Based on the clinical picture and the initial laboratory findings, what is the most likely diagnosis?
A. Primary syphilis B. Herpetic penile ulcer C. Chancroid D. Granuloma inguinale E. Squamous cell carcinoma of the penis (Answer and discussion begin on the next page.)WHAT’S WRONG: The dark-field examination shows typical Treponema palladium spirochetes. This finding in a patient with a history of multiple sex partners and a single painless, clean-cut ulcer with indurated base and rubbery, nontender inguinal adenopathy on the ipsilateral side points to a diagnosis of primary syphilis, A. Further evaluation revealed positive results on rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) testing. Culture of the discharge was negative for herpesvirus. Results of HIV testing were negative. Management. The patient was treated with benzathine penicillin G, 2.4 million units IM. When he was examined 10 days later, the chancre had healed completely.EPIDEMIOLOGY AND CLINICAL MANIFESTATIONS Since 2000, the incidence of primary and secondary syphilis has increased
