In the previous scenario, the woman with a nontender vulvar ulcer likely has syphilis. Confirmation can be achieved by serology (RPR or VDRL test) and specific treponemal test: however, there is a significant possibility that patients with primary syphilis may not have developed an antibody response yet and will have negative serology. Thus, confirmation of the diagnosis would be attained with dark-field microscopy. The student should strive to know the limitations of various diagnostic tests and the manifestations of disease.
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