A 22-year-old female with no significant past medical history presents to her primary care physician complaining of a painless lesion she discovered on her vulva the day before. Upon further questioning she admits to unprotected sex with a new partner. Her blood work reveals that her HIV ELISA is negative but her VDRL and FTA results are positive. If this patient were to go untreated, which of the following sequelae would develop within 1-6 months of the primary infection?
1.Arthritis
2.Maculopapular rash
3.Pelvic inflammatory disease
4.Shingles
5.Paresis
Correct answer
Maculopapular rash
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correct answer: B
The spirochete Treponemia pallidum causes the chronic systemic infection of syphilis, which is transmitted primarily through sexual contact. Primary syphilis manifests as chancres – or painless, elevated ulcers – that develop approximately 3 weeks after inoculation and heal within 2 to 6 weeks. If untreated, the secondary stage of syphilis manifests as a maculopaular rash (Choice B) on the palms and soles. After resolution of the second stage, the infection enters a latent phase that can last for years. Tertiary syphilis is characterized by gummas of the skin and bones, cardiovascular syphilis with aortitis, and neurosyphilis with menigovascular disease, paresis (Choice E), and tabes dorsalis. Although unlikely, tertiary syphilis could present within 6 months but only if the patient were immunosuppressed (HIV/AIDS, or on immune suppressive drugs). However, the patient has no past medical history and does not have active HIV, so tertiary syphilis is very unlikely.
Untreated infection with Neisseria gonorrhoeae can lead to arthritis (Choice A).
Pelvic inflammatory disease (Choice C), or acute salpingitis, generally begins as a Neisseria gonorrhoeae or Chlaymdia trachomatis cervicitis that ascends the female reproductive tract if untreated.
Shingles (Choice D) is a viral disease characterized by painful blisters in a dermatomal distribution. It is caused by reactivation of a previous varicella zoster virus infection.