Immediately after you finished the physician’s assistant program
you took a job at a free clinic in the heart of a large city. You
always wanted to help society, especially those in the direst of
life’s circumstances. During your first week, you met Dwight, a
53-year-old overweight white man with several obvious problems.
Dwight’s feet are cracked and blistered and he has three infected
toenails. (He tells you he has been homeless for various periods
during the last 10 years). There are seeping sores in the folds of
his wrists and under his arms. His gums are bleeding. Dwight is
here because he has been greatly confused over the past eight
months and

it seems to be getting worse. He has episodes of ranting and
raving. He reports ”feeling crazy” and being very scared. His
friends brought him to the clinic and are waiting outside.

The supervising physician quickly joins you in the examining
room. Together you examine Dwight thoroughly and make a plan for
addressing his pressing needs for wound care. The physician starts
asking him about his health history. Dwight reveals very little,
saying his memory is very bad. But he talks a lot about his past
sexual exploits.

Questions

The doctor tells you that mental illness is very common among
the homeless population. Dwight needs a thorough psychiatric
evaluation. The doctor is fairly sure that some of Dwight’s neural
symptoms are caused by a sexually transmitted infection. Which one
(2 points)? Caused by which microorganism (3 points)?
  

If the blood test comes back positive, does it mean that Dwight
can transmit the disease to others? Explain. (4 points)
  

Should Dwight be treated with antibiotics to remedy his neural
symptoms? Why or why not? (4 points)
  

The patient’s blood test came back positive. For what other
infectious disease should he now be tested? (3 points)
  

The doctor tells you to expect to see more of these cases in the
future. But a coworker, who graduated from nursing school 10 years
ago, tells you that this disease (especially its later forms) is
relatively rare and is decreasing in incidence. Who is right? (4
points)