View source for WBR0004

{{WBRQuestion
|QuestionAuthor=Anonymous (Edited by Will Gibson)
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Infectious Disease, Infectious Disease
|Prompt=A 34-year-old man presents to the health center concerned that he has contracted a venereal disease. He nervously shows you an ulcerated lesion on the shaft of his penis and states that it has been present for over 1 week. On physical exam, the man is afebrile and except for mild lymphadenopathy in the neck, has a nontender ulcer on his penis measuring 1.5 x 1 x 0.5 cm. Laboratory testing shows him to be VDRL positive. What is the next step in diagnosis?
|Explanation=This patient's clinical presentation and positive VDRL are consistent with primary syphilis.  However, correct diagnosis should be made with confirmation with treponemal testing (either FTA-ABS or FTA-TP) before treatment since VDRL and RPR may be turned falsely positive by some autoimmune diseases.

WJG NOTES: This question strikes me as a bit off.  Why wouldn't you just treat the patient with penicillin?  It's not as though you are giving a toxic chemotherapy - and there are no other signs of autoimmune disease in this patient such as synovitis or joint problems.
|AnswerA=Repeat VDRL in 1 week.
|AnswerB=Obtain RPR for confirmation.
|AnswerC=Obtain DS-DNA serology.
|AnswerD=Obtain a fluorescent treponemal antibody absorption (FTA-ABS).
|AnswerE=Proceed with treatment of the suspected disease.
|RightAnswer=D
|WBRKeyword=Syphilis, Venereal, Sexual, Sexually transmitted infections, STI, STD
|Approved=No
|Answer=Repeat VDRL in 1 week.,Obtain RPR for confirmation.,Obtain DS-DNA serology.,Proceed with treatment of the suspected disease.
}}