Treponema pallidum (Syphilis) Quiz: Ace Your Exams

A 58-year-old woman presents to the clinic with a history of fever and painless genital lesions that she first noticed a week ago. Two months ago, she was treated for a urinary tract infection with oral nitrofurantoin. She lives in New Hampshire and goes hiking in the woods often. The patient is sexually active and began a relationship with a new partners six months ago. They use condoms inconsistently. Past medical history is significant for an episode of cervicitis and pelvic inflammatory disease in her teens. Temperature is 37.7°C (100°F), pulse is 99/min, respirations are 20/min, and blood pressure is 120/75 mmHg. Physical examination reveals diffuse cervical lymphadenopathy and a maculopapular rash over the trunk, abdomen, and extremities, including the palms and soles of the feet. The abdomen is soft and nontender. An image of the initial genital examination is demonstrated below.

The patient is started on appropriate pharmacologic treatment, but she returns to the clinic two days later after experiencing a continued fever plus chills, headaches, myalgias, and worsening of the maculopapular rash. Which of the following is the most likely diagnosis?

 
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