Syphilis: The Daily PANCE Blueprint

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Syphilis: The Daily PANCE Blueprint

A 28-year-old man presents to the clinic for a routine check-up. He reports having multiple sexual partners in the past year and occasionally forgetting to use condoms. He denies any symptoms of genital ulcers or rashes. Physical examination is unremarkable. Given his sexual history, you decide to screen him for sexually transmitted infections, including syphilis. His nontreponemal test comes back positive, but the subsequent treponemal test is negative. What is the most appropriate next step in the management of this patient?

A) Treat for syphilis with intramuscular penicillin G
B) Repeat both nontreponemal and treponemal tests
C) Perform cerebrospinal fluid evaluation for neurosyphilis
D) Consider the result as a false positive and provide counseling on safe sexual practices
E) Refer to the local health department for details of prior testing and treatment

Answer and topic summary

The answer is D) Consider the result as a false-positive and provide counseling on safe sexual practices

In this asymptomatic patient with a positive nontreponemal test and a negative treponemal test, the most likely explanation is a false-positive syphilis result. False-positive nontreponemal tests are common and can occur for various reasons, including acute infections and autoimmune conditions. Given the negative treponemal test, syphilis is unlikely, and the focus should be on counseling the patient about safe sexual practices. However, testing should be repeated in those with a recent high-risk exposure.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Infectious Disease (6%) ⇒ Spirochetal Disease

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