Presentation Date
13-10-2022 12:00 AM
Description
A 38-year-old male presented to the emergency department with complaints of a painful penile ulcer for four weeks. Six months prior to presentation, the patient was diagnosed with secondary syphilis and clinically treated with Bicillin; however, RPR titers posttreatment were not ordered, as is standard of care. One week before presentation, the patient visited his primary care physician and had a urine PCR screening for sexually transmitted infection, which provided the diagnosis of Chlamydia. This infection was treated with azithromycin. Following no improvement from treatment, the patient presented to the ED with the complaint of painful penile lesion x days, as well as a variety of symptoms including paresthesias, blurred vision and notably chronic hearing loss that had been progressing for months and previously evaluated by audiology. Concerned for neurosyphilis RPR titers revealed values which were unchanged from titers drawn before past treatment of his secondary syphilis. The CDC recommends monitoring of RPR post-syphilis treatment to assess treatment efficacy, with a subsequent decrease in titers expected. This case demonstrates its role in preventing progression, as in this case, to neurosyphilis [1]. Beyond neurological symptoms, the patient also had painful inguinal lymphadenopathy associated with a painful penile ulcer which was diagnosed as Lymphogranuloma Venereum. Additionally, though the patient had no complaints, further STI testing was done via swabbing genital, anal and pharyngeal locations which revealed anal Gonorrhea. As a result, this case demonstrates the importance for comprehensive STI screening to be performed at all possible contact locations regardless of condom use including genital, anal, and oropharyngeal sites in patient who present with a sexually transmitted infection [2]. 1. Centers for Disease Control and Prevention. (2022, March 30). Syphilis - STI treatment guidelines. Centers for Disease Control and Prevention. Retrieved September 8, 2022, from https://www.cdc.gov/std/treatmentguidelines/syphilis.htm 2. Centers for Disease Control and Prevention. (2022, June 6). STI screening recommendations. Centers for Disease Control and Prevention. Retrieved September 8, 2022, from https://www.cdc.gov/std/treatmentguidelines/screening-recommendations.htm
Recommended Citation
Corley, Sarah; Knighton, Caila; and Moise, Hope Oddo, "Neurosyphilis, Lymphogranuloma Venereum, and N. Gonorrhea reveal importance of appropriate STI testing and follow-up" (2022). Medical Research Day. 20.
https://digitalscholar.lsuhsc.edu/sommrd/2022MRD/Posters/20
Included in
Neurosyphilis, Lymphogranuloma Venereum, and N. Gonorrhea reveal importance of appropriate STI testing and follow-up
A 38-year-old male presented to the emergency department with complaints of a painful penile ulcer for four weeks. Six months prior to presentation, the patient was diagnosed with secondary syphilis and clinically treated with Bicillin; however, RPR titers posttreatment were not ordered, as is standard of care. One week before presentation, the patient visited his primary care physician and had a urine PCR screening for sexually transmitted infection, which provided the diagnosis of Chlamydia. This infection was treated with azithromycin. Following no improvement from treatment, the patient presented to the ED with the complaint of painful penile lesion x days, as well as a variety of symptoms including paresthesias, blurred vision and notably chronic hearing loss that had been progressing for months and previously evaluated by audiology. Concerned for neurosyphilis RPR titers revealed values which were unchanged from titers drawn before past treatment of his secondary syphilis. The CDC recommends monitoring of RPR post-syphilis treatment to assess treatment efficacy, with a subsequent decrease in titers expected. This case demonstrates its role in preventing progression, as in this case, to neurosyphilis [1]. Beyond neurological symptoms, the patient also had painful inguinal lymphadenopathy associated with a painful penile ulcer which was diagnosed as Lymphogranuloma Venereum. Additionally, though the patient had no complaints, further STI testing was done via swabbing genital, anal and pharyngeal locations which revealed anal Gonorrhea. As a result, this case demonstrates the importance for comprehensive STI screening to be performed at all possible contact locations regardless of condom use including genital, anal, and oropharyngeal sites in patient who present with a sexually transmitted infection [2]. 1. Centers for Disease Control and Prevention. (2022, March 30). Syphilis - STI treatment guidelines. Centers for Disease Control and Prevention. Retrieved September 8, 2022, from https://www.cdc.gov/std/treatmentguidelines/syphilis.htm 2. Centers for Disease Control and Prevention. (2022, June 6). STI screening recommendations. Centers for Disease Control and Prevention. Retrieved September 8, 2022, from https://www.cdc.gov/std/treatmentguidelines/screening-recommendations.htm
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