1. What is the diagnosis?
The rash is typical of secondary syphilis. It is characteristically red, symmetrical and patchy and of note involves the palms and soles. Secondary syphilis usually occurs 2-8 weeks after the primary infection and is the point at which the patient is most contagious.

Syphilis in general is making a comeback in the UK and is more prevalent in the male homosexual community.

2. How would you confirm this?
The diagnosis of secondary syphilis is usually based on blood tests. An initial screening is done with the non-treponemal tests such as VDRL or RPR. If these are positive, the diagnosis is confirmed by another blood test for a specific antibody - the FTA-ABS fluorescent treponemal antibody test.

3. What else would you want to know from him in the history?
You would want to know if he had symptoms of primary syphilis prior to this, i.e. a chancre. You would also want to know if he was still sexually active as his partners would be at risk.

4. Where next?
He needs to be referred to the genito-urinary medicine clinic for further treatment, screening for other sexually transmitted infections and for contact tracing. Treatment usually consists of a 3 week course of penicillin.