Case

A 50-year-old G5P5 woman complains of postcoital spotting over the past 6 months. Most recently, she complains of a malodorous vaginal discharge. She states that she has had syphilis in the past. Her deliveries were all vaginal and uncomplicated. She has smoked 1 pack per day for 20 years. On examination, her blood pressure is 100/80 mm Hg, temperature is 99°F (37.2°C), and heart rate is 80 beats per minute. Her heart and lung examinations are within normal limits. The abdomen reveals no masses, ascites, or tenderness. Her back examination shows right costovertebral angle tenderness (CVAT). The pelvic examination reveals normal external female genitalia. The speculum examination reveals a 3-cm exophytic lesion on the anterior lip of the cervix. No other masses are palpated. Her right leg is more swollen than her left leg.

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