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Syphilis ulcer assessment — DFSRH MCQ

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HardSTI diagnosis and managementSyphilis ulcer assessmentDFSRH

A 34-year-old man presents with a painless penile ulcer and non-tender inguinal lymph nodes. He had condomless sex with a new male partner 5 weeks ago. Dark-ground microscopy is unavailable. What is the most appropriate investigation?

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Correct answer: B — Syphilis serology with lesion PCR if available

A painless chancre with regional nodes suggests primary syphilis, so serology and lesion testing where available are appropriate. HSV can cause ulcers, but IgG alone does not diagnose the lesion. A broader STI screen should also be offered, but the best investigation for this presentation targets syphilis.

Reference: BASHH Syphilis Guideline; BASHH STI Testing Guidance