A 26-Year-Old Man Comes to the Office After Learning That

question 434

Multiple Choice

A 26-year-old man comes to the office after learning that one of his sexual partners tested positive for HIV.  The patient has had intermittent headaches, malaise, nausea, and blurry vision over the last several weeks.  He has had no fever, sore throat, skin rash, genital lesions, or weight loss.  The patient has no prior history of sexually transmitted infections or chronic medical problems.  He smokes a pack of cigarettes daily, consumes alcohol occasionally, and does not use illicit drugs.  The patient has had multiple sexual partners over the last several years and does not use condoms consistently.  Temperature is 37.1 C (98.8 F) , blood pressure is 122/74 mm Hg, and pulse is 72/min.  There is no scleral icterus, oropharyngeal lesions, or skin rash.  Mild, generalized lymphadenopathy is present.  Cardiopulmonary and abdominal examinations are normal.  Cranial nerves, deep tendon reflexes, and sensation are normal.  No nuchal rigidity is present.  Ophthalmologic examination reveals no abnormalities.  Screening HIV immunoassay is positive.  Other laboratory studies are as follows: A subsequent fluorescent treponemal antibody absorption test is positive.  Contrast-enhanced CT scan of the head reveals no space-occupying lesions. Which of the following is the most appropriate next step in management of this patient's treponemal infection?

• A)Administer antitreponemal treatment with no further testing
• B)No further intervention is necessary due to false positive results
• C)Obtain confirmatory Treponema pallidum enzyme immunoassay
• D)Perform lumbar puncture and cerebrospinal fluid analysis for neurosyphilis
• E)Repeat serologic syphilis testing after antiretroviral therapy initiation

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