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PATIENT PRESENTATION

Chief Complaint

“My doctor told me that I might have syphilis but I’m feeling just fine.”

History of Present Illness

A patient presents to you in disbelief that he has been infected by syphilis as he has felt very well for some time. He is asking for your second opinion and help in managing this issue.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. Which key lab findings and patient information suggest that this infection should be classified as late latent syphilis? Is it possible that this patient may have another stage of infection such as early latent syphilis? If so, why can or cannot this patient be treated as such?

    Hint: See Syphilis in PPP

  2. What questions could be asked to help try and determine when the patient may have become infected with syphilis?

    Hint: See Syphilis in PPP

  3. If the patient were to prefer the oral alternative treatment for syphilis as he heard from friends that “the shots hurt,” could this be permitted? Why or why not?

    Hint: See Syphilis in PPP

  4. What lab-based treatment goal differs from more overt stages of syphilis infection such as primary or secondary syphilis when compared to late latent syphilis? How might this complicate managing this patient in the future?

    Hint: See Syphilis in PPP

  5. Why might you recommend that this patient consider continuing on PrEP for HIV prevention in the setting of syphilis infection?

    Hint: See “Latent Syphilis” in the Sexually Transmitted Infections Treatment Guidelines, 2021 on the Centers for Disease Control and Prevention (CDC) web site

FOLLOW-UP

What is the most likely explanation for the patient’s perceived penicillin allergy? How might this issue have been better managed had the patient reached out to the clinic?

Hint: See Syphilis in PPP

CASE SUMMARY

Global Perspective

Syphilis represents a deceptively difficult to identify and manage STI that continues to contribute to morbidity/mortality all over the world. Recent WHO estimates suggest that there are around 6 million new cases of syphilis each year. A meta-analysis reviewing data from 2000-2020 suggests unacceptably high numbers of syphilis prevalence among men who have sex with men (MSM) across various countries. Although latent syphilis may not be transmitted sexually, it can be transmitted vertically from mother to child leading to congenital syphilis. WHO estimated 661,000 cases of congenital syphilis occurred in 2016 leading to approximately 143,000 fetal deaths and stillbirths, making it the second leading cause of preventable stillbirth in the world.

Key References

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