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2. Spot Dx: What’ s behind these ulcers?
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at 38 ° C, with otherwise normal vital signs. The rash( pictured) is red, maculopapular to nodular ranging from 0.5-2cm, non-tender, on the face, scalp, trunk, upper and lower |
pallidum haemagglutination assay( TPHA) is highly positive at 1:1024. HBV, HCV and HIV serology are negative, the swab is negative for Mpox, and chlamydia and gonorrhoea PCR |
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limbs. There is no associated ulcer- |
are also negative. |
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3. Spot Dx: What’ s causing this pigmentation?
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Dr Hytham Saleh is a GP in Mernda, Victoria. |
ation, and the palm lesions have a wart-like appearance. There is non-tender posterior cervical, axillary and inguinal lymphadenopathy. Systemic examination is otherwise normal. Jack had a referral for rou- |
Discussion
The painless, non-itchy rash involving palms and soles with a condylomata lata appearance is characteristic of secondary syphilis.
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4. ACS in young women: Landmark advice urges lower threshold for invasive angiography |
JACK, a 52-year-old sales agent, presents with a disseminated rash for over two weeks. The rash is reddish, not painful or itchy, and a little raised. It involves the face, trunk, abdomen, arms, legs, palms and soles. Jack has also had fever, headache, lethargy and |
tine blood tests from his routine last checkup and attended these before his appointment. These reveal a normal FBC, elevated CRP at 27mg / L( normal 5), normal UEC / LFT and fasting BSL / cholesterol.
Jack’ s GP suspects secondary syphilis is the most likely cause,
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Condylomata lata appear as 1 – 2cm, flat-topped, smooth-surfaced papules and small plaques with varying skin surface colours. 1
Syphilis is a highly infectious systemic STI caused by the spirochete Treponema pallidum. Incidence data shows increasing rates of syphilis in
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to particular groups or regions, with increases seen across urban, regional and remote areas nationally. Rates continue to be high in Aboriginal and Torres Strait Islander |
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myalgia for over two weeks. He is an ex-smoker who drinks alcohol occa- |
after considering a range of differential diagnoses, including erythema |
regions worldwide. The 2019 Global Burden of Disease Study indicated |
people in remote and very remote areas of Australia and men who have |
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5. Did a spider bite cause these skin lesions?
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sionally. Jack has no significant past medical history, though is allergic to penicillin. He has no history of STI, or recent contact or exposure to at-risk sexual contacts. Jack has been using ibuprofen symptomati- |
nodosum, Sweet syndrome and Mpox. The GP swabs one of the palmar lesions for Mpox PCR, requests add-on STIs serologies for hepatitis B and C, HIV and syphilis, and has Jack complete urine for chlamydia and |
a worldwide prevalence of about 50 million syphilis cases, representing a 60 % overall increase is cases from 1990 to 2019. The World Health Organization( WHO) estimated there were 7.1 million cases in 2020. 3 |
sex with men. Additionally, cases in women and in men of reproductive age have increased, leading to a heightened risk of congenital syphilis. 2, 4
The symptoms depend on the
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Source: AusDoc website; 1 Feb to 8 Mar 2026. |
cally during the illness, with shortterm effect.
On examination, Jack is febrile
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gonorrhoea PCR. The add-on pathology reveals rapid plasma reagent( RPR) is reactive and Treponema |
In Australia, cases have more than tripled from 2013 to 2022. Locally, syphilis is not limited |
stage of infection: primary, secondary, latent and tertiary. The primary phase is characterised by painless |
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