Question of the Week # 35

A 32 year old man present to your office with complaints of a lesio on his penis that developed 3 days ago. He denies any fever or chills or pain. On further questioning, he reports an unprotected sexual intercourse with a stranger that he met in a night club 2 weeks ago.  Physical examination reveals a normal vitals and no lymhadenopathy. The genitilia examination reveals the following findings as depicted in the picture

What is the Next Step ? Is it Syphilis or Chancroid or Herpes?

Most appropriate next Step in confirming the Diagnosis :




D. Cultures

E. Dark field microscopy of the scraping

15 Responses

  1. e

  2. e

  3. E. Dark field microscopy of the scraping……. Primary syphilis

  4. E

  5. eeee

  6. c.ftab is confirmatory test for syphilis.

  7. c. ftabs is the confirmatory test for syphilis. dark field microscopy is the most accurate test but it is rarely done.

  8. E is the answer as FTABS and VDRL might be falsely neg in primary syphilis..,

  9. Screening Tests (VDRL, RPR) will be falsely ⊖ in 1° syphilis.

    IF case describes a painless genital ulcer → order darkfield microscopy for Dx of 1° syphilis.

    • and need 3x negative tests on different days to R/o syphilis

      • there is a false ⊖ rate of 25% for both the VDRL and RPR. In other words, these serologic tests need several weeks to become ⊕, and they are only 75% sensitive in 1° syphilis.

  10. E

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