From the Research
For a low-risk female patient with a generalized rash and no other symptoms, a comprehensive STD screening should include tests for syphilis, HIV, gonorrhea, chlamydia, and potentially hepatitis B and C. I recommend blood tests for syphilis (RPR or VDRL with confirmatory treponemal test if positive), HIV (4th generation antibody/antigen test), and hepatitis B and C serologies. Urine nucleic acid amplification testing (NAAT) should be performed for gonorrhea and chlamydia, as recommended by the US Preventive Services Task Force 1. Given the presence of a generalized rash, particular attention should be paid to syphilis testing, as secondary syphilis commonly presents with a diffuse maculopapular rash, according to the 2021 CDC guidelines 2. If the rash involves the palms and soles, this increases suspicion for syphilis. While the patient reports low risk with only one sexual partner in the past year, it's essential to remember that partners may have other undisclosed contacts. Treatment should be guided by test results, with doxycycline 100mg twice daily for 7 days for chlamydia or 100mg twice daily for 14 days for syphilis being common regimens, as outlined in the 2021 CDC guidelines 2. The patient should be advised to abstain from sexual activity until testing is complete and any necessary treatment is finished.
Some key points to consider in this patient's evaluation include:
- The importance of taking a thorough sexual history, as emphasized in the 2021 CDC guidelines 2
- The need for screening tests and treatment based on the updated CDC guidelines, as discussed in the 2022 American Family Physician article 2
- The potential for syphilis to present with a generalized rash, as noted in the 2022 American Family Physician article 2
- The recommendation for screening for chlamydia and gonorrhea in sexually active women, as stated in the 2021 US Preventive Services Task Force recommendation statement 1