39 year old woman presents with itchy, scaling maculo-papules on her palms of 10 days duration. Very faint similar lesions on her soles. No papules on her face or in her mouth. She reports mild flu-like symptoms for the past week or so and is otherwise healthy taking only a multi vitamin and oral contraceptives.

What’s your diagnosis?

Diagnosis: Secondary Syphilis

Secondary Syphilis Biopsy confirmed floridly positive fluorescent treptoneme antibodies assay and her RPR test was strongly positive. Treatment of choice is high dose IM penicillin. Some even repeat the injection 2 weeks later. The patient and partner were referred to the department of health STD clinic for treatment, partner testing, and both for HIV testing. They will also be followed/monitored by that clinic. The lesions are what some texts refer to as “copper pennies” (British pennies) of secondary syphilis.

For additional information and information for patients please see:
http://www.nlm.nih.gov/medlineplus/syphilis.html
http://www.mayoclinic.org/diseases-conditions/syphilis/basics/definition/con-20021862
http://www.webmd.com/sexual-conditions/guide/syphilis

For more Cases of the month see:
		Cases of the Month Archives