A 25-year-old previously healthy woman comes to the office after her sex partner was diagnosed with primary syphilis 2 weeks ago. She has no symptoms. The patient uses barrier contraceptives inconsistently. Her physical examination is unremarkable.
Which of the following is the most appropriate management for this patient?

Question

A 25-year-old previously healthy woman comes to the office after her sex partner was diagnosed with primary syphilis 2 weeks ago.  She has no symptoms.  The patient uses barrier contraceptives inconsistently.  Her physical examination is unremarkable.
Which of the following is the most appropriate management for this patient?

Quizplus · Accepted Answer

11ec193a_986a_b4ab_853d_1d3c08e0a0c6_MD0002_00 Syphilis is typically transmitted by direct contact with infected lesions on the genitalia, lips, oral cavity, or breasts. Although most transmission occurs during the first year of infection, patients exposed sexually to an individual at any stage of syphilis should be evaluated and treated appropriately. The Centers for Disease Control and Prevention (CDC) guidelines recommend that a patient exposed within 90 days prior to the diagnosis of primary, secondary, or early latent syphilis in a sex partner should receive presumptive treatment (even if the patient is seronegative for syphilis). A patient exposed >90 days before diagnosis of primary, secondary, or early latent syphilis in a sex partner can undergo serologic testing and treatment accordingly. Presumptive treatment should be given if serologic results are not immediately available or follow-up is uncertain. Long-term sex partners of patients with latent syphilis should also be evaluated with serologic testing and treated appropriately. Although CDC guidelines recommend that nontreponemal tests (eg, rapid plasma reagin) be performed first and that treponemal tests (eg, Treponema pallidum enzyme immunoassay) be used for confirmation, many laboratories have switched the order due to cost-related reasons (Choices B and C). (Choice D) Due to emerging macrolide (azithromycin) resistance in many areas, doxycycline is preferred as an alternative to benzathine penicillin for treating syphilis in penicillin-allergic patients. However, this patient has no documented penicillin allergy and should receive benzathine penicillin. Educational objective: A patient exposed within 90 days of diagnosis of primary, secondary, or early latent syphilis in a sex partner should receive treatment (even if the patient is seronegative for syphilis). A patient exposed >90 days after diagnosis of primary, secondary, or early latent syphilis in a sex partner should undergo serologic testing and also receive treatment if results are not immediately available or follow-up is uncertain. __________ References: Treatment of syphilis: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/25387188)

A 25-Year-Old Previously Healthy Woman Comes to the Office After