Frans Radebe – Centre for HIV & STIs, NICD/NHLS
A 29-year man presented at a dedicated Sexually Transmitted Infections (STIs) clinic in Johannesburg, complaining of a mucocutaneous, florid eruption on the external extremities involving fingers, arms, buttocks, neck, penile shaft and face for 3 weeks. Prior to that, he noticed a painless, solid ulcer which was in the process of healing without receiving treatment. He also complained about headache, body weakness and discomfort due to icthiness of the rash. He was uncircumcised and had phimosis of the penis. No history of anal intercourse was reported.
On physical examination, the diffuse mucocutaneous rash was evident, in addition to patchy alopecia, and non-tender, regional lymphadenopathy.
Genital swabs were taken after the ulcer was scraped to expose the lesion. Swabs were also collected from areas of rash on the proximal extremities, and laboratory testing by a Multiplex PCR, for HSV-2,
, Haemophilus ducreyi
and Chlamydia trachomatis
L1-3 strains was undertaken. Blood sample was collected for serological testing for syphilis and HIV rapid testing.
His record card indicated that he had been treated for syphilis three years previously and had tested HIV-seropositive.
He was treated syndromically for genital ulcer syndrome with Benzathine benzyl penicillin IM, 2.4 MU and since his HIV status was known, Acyclovir, oral 400mg 8 hourly for 7 days was added. He was asked to return to the clinic after a week for further assessment with the laboratory report for PCR and serology.
- What is the likely diagnosis and describe its clinical presentation?
- What are the common differential diagnoses?
- What role does laboratory testing play in terms of diagnosis and treatment?
- How would you treat the case?
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