Monday, February 8, 2016

24-year-old woman who was recently treated for vaginal discharge--DrSudeep KC

A 24-year-old woman who was recently treated for vaginal discharge now returns after she received a letter telling her that she had a positive VDRL. She recalls having had a painless ulcer 5 or 10 years ago that resolved without treatment. She has no complaints or physical findings on your examination.


What is the treatment of choice for this patient?


a. Benzathine penicillin G, 2.4 million units IM weekly for 3 weeks.
b. Benzathine penicillin G, 2.4 million units IM daily for 14 days.
c. Aqueous crystalline penicillin G, 50,000 U/kg IV every 6 hours for 3 weeks.
d. Procaine penicillin, 2.4 million units IM daily for 10–14 days and probenecid 500 mg orally 4 times daily for 17–21 days.
e. Benzathine penicillin G, 2.4 million units IM, one dose only.


The answer is a. Because she has likely had syphilis for longer than 1 year, this patient has late latent syphilis.
During latent syphilis, there are no clinical symptoms and laboratory testing is the only means of identification.


The positive VDRL should be confirmed with subsequent fluorescent treponemal antibody absorption (FTA-ABS) tests. Treatment with benzathine penicillin G 2.4 million units IM weekly for 3 weeks should be initiated. The patient should be advised to undergo HIV testing and her sexual partners should be evaluated for syphilis. Choice d is an acceptable treatment for neurosyphilis.

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