A patient presents to your office for her annual examination. She admits to having intercourse with multiple sexual partners over the past year. Her only medication is an oral contra ceptive pill (O C P ) which she takes very regularly. She has no new symptoms or concerns. On physical examination, a painless punched-out ulcer is appreciated on the left labia.After appropriate testing and treatment, you counsel the patient to practice safer sex in the future. If this patient had not been treated, what would be the next sequelae?

Correct Answer: Rash involving palms and soles
Description: Source: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"> Ans. (d) Rash involving palms and soles.Based on the description of a hard painless chancre, this patient likely has syphilis. The primary stage of syphilis is characterized by painless chancre. Secondary stage includes a red rash involving the palms and soles, Tertiary stage is characterized by Argyll-Robertson pupil, tabes dorsalis, paresis, gummas of skin and bone, and aortic aneurysm. Confused imageDiagnosis and ClueChancroid Painful Ulcer - Look for this in the history
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