A 39-year-old woman presents with itchy, scaling maculopapules on her palms and very faint, similar lesions on her soles of 10 days duration. There are 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 multivitamin and oral contraceptives.
DIAGNOSIS: secondary syphilis
A 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 two 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.
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For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit CrutchfieldDermatology.com.