Step 3 Questions

A question from QBank:


A 29 year old man comes to the office because one of his 3 sexual partners recently had a Pap smear that showed dysplasia and koilocytic changes. Her physician recommended that all her sexual partners be evaluated. He has always been healthy and has never had any sexually transmitted diseases. All of his partners are "on the pill" so they do not use condoms. Physical exam is completely unremarkable. There are no visible leasions on his anogenital region. He is still very concerned that he has an infection that you cannot see. The most appropriate next step is to

(A) advise him to return if he develops any lesions

(B) apply vinegar to his penis and scrotum

(C) recommend that he use condoms during all sexual activity

(D) Send for a fluorescent treponemal antibody absorption serology

(E) take random biopsies of the penis

(F) tell him that he is healthy


Answer: (B)

Now I know that acetic acid (which is in vinegar) can bring out lesions caused by HPV, but I've only heard of it being used in women and symptomatic males. In fact, when I looked it up on uptodate and emedicine, there was nothing mentioned about vinegar being used to diagnose men. When I finally googled "vinegar" and "HPV", they said that vinegar could be used when a guy is complaining of symptoms of warts if no lesions can be seen, however it's not that useful because it's neither sensitive nor specific. Furthermore, I've never seen a little bottle of vinegar anywhere in clinic that could be used for this purpose... maybe you have to run down to the cafeteria to get it.

So are there any guys reading this who are willing to try a little experiment? Go to your PMD, tell them that your girlfriend has dysplasia and koilocytic changes and see if they apply vinegar to your penis and scrotum. If they don't, you could tell them that they're ill-prepared for Step 3.