On pelvic examination, you observe a non-tender, ulcerated, red lesion with raised borders on a patient's labia. Her inguinal lymph nodes are enlarged but non-tender
The patient reports that her partner who is HIV+ has a similar lesion on his penis. The clinician should have a high suspicion of:
A. Herpes simplex I
B. Herpes simplex II
C. Condyloma acuminata
D. Syphilis
ANS: D
The incidence of syphilis has risen dramatically in the last 30 years with the increase in HIV and other STDs. In syphilis, the primary chancre lesion appears as a firm, indurated, painless papule that erodes into an ulcer with raised or reddened borders. Chances are usually single lesions and can occur on any mucous membrane or skin area. Nontender lymphadenopathy is present in the regional nodes. Genital lesions are most commonly seen in women on the external genitalia. Symptoms may be mild enough to go unnoticed, especially when they are in areas other than the genitalia, and they heal without treatment in 4 to 8 weeks.
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