Do vulvar sores indicate syphilis in a 22-year-old?

Hello,

Welcome to icliniq.com.

I understand your concern.

Looking at your history, a vulvar sore that has been there for a week plus the brown spots on your soles are concerning. Primary syphilis usually starts as a painless ulcer, and then secondary syphilis can give you rashes on the palms or soles. The fact that you have had unprotected sex just before this makes it important not to ignore. Other possibilities are herpes (usually painful), chancroid, or even traumatic or aphthous ulcers, but with the rash you describe, syphilis really needs to be ruled out first.

• The Probable causes: Most likely sexually transmitted infection, syphilis is at the top of the list, given the sores and the rash on the feet.

• Investigations to be done: VDRL (venereal disease research laboratory) or RPR (rapid plasma reagin) blood test for syphilis, TPHA (Treponema pallidum hemagglutination assay) or FTA-ABS (fluorescent Treponemal antibody absorption) (confirmatory test), HIV (human immunodeficiency virus), hepatitis B, hepatitis C screening (since STIs (sexually transmitted infections) often travel together), swab for herpes if the sore is painful or vesicular.

• Differential diagnosis: Genital herpes, chancroid, non-infectious vulvar ulcer (aphthous, trauma).

• Probable diagnosis: Syphilis (need confirmation).

• Treatment plan: Do not self-treat. If syphilis is confirmed, standard treatment is Benzathine Penicillin injection (single or multiple, depending on stage). A doctor, not at home, must give this. If you have a Penicillin allergy, alternative regimens exist. If herpes, an antiviral course is needed. The best is to stop sexual contact till diagnosis and treatment are complete. The partner should also be tested and treated.

• Regarding follow-up: You should see a gynecologist or a dermatologist-venereologist in person urgently, have blood tests done, and share the results. Do not delay, because syphilis is fully curable early but has long-term risks if untreated. Please update me once you get your test results, so I can guide you further.

• Preventive measures: Avoid unprotected sex until you and your partner are tested and treated, and regular STI screening if sexually active with new partners. Always use barrier protection.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.