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Syphilis diagnosis — DFSRH MCQ

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HardSTI diagnosis and managementSyphilis diagnosisDFSRH

A patient has a painless vulval ulcer and a generalised rash involving the palms and soles. What is the most appropriate initial investigation plan?

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

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Correct answer: D — Arrange syphilis serology, lesion testing, and a full STI screen

The best answer is “Arrange syphilis serology, lesion testing, and a full STI screen”. The presentation is strongly suggestive of syphilis. BASHH recommends serological testing and direct detection from a lesion when available, alongside assessment for other STIs including HIV. Candida testing, cervical screening and tumour markers do not diagnose this syndrome and would delay appropriate infection assessment.

Reference: BASHH, Syphilis 2024: Updated Guideline: https://www.bashh.org/resources/25/guidelines_updated_guideline_syphilis_2024/