Table 1.

Case summary

TIMEPATIENT’S HISTORY AND ASSESSMENTS, PLANS, AND RESULTS
Past medical history

  • Gonorrhea (no other previous STIs)

  • Negative test results for HIV

  • Taking HIV PrEP

  • Insomnia

  • GERD

  • Hypertension

Visit 1Assessment

  • Presented to clinic as a gonorrhea contact

  • Reported a painless 1-cm2 penile lesion about 4–6 wk earlier that resolved without marking

  • Asymptomatic at time of visit

  • Unremarkable findings on examination


Plan

  • Tested for chlamydia and gonorrhea (urine sample, oral and rectal swabs), HIV, and syphilis

  • Treated empirically for gonorrhea


Results

  • Rectal gonorrhea detected

  • Syphilis testing: CMIA result reactive, RPR titre 1:4, TPPA result reactive

Visit 2 (8 d after visit 1)Assessment

  • Asymptomatic

  • Reported rigour about 2 h after empiric gonorrhea treatment at visit 1


Plan

  • Syphilis stage determined as early latent; treatment administered

  • Repeated syphilis serology


Results

  • Syphilis testing: CMIA results reactive, RPR titre 1:8, TPPA results reactive


Follow-up

  • Reported same rigour about 2 h after treatment

  • CMIA—chemiluminescent microparticle immunoassay, GERD—gastroesophageal reflux disease, PrEP—preexposure prophylaxis, RPR—rapid plasma reagin, STI—sexually transmitted infection, TPPA—Treponema pallidum passive particle agglutination assay.