Question

23 year-old patient presents with a rash on his palms and soles. He also states that he had a something strange on his genitals several weeks before. What's the diagnosis and what’s the treatment (including dosing) for this disease?

Answer

• This is secondary syphilis
• The preferred treatment is Benzathine Penicillin G
  • 2.4 million units intramuscularly
  • Note: this dose is also the same primary syphilis
• Patients with a true penicillin allergy should receive either:
  • Doxycycline 100mg BID x 14 days
  • Tetracycline 500mg QID x 14 days
• A one-time dose of Azithromycin was previously recommended because of increased patient compliance. Many studies, however, suggest resistant species emerging and subsequent risk of treatment failure.

References

Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention. 2010 Treatment Update.

http://www.cdc.gov/std/syphilis/treatment.htm

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