Infectious Diseases Q 12

A 26-year-old woman is seen for follow-up discussion of test results. Three days ago, she was evaluated for a 1-week history of a nonpruritic rash that appears to be resolving since the initial evaluation. The patient reports no recent history of oral or genital ulcers. She is transgender. She has multiple sexual partners (men and women) and reports consistent use of condoms except for oral sex. Medical history is notable for two instances of gonorrhea and treatment for early latent syphilis 1 year ago. Medications are combination tenofovir-emtricitabine. On physical examination, temperature is 37.9 °C (100.2 °F); other vital signs are normal. Enlarged cervical, axillary, and epitrochlear lymph nodes are present. Faint, erythematous macules and papules are spread over the trunk and extremities; a few lesions are noted on the left palm. Rapid plasma reagin (RPR) is 1:128; RPR 3 months ago was 1:2. Testing of urine and throat and anal swabs for gonorrhea and chlamydia is negative. HIV testing is negative.

Which of the following is the most appropriate treatment?

A Benzathine penicillin, intramuscularly (single dose)

B Benzathine penicillin, intramuscularly (weekly for three doses)

C Ceftriaxone, intramuscularly (single dose)

D Doxycycline, orally (for 14 days)

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