Skin Signs of STDs: A Photo Quiz

Question 1:
A 24-year-old HIV-positive homosexual man presented with a macular rash on his palms and soles. The lesions were not pruritic or painful. He also had a brighter, more inflamed rash in the groin and antecubital fossae.

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Question 2:
A 31-year-old woman presents for evaluation of an asymptomatic, firm plaque on the forehead. Lesions of similar size and consistency were present at the nape of the neck and on the chest. A biopsy was performed. It revealed almost pure sheets of plasma cells in the dermis. A syphilis serology was obtained; results were positive.

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Question 3:
A 28-year-old unmarried man was dating widely, but always wore a condom during intercourse. One week after sex with a new partner, a painful rash developed at the base of the penis.

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Question 4:
A 38-year-old man presented with a 2-week history of mental status changes and impaired memory. He also had a rash on both hands and feet that had been getting worse for the past few months. The rash was initially red and pruritic and then became scaly. There were 3 rounded purpuric lesions below the right knee, and bilateral toe nail onychomycosis. The patient was oriented to person and place but had difficulty with memory testing. Laboratory findings included a positive rapid plasma regain value. This patient was found to have neurosyphilis.

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Question 5:
A 17-year-old woman noted a gradually increasing, asymptomatic “sore” on her lower lip. She admitted to multiple episodes of oro-genital contact with different partners within the past 3 months.

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Question 6:
A 38-year-old man presented with multiple painful penile ulcerations, as well as tender, bilateral inguinal adenopathy.

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ANSWER KEY:

Question 1. Answer: C

Question 2. Answer: A

Question 3. Answer: B

Question 4. Answer: C

Question 5. Answer: A

Question 6. Answer: E