Syphilis

(1).A 35-year-old man comes to the out-patient clinic with a 2month history of painless, non-pruritus eruption that had begun in
his genital area. 2 months ago, a painless nonbleeding ulcer
occurred on his caput penis and it healed within one month without
any therapy. One month later, he developed diffuse symmetric
lesions on the trunk and proximal extremities. Lesions are pale red
to pink, discrete, round macules that measure 5-10 mm in diameter.
3 months earlier, he had an unsafe sex practice.

What is the possible diagnosis?

Secondary syphilis

What investigation do you think is required?

Serologic test for syphilis (STS):
RPR (or VDRL or USR) &TPPA(or TPHA or FTA-ABS)

What therapy would you prescribe?

procaine penicillin 0.8 million U daily by intramuscular
injection for 10-15 days. OR
benzathine penicillin 2.4 million U by intramuscular injection
per week for 2-3 weeks
If allergic to penicillin: tetracycline/erythromycin 500 mg
qid for 15 days OR doxycycline 100 mg bid for 15 days

What is your advice to the patient?

Follow-up care is needed. Quantitative RPR test at 3, 6, 9, 12,
18 and 24 months following treatment.
Partner management is of great significance.

Gonorrhea

(2).Male ,31-year-old He complained of urethral burning during

urination and for 2 days. Examination showed reddish and swollen
opening of urethra, with yellowish discharges after squeezing. 5
days ago he had an unsafe sex practice.

Q.What is the possible diagnosis?

Gonococcal urethritis (Gonorrhea)

What investigation do you think is required?

Gram-stained smear and Neisseria gonorrhoeae cultures.
Tissue culture for mycoplasmas,
EIA

or NA probe or PCR or LCR for Chlamydia

urine routine test.

What therapy would you prescribe?

Ceftriaxone 125 mg IM in a single dose. OR
Spectinomycin 2g IM in a single dose.

What is your advice to the patient?

7 days after treatment to recheck cultures and confirm the cure
of infection.
Partner management is of great significance.

3.Non-gonococcal infections
Male ,21-year-old, He complained of painful urination and urinary
urgency for 2 days. Examination revealed inflamed urethra, with
clear discharges after squeezing. 3 weeks earlier, he had an unsafe
sex practice.

What is the possible diagnosis?

Non-gonococcal urethritis

What investigation do you think is required?

Gram-stained smear and Neisseria gonorrhoeae cultures.
urine routine test.

Tissue culture for mycoplasmas,

EIA or NA probe or PCR or LCR for Chlamydia

What therapy would you prescribe?

Azithromycin 1g p.o. in a single dose. OR
Doxycycline 100mg p.o.bid for 7~10 days.

What is your advice to the patient?

7 days after treatment to recheck urine routine test and
confirm the cure of infection.
Partner management is of great significance.