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Zorluk: KolayInfectious Diseases

A 24-year-old man comes to the clinic due to a sore on his penis that he noticed 5 days ago. He reports no pain, itching, or penile discharge. He is sexually active with a new male partner and does not use condoms consistently. Vital signs are within normal limits. Physical examination reveals a single, 1.5-cm, sharply circumscribed, indurated, and painless ulcer on the penile shaft. Bilateral, non-tender inguinal lymphadenopathy is present. Which of the following is the most appropriate pharmacotherapy for this patient?

  1. A
    Intramuscular ceftriaxone
  2. B
    Oral acyclovir
  3. Intramuscular benzathine penicillin GCevap
  4. D
    Oral azithromycin
  5. E
    Intravenous aqueous penicillin G

Cevap

Intramuscular benzathine penicillin G
The patient's painless, indurated genital ulcer with non-tender inguinal lymphadenopathy is the classic presentation of a primary syphilitic chancre, caused by the spirochete Treponema pallidum. The most appropriate first-line treatment for primary, secondary, and early latent syphilis is a single dose of intramuscular benzathine penicillin G.

Adım Adım Çözüm

1
Analyze the clinical presentation of the genital ulcer.
The patient has a single, indurated, sharply circumscribed, and painless ulcer accompanied by non-tender inguinal lymphadenopathy.
Identifying the specific characteristics of genital ulcers (painful vs. painless, single vs. multiple, purulent vs. clean) is essential for diagnosing the underlying sexually transmitted infection.
2
Formulate the most likely diagnosis.
The classic presentation of a painless chancre indicates primary syphilis caused by Treponema pallidum.
Other common causes of genital ulcers, such as herpes simplex virus and Haemophilus ducreyi, typically present with painful lesions.
3
Select the appropriate pharmacotherapy based on the diagnosis.
Intramuscular benzathine penicillin G is selected.
A single dose of long-acting intramuscular benzathine penicillin G is the standard of care and highly effective first-line therapy for primary, secondary, and early latent syphilis.

Anahtar Kavram

The hallmark of primary syphilis is a painless, indurated genital chancre, and the standard first-line treatment is a single dose of intramuscular benzathine penicillin G.
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Infectious Diseases

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