Richard Warner

A 19 year old male with no previous medical history presented to hospital with an eight day history of jaundice and general malaise. He was homosexual with a history of unprotected sex with multiple partners over the last two years. He drank heavily in binge sessions and occasionally recreational drug use, cocaine and ecstasy but he had never injected. There was no history of recent travel. He had never had a previous HIV test or Sexual Transmitted Infection screen.

His syphilis serology was positive
– Initial IgG ELISA test positive
– TPHA positive
– IgM positive and RPR (128) positive confirm recent infection

All other screening tests (including viral hepatitis and HIV test) were unremarkable, hence a diagnosis of secondary syphilis causing hepatitis was made. Further examination revealed a healing chancre on the shaft of his penis and pustules around the anu.