Question

History and Physical Examination

A 25-year-old female comes to an ambulatory centre with pain in the right side of her pelvis and a slight temperature. She has a history of two episodes of Chlamydia cervicitis and herpes simplex vulvitis.

On physical examination, she is found to have abundant mucopurulent cervical discharge and painless genital lesion. She also has some swelling of her inguinal lymph glands.

Laboratory Data: A stat pregnancy test is order. It is positive.

Questions:

1. What other laboratory tests would you expect to be ordered?

2. Could this patient have syphilis?

3. If syphilis is suspected, what tests should be ordered?

4. Is there risk of congenital infection in this woman’s unborn child?

Answer 1

1.

Along with pregnancy test, some other tests to be ordered to rule out the disease. Those include

• VDRL for sexually transmitted diseases.
• Complete blood picture
• Blood for Total count and differential count
• Urine examination
• Serological tests for the detection of antibodies against a specific pathogen.

2. Yes. This patient have syphil. As she is having following clinical features we can say as she is having syphilis.

• A painless genital lesion. It is the main sign of syphilis
• Swelling of inguinal lymph glands
• Abundant mucopurulent discharges

3.

A single test is not enough to detect syphilis. It requires combination of tests.

These include

• dark-field microscopy,
• PCR, and
• direct fluorescent antibody testing for T pallidum:-
  • Pallidum hemagglutination assay,
  • the fluorescent treponemal antibody absorbed (FTA-ABS) test, and
  • Chemoluminescence immunoassays and enzyme immunoassays that detect Treponemal antibodies.

4.

Yes. The unborn child may get congenital syphilis through placenta.