On June 14th Dr. Sam Windham gave us two fun cases. One on secondary syphilis and the other on aseptic meningitis
Teaching points on Syphilis
▪ Currently, we screen syphilis with RPR or VDRL and confirm with FTA-ABS or TPPA.
▪ FTA-ABS and TPPA look at specific antibodies to the treponeme.
▪ Once infected with syphilis, FTA-ABS and TPPA remains positive for life (generally speaking). Caution false positives for this reason.
▪ Treatment of syphilis in pen allergic patients = doxycycline.
Teaching points on Aseptic Meningitis
▪ According to JAMA’s “Rational Clinical Exam” the history is not helpful for “ruling out” meningitis. The physical exam, however, is. Consider the triad of
1. Objective fever
2. Objective neck stiffness
3. Objective confusion
*If 2/3 of these features are present, the sensitivity for meningitis is 95%. If you are unable to “rule out” meningitis, one must strongly consider LP.
Comments