A 23-year-old man presents with a painless penile ulcer. Syphilis serology (RPR/VDRL and treponemal test) is negative. However, dark-ground microscopy...

Question

A 23-year-old man presents with a painless penile ulcer. Syphilis serology (RPR/VDRL and treponemal test) is negative. However, dark-ground microscopy from the ulcer is positive for spirochaetes. How should this result be interpreted?

Accepted Answer

Primary syphilis can present with negative serology in the early stages; dark-ground microscopy is diagnostic. Serology should be repeated in 2-4 weeks

Answer

The patient does not have syphilis because serology is negative

Answer

Dark-ground microscopy is unreliable and should be ignored

Answer

He has secondary syphilis

Answer

He needs no treatment if serology is negative

uk-dfsrh MCQ (SBA): Primary Syphilis Seronegative Window Period

A 23-year-old man presents with a painless penile ulcer. Syphilis serology (RPR/VDRL and treponemal test) is negative. However, dark-ground microscopy from the ulcer is positive for spirochaetes. How should this result be interpreted?