<prompt> A young man presents with asymptomatic macules and erythematous painless lesion over glans with generalized lymphadenopathy. Treatment of choice in this condition:CeftriaxoneBenzathine penicillinAcyclovirFluconazole  <response>: Ans. b. Benzathine penicillin Ref: Fitzpatricks 6e p2164-2212; Rooks Textbook of Dermatology 7e p30.1-35, 25.20-39Asymptomatic macules and papule over the trunk and reddish patch over the palate with a flat, moist lesion on glans penis in a young man with generalized lymphadenopathy is suggestive of syphilis.Benzathine penicillin first line of treatment for syphilis.Clinical Presentation of SyphilisEarly Congenital Syphilis:Snuffles rhinitisQ is the earliest feature.Lesions are vesiculobullous and snail track ulcers on the mucosaLate Congenital Syphilis:Characterized by Hutchinsons triad interstitial keratitis 8th nerve deafness Hutchinsons teeth i.e. pegged central upper incisorsQSaddle nose, saber tibia, mulberry molarsBull dogs jaw protrusion of jawRhagadesQ linear fissure at the mouth, naresFrontal bossing, hot cross bun deformity of the skullCluttons joints painless swelling of joints, most commonly both kneePalatal perforationsHigaumenakis sign periostitis leads to unilateral enlargement of sternal end of claviclePrimary Syphilis:Painless, indurated, non-bleeding, usually single punched out ulcer hard chancreQPainless, rubbery shotty lymphadenopathySecondary Syphilis:Bilateral symmetrical asymptomatic localized or diffuse mucocutaneous lesions macule, papule, papulosquamous and rarely pustuleNon-tender generalized lymphadenopathyHighly infectious condylomata IataQ, in warm moist intertriginous areasMoth ate alopecia, arthritis, proteinuriaQTertiary Syphilis:Gumma, neurosyphilistabes dorsalisQOstitis, periostitisAortitis, aortic insufficiencyQ coronary stenosis and nocturnal anginaQSyphilisCaused by Treponema pallidumQDiagnosed by dark field microscopyFTA-ABS most sensitive test, earliest test to become positiveQVDRL or RPR titer determine response to treatment as they become negativeQTPI most specific testQTPH 2nd most sensitive testTreatment of Sexually transmitted DiseasesDiseaseDrug of choice Gonorrhea- Non-penicillinase producing- Penicillinase-producing or disseminated gonorrhea- Amoxyampicillin, Procaine penicillin G - Ceftriaxone, cefuroximeQ Syphilis- Early Primary, secondary and latent and Late- Neurosyphilis- Benzathine Penicillin GQProcaine penicillin G- Aqueous penicillin GAqueous Pen. G procaineQ LGV Chlamydia trachomatis- AzithromycinQ- DoxycyclineQ DonovanosisGranuloma inguinale Calymmobacterium granulomatis- DoxycyclinetetracyclineQ Chancroid H. ducreyi- CeftriaxoneQ- AzithroErytrhromycinQ- CotrimoxazoleQ 