 hours for 10 days
- B: Penicillin G benzathine 2.4 million units intramuscularly in a single dose
- C: Metronidazole 500 mg orally twice a day for 7 days
- D: Azithromycin 1 g orally in a single dose

Question 5: Which of the following is the most appropriate initial diagnostic assay to test for syphilis?*
- A: A non-treponemal test (e.g. a rapid plasma reagin, RPR)
- B: A treponemal test (e.g. a T. pallidum particle agglutination assay, TP-PA)
- C: A culture
- D: A or B
- E: A, B or C

Question 6: The patient does not follow up for treatment and presents a couple months later with persistent headaches and blurry vision. What are the next appropriate steps?*
- A: Administer a single intramuscular dose of benzathine penicillin
- B: Administer three intramuscular doses of benzathine penicillin, one week apart
- C: Lumbar puncture (LP) and cerebral spinal fluid (CSF) examination
- D: Refer to neurology
- E: Provide reassurance only
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