Justice
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A 23-year-old man was seen at a local clinic for sexually transmitted diseases because of his second episode of symptomatic primary genital syphilis. He asked why this happened on two different occasions. He has been sexually active since 15 years of age, and most of his contacts have been with other men. He usually uses condoms but reports that they sometimes tear. His last HIV test 9 months ago was negative.
Which of the following is the best explanation for his repeated episodes of syphilis?
A. Occult HIV infection
B. Failure to treat occult Chlamydia infection
C. Sexual contacts within a partner network with a high prevalence of syphilis
D. Incomplete treatment of his previous episode of syphilis
E. Infection with penicillin-resistant Treponema pallidum
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| WaqasQureshi
Forum Junior
Topics: 3
Posts: 96
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C
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| dr.wad
Forum Senior
Topics: 3
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yes C
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| peter90036
Forum Elite
Topics: 28
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C ... too much porn on this exam
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,893
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Yea, this one is easy:
The correct answer is C
Although the prevalence of syphilis transmission is currently low in the United States, there are populations in whom the disease is still relatively common. In these groups involving certain sexual partner networks, the probability of acquiring syphilis from any given sexual encounter is many fold higher than in the general population. The sexual partner networks have been described in the context of Internet chat rooms, but they also apply to populations of people with multiple sexual partners within a limited demographic setting.
HIV infection can be subtle, but a negative HIV test in the past year makes HIV-related syphilis extremely unlikely. It is, however, prudent to test all patients with newly diagnosed syphilis for HIV infection. Although occult chlamydial infections may occur in men or women, these infections do not seem to be related to the acquisition of syphilis. Gonorrhea is the most common setting for such concomitant chlamydial infections. When syphilis treatment is incomplete, the manifestations are of secondary or tertiary syphilis. To date, there are no penicillin-resistant strains of syphilis. Although testing of clinical specimens for resistance is not available, in vitro testing and clinical experience support this conclusion.
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