A 30-year-old man treated for primary syphilis 3 weeks ago now develops a generalized maculopapular rash involving the palms and soles, mucous patches on the tongue, and condylomata lata in the perineum. His VDRL titre is 1:64. The treatment of choice is:

• A Benzathine penicillin G 2.4 MU IM weekly x3 doses
• B Doxycycline 100 mg BD for 28 days
• C Azithromycin 2 g single oral dose
• D Benzathine penicillin G 2.4 MU IM single dose ✓

Explanation

This patient has developed secondary syphilis despite prior treatment for primary syphilis — suggesting either reinfection or treatment failure. Secondary syphilis (generalized maculopapular rash, palms/soles involvement, condylomata lata, mucous patches) is classified as early syphilis (<1 year duration). Treatment for early syphilis (primary, secondary, early latent) is benzathine penicillin G 2.4 million units IM as a single dose. Three doses weekly (for 3 weeks) are reserved for late latent syphilis (>1 year) or latent syphilis of unknown duration, and for tertiary syphilis (except neurosyphilis). Doxycycline is an alternative for penicillin-allergic patients.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.