Syphilis in HIV

syphilis rash

ITE 2013, Q#101.
A 25-year-old male has developed a painless ulcer on the glans of his penis. After an appropriate examination and testing you diagnose primary syphilis and treat him with 2.4 million units of benzathine penicillin intramuscularly in a single dose. Eight hours later, while you are working the evening clinic, he returns because he has a fever of 100.6°F and a bad headache, which he rarely gets. He says he “aches all over.”

Which one of the following would be most appropriate at this time?

A) Three blood cultures from different sites at 30-minute intervals
B) CT of the head
C) A lumbar puncture
D) Doxycycline, 100 mg orally twice a day for 14 days
E) Reassurance and antipyretics