07-23-2010, 09:40 AM
A 24-year-old bartender returning from Panama presents to the clinic because of a painful
penile lesion that appeared about 1 week after having unprotected sex with a new female partner. On examination the ulcer is 1.5 cm in diameter with an erythematous base and clearly covered with a yellow purulent exudate and bleeds when scraped. Gram stain of the exudates shows gram-negative rods in chains in a school-of-ï¬ sh appearance. Otherwise, examination is notable only for tender inguinal lymphadenopathy. Which of the following is the most appropriate treatment at this time?
(A) A 10-day course of oral acyclovir
(B) Highly active retroviral therapy until the lesion resolves
© Nystatin powder to the lesion daily for at least 1 week
(D) One high dose of intramuscular penicillin G
(E) One high dose of oral azithromycin
penile lesion that appeared about 1 week after having unprotected sex with a new female partner. On examination the ulcer is 1.5 cm in diameter with an erythematous base and clearly covered with a yellow purulent exudate and bleeds when scraped. Gram stain of the exudates shows gram-negative rods in chains in a school-of-ï¬ sh appearance. Otherwise, examination is notable only for tender inguinal lymphadenopathy. Which of the following is the most appropriate treatment at this time?
(A) A 10-day course of oral acyclovir
(B) Highly active retroviral therapy until the lesion resolves
© Nystatin powder to the lesion daily for at least 1 week
(D) One high dose of intramuscular penicillin G
(E) One high dose of oral azithromycin
