A 26-year-old woman with new-onset vaginal discharge is diagnosed with Trichomonas infection. She has had several sexual partners over the last year. The patient has no genital ulcers, skin rash, back pain, headaches, vision problems, or fever. She has no other known medical problems or drug allergies. She does not recall having previous testing for sexually transmitted infections.
Physical examination is unremarkable.
Laboratory results are as follows:
In addition to treating the Trichomonas infection, which of the following is the best next step in management of this patient?

Question

A 26-year-old woman with new-onset vaginal discharge is diagnosed with Trichomonas infection.  She has had several sexual partners over the last year.  The patient has no genital ulcers, skin rash, back pain, headaches, vision problems, or fever.  She has no other known medical problems or drug allergies.  She does not recall having previous testing for sexually transmitted infections.
Physical examination is unremarkable.
Laboratory results are as follows:
 In addition to treating the Trichomonas infection, which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec193a_986a_668a_853d_e1c558b6e466_MD0002_00 This patient has an elevated rapid plasma reagin (RPR) titer with positive confirmatory testing by Treponema pallidum enzyme immunoassay and no symptoms of primary syphilis (eg, chancre) or secondary syphilis (eg, rash or aseptic meningitis). These findings are consistent with latent syphilis of an unknown duration. Without treatment, she will be at risk for sequelae of tertiary syphilis, including cardiac and neurological complications. The regimen of choice for latent syphilis of unknown duration and for tertiary syphilis (not including neurosyphilis) is benzathine penicillin G 2.4 million units intramuscularly weekly for 3 weeks. This is typically administered in the outpatient setting. Benzathine penicillin 2.4 million units intramuscularly for a single dose is the appropriate management for early syphilis (Choice B). This includes primary syphilis, secondary syphilis, or latent syphilis of <1 year duration (if proven conclusively). Doxycycline is sometimes used in patients with severe penicillin allergy (Choice D). Intravenous penicillin is the treatment of choice for neurosyphilis. (Choice A) False-positive RPR results can occur in patients with autoimmune conditions such as systemic lupus erythematous (SLE), which is often marked by an elevated antinuclear antibody titer. This patient has no symptoms of SLE but does have risk factors for syphilis as well as positive nontreponemal and treponemal (T pallidum enzyme immunoassay) test results. These are unlikely to be false positives, and antinuclear antibody screening is unlikely to change management. (Choice E) Cerebrospinal fluid analysis is recommended for patients who have neurological/ophthalmologic symptoms of syphilis, evidence of active tertiary syphilis in other areas (cardiovascular, gummas), or HIV infection. Lumbar puncture is not indicated in this patient who is HIV-negative and asymptomatic. Educational objective: Asymptomatic patients with late syphilis or syphilis of unknown duration (>1 year) who are HIV-negative should be treated with benzathine penicillin weekly for 3 weeks. __________ References: Syphilis: a reemerging infection. (http://www.ncbi.nlm.nih.gov/pubmed/22963062)

A 26-Year-Old Woman with New-Onset Vaginal Discharge Is Diagnosed with Trichomonas