usmlebuzz
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A 50-year-old man presents with a sore on the head of his penis. He states that he is sexually active with many different women. You are very concerned for syphilis and send a serum VDRL along with a swab of the lesion looking for treponema. Upon further questioning, the patient states that the lesion is not painless but not particularly painful; on exam, it appears ulcerated. The patient is uncircumcised. What was the likely exposure?
A. Chlamydia
B. HIV
C. HPV
D. HSV
E. Trichomonas
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| benicio
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d . HSV
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| usmlebuzz
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I am not sure :?: :?: :roll:
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| Malaysian
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i agree with the answer.
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| bactitech
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If you send that swab looking for Treponema without calling the lab first you'll be in big trouble. These are only seen by darkfield, and not all labs are even set up to do these. I've never done one in 30 years! The only ones I know of that have been done in the past have been done by our Ph.D. microbiologists, but they need to know ahead of time that the specimen is coming. I'm not sure even how to submit it. It may not even be on a swab. We may get one request every couple of years or so for this test, if that.
RPR is the test done on serum. VDRL's are hardly ever done on serum anymore. VDRL's are the ONLY test, however, that can be run on CSF. If a RPR is positive, a FTA-ABS must be run as a confirmatory test, which is usually a sendout to a reference lab unless you work in a REAL big place.
Also, RPR's are not usually done as STAT testing, so I would advise a good history taking session with this patient. Cultures for HSV take days. Smaller labs send out their HSV cultures also.
Just thought you'd all want to know the real world situation with this question.
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Clinical Microbiology since 1974
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| Malaysian
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Thanks bactitech....you mentioned HSV is grown on culture......which culture is this.....I thought a tzanck body was seen in microscopy to determine HSV.
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| bactitech
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Tzanck smears are real old hat stuff. They are done in Histology if they are performed at all. HSV is readily grown in viral culture medium (cell of some type - I know zero about virology). We get multiple cultures a day for HSV. I believe they can also be differentiated between HSV I and II. Negatives take 3-4 days before they're signed out, I believe.
If you order a Tzanck smear, you're dating yourself, I believe, although there may be more orders than I know about, as I don't work in Histology. I tend to doubt it, however.
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Clinical Microbiology since 1974
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