Clinical Pearls

Syphilis of less than 1-yr duration can be treated with a single intramuscular course of penicillin; infection of more than 1 -yr duration is treated by three courses of penicillin at 1-week intervals.

The nontender ulcer with indurated edges is typical for the chancre lesion of primary syphilis. If serology is negative, then dark-field examination is warranted.

The best treatment of syphilis in pregnancy is penicillin.

Pregnant women with syphilis and an allergy to penicillin should undergo penicillin desensitization and then receive penicillin.

The three most common infectious vulvar ulcers in the United States are herpes simplex virus, syphilis, and chancroid.

REFERENCES

Droegemueller W. Infections of the lower genital tract. In: Stenchever MA, Droegemueller W, Herbst AL. Mishell DR. eds. Comprehensive gynecology, 4th ed. St. Louis: Mosby-Year Book. 2001:641-706.

McGregor JA. French JI, Lench JB. Pelvic infections: vulvovaginitis, sexually transmitted infections, and pelvic inflammatory disease. In: Hacker NF, Moore JG, Gambone JC, eds. Essentials of obstetrics and gynecology, 4th ed. Philadelphia: Saunders. 2004:296-308.

Centers for Disease Control and Prevention. Guidelines for treatment of sexually transmitted diseases 2002. Morb Mortal Wkly Rep 2002:5 KRR06): 13-32.

A 24-year-old woman G2 PI at 30 weeks' gestation was admitted 2 days ago for premature rupture of membranes. Her antenatal history has been unremarkable. Today, she states that her baby is moving normally, and she denies having fever or chills. Her past medical and surgical histories are unremarkable. On examination, her blood pressure is 100/60. heart rate 90 bpm. and temperature 100.8°F. Her lungs are clear to auscultation. No costovertebral angle tenderness is found. The uterine fundus is 30 cm and is slightly tender. No lower extremity cords are palpated. Fetal heart tones persistently range from 170 to 175 bpm without decelerations.

♦ What is the most likely diagnosis?

^ What is the best management for this patient?

♦ What is the most likely etiology of this condition?

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