A HEALTHY 27-YEAR-OLD HETEROSEXUAL MAN PRESENTS WITH A CRUSTED plaque on his right nipple. The lesion formed gradually over a week after a bite during sexual intercourse and has persisted for a month. The patient reports that over the following 2 to 3 weeks, no significant change in size or morphology of this lesion occurred. The lesion is not painful; neither fever nor associated systemic symptoms are noted. Now, 1 month later, the patient presents with a generalized asymptomatic skin eruption. Physical examination reveals generalized pink macules on the trunk and extremities (FIGURE 1A). A crusted, erythematous plaque is noted over the enlarged right nipple (Figure 1B). What Would You Do Next?
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Chiu et al. (2012) studied this question.
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