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简单病例
Case 4
82-year-old man presents with a small non-healing ulcer on the frenulum of his penis; the lesion apparently appeared after minimal trauma.
History
Do you have any other problems?
Yes, I have a swelling in my left groin, but it isn't painful.
Search for other findings which fit with the clinical problem.
Have you have unprotected sex recently?
No, I was at a Thai massage parlor 2 months ago but only had oral sex there.
Most often this disease is transmitted by unprotected genital sexual contact.
Have you had any other sexual contact?
Yes, I had intercourse with my regular partner about a week ago.
Always repeat the questionoften the first answer is not complete.
Are you married or do you have a regular sexual partner?
I have been married for 61 years but I have always had something on the side.
Search for source of infection, as well as for those who could have become infected.
Have you had multiple sexual partners?
I have had sex with 4 different women in the past 6 months but I had unprotected sexual contact only with my wife.
Important for determining risk-taking behavior.
Have you ever had a venereal disease?
Yes, I got shots for syphilis about 35 years ago.
Important for determining risk-taking behavior.
Have you ever had a HIV or syphilis blood test?
I have had a syphilis test, but never an HIV test. I didn't think it was needed.
These two important diseases are usually sexually transmitted.
Lesion
Choose the right efflorescences:
Correct.
False. No erosion is seen.
False. A lesion is seen.
False. No pustule is seen.
False. No papule is seen.
诊断
Choose the right diagnosis:
False. This disease usually presents with painful lymphadenopathy.
False. This disease presents with urethritis.
False. You are close, but the ulcer in chancroid is usually large and painful.
Correct. The firm hard painless ulcer in syphilis is known as a chance.
Therapy
Choose the right therapy(ies):
False. This is not appropriate for syphilis.
False. Syphilis is a potentially fatal disease, which is best treated early.
Correct. This is the recommended approach to syphilis.
False. Don't forget the syphilis serology and the partner examination and treatment.
False. This is the approach for gonorrhea.
