A 25-year-old male student presents with the chief complaint of rash...

A 25-year-old male student presents with the chief complaint of rash. There is no headache, fever, or myalgia. A slightly pruritic maculopapular rash is noted over the abdomen, trunk, palms of the hands, and soles of the feet.
Inguinal, occipital, and cervical lymphadenopathy is also noted.
Hypertrophic, flat, wartlike lesions are noted around the anal area.
Laboratory studies show the following:
Hct: 40%
Hgb: 14 g/dL
WBC: 13,000/μL
Diff:
Segmented neutrophils: 50%
Lymphocytes: 50%

The most useful laboratory test in this patient is
a. Weil-Felix titer
b. Venereal Disease Research Laboratory (VDRL) test
c. Chlamydia titer
d. Blood cultures

Answer: b. Venereal Disease Research Laboratory (VDRL) test

The treatment of choice for this patient is
a. Penicillin
b. Ceftriaxone
c. Tetracycline
d. Interferon α
e. Erythromycin

Answer: a. Penicillin

Discussion:
The diffuse rash involving palms and soles would in itself suggest the possibility of secondary syphilis. The hypertrophic, wartlike lesions around the anal area, called condylomata lata, are specific for secondary syphilis.
The VDRL slide test will be positive in all patients with secondary syphilis.

The Weil-Felix titer has been used as a screening test for rickettsial infection. In this patient, who has condylomata and no systemic symptoms, Rocky Mountain spotted fever would be unlikely.

No chlamydial infection would present in this way. Blood cultures might be drawn to rule out bacterial infection such as chronic meningococcemia; however, the clinical picture is not consistent with a systemic bacterial infection.

Penicillin is the drug of choice for secondary syphilis. Ceftriaxone and tetracycline are usually considered to be alternative therapies. Interferon α has been used in the treatment of condyloma acuminata, a lesion that can be mistaken for syphilitic condyloma.