A 32-year-old heterosexual male presents to a physician with a 3-day history of multiple skin lesions located all over his body and on his mucous membranes.He hasn't felt well and has a low-grade fever.The patient cuts down trees in Massachusetts for a living.He has had multiple sex partners and does not use condoms.Here are the results of his laboratory tests: RPR = reactive 1:128; TP-PA = reactive; Borrelia burgdorferi IgM = less than 1:8; Rickettsia rickettsii IgM less than 1:8.This patient most likely has:

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The patient's laboratory tests suggest a diagnosis of syphilis, with a reactive RPR at a high titer (1:128) and a positive TP-PA. The presentation of multiple skin lesions and mucous membrane involvement is consistent with secondary syphilis, which typically occurs 2-8 weeks after the initial infection. The negative results for Lyme disease and Rocky Mountain spotted fever indicate that these are not the cause of the patient's symptoms. The patient's occupation and sexual history suggest a higher risk for acquiring sexually transmitted infections, including syphilis.

A 32-Year-Old Heterosexual Male Presents to a Physician with a 3-Day