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C. difficile — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipC. difficileSCE Infectious Diseases

A patient with secondary syphilis develops panuveitis and optic-disc swelling. CSF is acellular and CSF VDRL is negative. Which treatment remains appropriate under BASHH guidance?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Procaine penicillin 2.4 MU IM daily plus probenecid QDS for 14 days

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · B = shown as D · C = shown as E

D is correct. Ocular syphilis is managed as neurological involvement even when CSF VDRL is negative, because that test lacks sensitivity and a normal CSF profile does not exclude isolated ocular disease. BASHH lists procaine penicillin 1.8–2.4 MU IM daily plus probenecid 500 mg four times daily for 14 days; IV benzylpenicillin is another recommended regimen. A single benzathine dose has inadequate CNS/ocular exposure, and the abbreviated doxycycline or ceftriaxone regimens are inadequate.

Reference: BASHH: syphilis guideline 2024: https://www.bashh.org/resources/25/guidelines_syphilis_2024/