Sexually transmitted infections Quiz: Ace Your Exams

A 22-year-old woman comes to a primary care physician’s clinic with fever, generalized muscle aches, and painful perineal ulcers. The patient had similar symptoms four months ago and did not seek treatment. Two months ago, she was diagnosed with acute cervicitis and treated with a course of ceftriaxone and doxycycline. She is sexually active and began a non-monogamous relationship with a new partner six months ago. They use condoms inconsistently. The patient has never traveled outside the country. Temperature is 37.0°C (98.6°F), pulse is 90/min, respirations are 20/min, and blood pressure is 120/75 mmHg. The abdomen is soft and nontender. External genital examination reveals multiple tender ulcers on the labia majora. Cervical motion tenderness is absent on bimanual examination. Bilateral tender inguinal lymphadenopathy is noted. Which of the following findings is likely to be seen on further laboratory evaluation?