Summary: A 31-year-old woman who comes in for a well-woman examination is noted to have a nontender, firm. 1-cm ulcerated lesion of the vulva: it has raised borders and an indurated base. She also has bilateral nontender inguinal lymphadenopathy.
^ Most likely diagnosis: Syphilis (primary chancre).
^ Next step in diagnosis: Syphilis serology (rapid plasma reagin |RPR| or Venereal Disease Research Laboratory |VDRL)) and, if negative, dark-field microscopy.
♦ Best therapy for this condition: Intramuscular penicillin.
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