Question

39 yr old G0 woman history of IV drug abuse, HIV non compliant, comes with non tender spots on vulva 1 week. No pain/pruritis. Also brown rash on palms. Vulva has non tender 3 elevated plaques with rolled edges. Next step? Tx?

Answer 1

A 39-year-old woman presenting with vulvar plaques and a palm rash might have secondary syphilis, and the next step is confirmatory serological testing. If diagnosed with syphilis, the treatment includes penicillin G.

Step-by-step explanation:

The 39-year-old female patient with a history of IV drug abuse, HIV non-compliance, and new lesions on her vulva suggests a possible case of a sexually transmitted infection (STI). The non-tender vulvar plaques with rolled edges, together with a brown rash on the palms, are highly suggestive of secondary syphilis. Treatment for syphilis typically includes penicillin G, which is the first-line therapy.

However, before initiating treatment, it is crucial to confirm the diagnosis with serological tests, such as rapid plasma reagin (RPR) or treponemal antibodies testing. This step is essential as it guides proper treatment and monitoring.

The next step for the patient would be to perform diagnostic tests for syphilis using a non-treponemal test such as RPR followed by a confirmatory treponemal antibody test. If the tests are positive, administration of intramuscular benzathine penicillin G would be indicated, as per CDC guidelines.