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Clinical Question

Discussion in 'Emergency Medicine' started by BADMD, May 1, 2007.

  1. BADMD

    BADMD Physician 10+ Year Member

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    Dec 28, 2006
    Detroit
    So I saw a 21 year old AA male with a painless penile lesion. He noticed it the night before. No symptoms of any kind. Only medical history is previously treated GC. No trauma

    The lesion is about 1 x 1 cm, red, flat, with a small abrasion in the center. He said it was bleeding early that day. No penile discharge. No testicular tenderness. No palpable nodes.

    Any thoughts?

    Oh yeah, and his RPR is negative.
     
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  3. mountainman123

    mountainman123 Guest

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    Jul 18, 2006
    Haemophilus Ducreyi is the only painless penile lesion that I can think of.
     
  4. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

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    SCREW IT!
    H. ducreyi has the painful soft chancre (a/k/a "chancroid"). T. pallidum is the painless hard chancre.
     
  5. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner Moderator Physician Faculty 10+ Year Member

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    Yep. Treponeme.
     
  6. NinerNiner999

    NinerNiner999 Senior Member 10+ Year Member

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    Where it's at.
    Primary syphillis - the painless chancre. RPR may remain negative until high titers are present (and this is a new lesion). Sample the lesion, send it for dark-field microscopy, and repeat RPR/FTA-ABS in two days. 2.4 Million units of Benzathene Pencillin G IM should to do the trick...
     
  7. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner Moderator Physician Faculty 10+ Year Member

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    Also, tell the patient to double bag it from now on.
     
  8. BADMD

    BADMD Physician 10+ Year Member

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    Dec 28, 2006
    Detroit
    I actually called one of the ID attendings today about this guy. It turns out that with a slightly off question, they are willing to put their clinic on hold and discuss a case.

    Anyway, he said much as you did, however he did say that in a certain percentage of case, chancroid is painless as well. He recommended an alternate test on the blood sample, which, thankfully, the lab can do as they didn't toss his blood sample yet.

    Fortunately, I gave him ceftriaxone and penicillin, so both diagnoses are covered. Hopefully he doesn't really have penile cancer, which is the third likely possibility that ID could come up with.
     

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