Question

A 34 year-old graduate student presents to the student health center with reddish, crusted lesions on his penis. He is treated with fungal cream. One week later he returns because the lesions are not getting better, and he is prescribed dicloxacillin (penicillin derivative) for a presumed staph infection. It’ been over 3 months since his initial visit, and the lesions on his penis have resolved. However, he now returns with a rash on his trunk and sees a different provider who knows the patient is a man who has sex with men.

3. The lesions are called __________ and are a “hallmark” of _________ stage of disease.

Question 3 options:

	A. chancres / primary
	B. chancres/ secondary
	C. Boils / primary
	D. Boils / primary

A 34 year-old graduate student presents to the student health center with reddish, crusted lesions on his penis. He is treated with fungal cream. One week later he returns because the lesions are not getting better, and he is prescribed dicloxacillin (penicillin derivative) for a presumed staph infection. It’ been over 3 months since his initial visit, and the lesions on his penis have resolved. However, he now returns with a rash on his trunk and sees a different provider who knows the patient is a man who has sex with men.

4. The rash indicates?

Question 4 options:

	A. Secondary syphilis
	B. The staph infection has developed into toxic shock syndrome
	C. Primary chlamydia
	D. The patient has a second infection with another pathogen

Answer 1

Question 3.

The lesions are called chancres and are a "hallmark" of primary stage of disease.

Explanation: This 34 years old graduate student has history of having sex with other men and presents with the complaints of reddish, crusted lesion on his p*nis which did not subside on application of antifungal cream ( hence not a fungal disease). Even after prescribing dicloxacillin- a penicillin derivative the lesion did not subside, hence not a staphylococcal bacterial infection. After three months, the lesions of the p*nis subsided but the patient developed rashes on his trunks. All these, points in the direction of the diagnosis of a sexually transmitted disease called syphilis.

Syphilis is a sexually transmitted diasease caused by a bacterium called treponema pallidum. It has four stages namely primary, secondary, latent and tertiary syphilis.

In primary syphilis, there is development of a painless but non itchy and firm skin ulceration most commonly on the p*nis in males in cervix in females. This lesion is known as chancre. It can also develop in rectum and anus. This lesion develops within 3-6 weeks after coming in contact with a lesion in an infected person.

In secondary syphilis, within 8-12 weeks of contacting the infection, the patient develops symmetrical reddish rash over the trunks and also over palms and soles. In addition to skin rashes, mucous membranes and lymph nodes may also get involved.

In latent syphilis, the symptoms subsides within 2-3 years of contacting the infection. Although the serological tests are positive for syphilis during this stage.

Tertiary syphilis develops within 5-15 years of primary syphilis and the the diasease becomes a systemic illness where it involves cardiovascular and nervous system.

Thus, this graduate student who has a history of having sexual contact with other men and presented with reddish crusted lesion on his p*nis and after three months presented with skin rashes over his trunk is a case of syphilis with the penile lesion being called as chancre which indicates primary stage of syphilis.  

Question 4

The rash indicates:

Answer: A) secondary syphilis.

Explanation: Symmetrical, reddish and non itchy rash develops over the trunk in a patient of syphilis within 8-12 weeks of contacting the infection. This is stage of secondary syphilis.

The patient is a 34 years old graduate student having a history of sexual contact with other men and complaints of reddish, crusted lesion on the p*enis which remained unaffected by antifungal cream (hence not a fungal infection). The lesion also remained unaffected by dicloxacillin-a penicillin derivative hence it is not a staphylococcal skin infection. All these points towards the diagnosis of a sexually transmitted disease called syphilis caused by a bacterium called treponema pallidum.

In the primary stage of the disease, there is development of painless, non itchy skin ulceration most commonly over the p*nis in males and cervix in females.

In 2-3 months, stage of secondary syphilis sets in where there is development of skin rashes over the trunk and also over palms and soles of the patient.

Thus, this 34 years old graduate student, skin rash indicates secondary syphilis as skin rashes are characteristic features of secondary syphilis along with some other features like involvement of mucous membranes and lymph nodes and in some cases weight loss, loss of hair, etc.