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Practice Question of the Week

A 46-year-old man with HIV (plasma HIV RNA <20 copies/mL; CD4+ count, 1100 cells/µL) presented to care with low-grade fever, hair loss, and a rash involving his palms and soles. His treponemal enzyme immunoassay was reactive, as was his serum rapid plasma reagin (RPR) with a titer of 1:64. He was diagnosed with secondary syphilis and treated with 2.4 million units of long-acting benzathine penicillin G intramuscularly. At 3 months, his RPR titer was 1:32. Now, at 6 months, his RPR titer is still 1:32. He denies any symptoms or new exposures since his treatment 6 months ago. Which of the following is the most appropriate approach at 6 months following treatment for early syphilis?
- A. No intervention is necessary at this time. Continue to follow the RPR titers
- B. Order a cerebrospinal fluid examination (ie, lumbar puncture)
- C. Treat with 1 intramuscular dose of 2.4 million units of long-acting benzathine penicillin G
- D. Treat with 3 intramuscular doses of 2.4 million units of long-acting benzathine penicillin G, each 1 week apart

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