A 23-year-old male presented himself to an urgent care center with urethral discharge and a red rash on his feet

and forearms. He stated that he had had unprotected sex with a prostitute within the past 2 weeks. He was treated empirically for chlamydia, gonorrhea (GC), and Rocky Mountain spotted fever (RMSF). The following laboratory tests were ordered: Chlamydia/GC PCR; RPR; serology testing for RMSF; hepatitis B, C; and HIV. All test results were negative except for Chlamydia PCR. Fourteen days later, the patient presents to an infectious disease clinic with a headache, a fever of 38.1C, nausea and vomiting, myalgia, 2 weeks of fatigue and mouth ulcers, and a 10 lb weight loss within the past 3 weeks. Laboratory tests at this time reveal the patient is lymphocytopenic, and his liver function enzymes are slightly elevated.