Serological Lab Work
The serological test for patient A and patient B would include non-Treponema and Treponema tests to ascertain the stage of syphilis. Syphilis shares similarities with Treponema and non-Treponema diseases; hence, it is important that the interpretation of laboratory results is made in regard to the patient’s history. In this case, patient B complains of a painless blister which is characterized with syphilis and often referred to as a cancroid (Ghanem et al., 2020). In addition, to determine whether or not the patients are infected with syphilis, it would require very equipped laboratory and skilled personnel, which the Venereal Disease Research Laboratory (VDRL) would serve efficiently.
Diagnosis for Patient A
Patient A physical observation shows that he has a visible anal fissure. It is also noted that the patient has disseminated papules in the trunk as well as sore macules on the palms. Patient A also experiences painful and bleeding defecation, which is because of a cancroid present in the anal opening. Since patient A is married to patient B, the diagnosis would be a sexually transmitted infection, as is in most cases where male partners have sexual contact. Syphilis is more common in male couples than in female ones (Kashyap et al., 2018). According to laboratory results, patient A is diagnosed with Treponema and non-Treponema, which is similar to syphilis.
Diagnosis for Patient B
Patient B has a visible painless blister on his genitals. With no relevant family history, patient B is more likely to be suffering from a sexually transmitted infection. With the laboratory results, Treponema is a positive indication the syphilis stage is not advanced, that is, the primary stage. Therefore, according to Kashyap et al. (2018), the interpretation of laboratory results of a patient with positive Treponema can be clarified with the patient’s history. In this case, patient B has no history which rules out the diagnosis of syphilis as it is in the case of the partner.
Differential Diagnosis for Patients A and B
The differential diagnosis for patient A and B would be the stage of the illness. In the case of patient A, he has painful bleeding defecation, which suggests the presence of a blister or cancroid. Secondly, patient A is experiencing intermittent pruritus, which can be characterized by bacterial reactions in his body in the attempt to fight the infection. Patient A is in the secondary stage of the infection. In patient A laboratory results, it is evident that Treponema and non-Treponema are present, unlike in the case of patient B, whose laboratory results show the presence of Treponema. Patient B, on the other hand, is only experiencing a painless cancroid. Therefore, the syphilis stage of patient A is advanced, while that of patient B is at the secondary level and poses insight regarding the possibility of genital herpes or Behcet syndrome diagnosis.
Treatment Procedure for Patient A
The treatment of syphilis varies according to the stage; at that of patient A, the clinical significance is secondary. It is appropriate to administer Benz PCN 2.4 million units IM per dose to patient A at least twice a day (Liu et al., 2019). Alternatively, patient A can use Doxycycline 100mg PO BID for fourteen days, according to the research by Liu et al. (2019). For intermittent pruritus, it is essential to administer calcaneum inhibitors, such as Tacrolimus and Pimecrolimus, based on the accessibility of the medication (Liu et al., 2019). In addition, the treatment of syphilis at the primary and secondary stages is achievable by administering penicillin as the first therapeutic step.
Treatment Procedure for Patient B
The treatment for patient B is quite similar to patient A since the advancement of syphilis is at the primary and secondary levels, respectively. However, patient B does not need calcaneum inhibitors since he is not experiencing intermittent pruritus. Primary syphilis can be treated with Benz PCN 2.4 million units IM per dose or Doxycycline 100mg PO BID for fourteen days (Liu et al., 2019). The alternative is dependent on the patient’s preference in terms of allergens, side effects of the medication, and the pricing.
Possible Cause of Infection Except Sex
The main cause of syphilis involves sexual encounters that increase the transmission rate from one partner to another. Ideally, when an individual is in contact with an infected person, there is an exchange of fluid through kissing and blood transfusion, thus fostering the transfer of the bacteria. The bacterium causing syphilis enters the body of the host through a thin membrane. A different medium that enhances the chance of infecting other people is sores in the mouth. In addition, an infected individual easily transmits the infection to other people through such engagements as anal sex and contact with open wounds from an infected individual.
Consequently, it is necessary to observe high standards of cleanliness and avoid sharing personal items with strangers. It is also crucial to cover wound openings on the skin after treating to avoid instances of syphilis bacterium entering the body. Patient A and patient B would have contracted the infection through the different forms of contracts if not through sexual encounters. Getting tested regularly can hinder the high risk of syphilis infection.
References
Ghanem, K. G., Ram, S., & Rice, P. A. (2020). The modern epidemic of syphilis. New England Journal of Medicine, 382(9), 845-854. Web.
Kashyap, B., Goyal, N., Gupta, N., Singh, N. P., & Kumar, V. (2018). Evaluation of Treponema pallidum hemagglutination assay among varying titers of the venereal disease research laboratory test. Indian Journal of Dermatology, 63(6), 479-483. Web.
Liu, H., Chen, N., Yu, J., Tang, W., He, J., Xiao, H., Lin, S., Hu, F., Feng, Q., Tucker, J., Xia, H., & Qiu, X. (2019). Syphilis-attributable adverse pregnancy outcomes in China: A retrospective cohort analysis of 1187 pregnant women with different syphilis treatment. BMC Infectious Diseases, 19(292). Web.