Gram Negative Spiral
A 28-year-old sexually active woman presents for her annual well-woman exam. She at times has a low-grade fever and lately has noticed a rash on her face, mainly on the cheeks. She is saddened to learn she has a positive VDRL test for syphilis. However, she is asymptomatic for syphilis and is in a monogamous relationship with her husband who has not had any other sexual contacts. Which of the following is the most likely reason for the positive syphilis test?
|A||She has secondary syphilis.|
|B||She has HIV, altering her immune reaction.|
|C||She had exposure to syphilis earlier this week.|
|D||She has systemic lupus erythematosus (SLE).|
a. In the presence of a woman with no known contacts with syphilis and a low-grade fever and rash, it is most likely that she had a false positive reaction to the VDRL test because of lupus (SLE).
b. This is often a common finding in lupus patients, and may be the first sign that they have lupus. In contrast, the VDRL test would be positive in secondary syphilis, often in high titer (greater than 1:32).
c. Her being positive for HIV, while she may also have a false positive reaction to the VDRL test if HIV positive, is not the most likely answer choice for this patient.
d. The presence of the malar rash makes SLE more likely. Recent exposure to syphilis would lead to a false negative test result; antibodies form between 4-8 weeks from exposure.
e. Chlamydia trachomatis infection would not lead to a positive test result for syphilis.