A 24-Year-Old Woman Is Being Evaluated for Positive Reactive Plasma

A 24-year-old woman is being evaluated for positive reactive plasma reagin (RPR) testing for syphilis as part of a routine prenatal workup.  The current titer is 1:8.  She feels well and has no complaints.  Six months ago, she went to the hospital with fever and a diffuse rash following sexual activity with a new male partner.  There she underwent testing that showed an RPR titer of 1:256.  The Treponema pallidum particle agglutination assay was positive at that time.  HIV testing was negative.  The patient was treated for secondary syphilis with intramuscular penicillin G.  Her symptoms resolved over the next week.  Her partner also was treated appropriately for syphilis at that time; she has had no new sexual partners.
Complete examination, including genital and neurologic examination, is normal.  Repeat HIV antibody testing is negative.
What is the best next step in management of this patient?

A) Administer intramuscular penicillin G
B) Admit to the hospital and initiate intravenous penicillin
C) Perform lumbar puncture
D) Repeat reactive plasma reagin in 6 months
E) Repeat Treponema pallidum particle agglutination testing in 6 months

Correct Answer:

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