Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report
Downloads
Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM. Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient's response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.
Holman KM, Goepfert A. Syphilis infection in women. In: Beigi RH, editor. Sexually transmitted diseases. London: Wiley-Blackwell; 2012. p. 36-43.
Mendoza N, Motta A, Ravanfar PP, Tyring SK. Syphilis and HIV. In: Gross G,Tyring SK, editors. Sexually transmitted infections and sexually transmitted diseases. London: Springer; 2011. p.173-82.
Das A, Li J, Zhong F, Ouyang L, Mahapatra T, Tang W, et al. Factors associated with HIV and syphilis co-infection among men who have sex with men in seven Chinese cities. Int J STD AIDS 2015; 26(3):45–55.
Jansen K, Schmidt AJ, Drewes J, Bremer V, Marcus U. Increased incidence of syphilis in men who have sex with men and risk management strategies, Germany, 2015. Euro Surveill 2016; 21(43):1-7.
Ministry of Health of the Republic Indonesia. Report on integrated biological- behavioral surveillance of most-at-risk groups (MARG). Jakarta: Directorate General of Communicable Disease Control and Environmental Health; 2012.
Morineau G, Nugrahini N, Riono P, Nurhayati, Girault P, Mustikawati DE, Magnani
R. Sexual risk taking, STI and HIV prevalence among men who have sex with men in six Indonesian cities. AIDS Behav 2011; 15(5):1033-44.
Petrosky E, Fanfair RN, Toevs K, DeSilva M, Schafer S, Hedberg K, et al. Early syphilis among men who have sex with men in the US Pacific Northwest, 2008–2013: clinical management and implications for prevention. AIDS Patient Care STDS 2016; 30(3):134–40.
Jain J, Santos GM, Scheer S, Gibson S, Crouch PC, Khon R, et al. Rates and correlates of syphilis reinfection in men who have sex with men. LGBT Health; 2016:1-7.
Solomon M, Mayer KH. Evolution of the syphilis epidemic among men who have sex with men. Sex Health 2015; 12(2):96–102.
Sánchez-Gómez A, Jacobson JO, Montoya O, Magallanes D, Bajaña W, Aviles O, et al. HIV, STI and behavioral risk among men who have sex with men in a setting of elevated HIV prevalence along Ecuador's Pacific Coast. AIDS Behav 2015; 19(9):1609-18.
Katz KA. Syphilis. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in general medicine. 8th ed. New York: McGraw Hill; 2012. p. 2471-92.
Wahab AA, Rahman MM, Mohammad M, Hussin S. Case series of syphilis and HIV co-infections. Pak J Med Sci 2013; 29(3):856-58.
Hu QH, Xu JJ, Zou HC, Liu J, Zhang J, Ding HB, et al. Risk factors associated with prevalent and incident syphilis among an HIV-infected cohort in Northeast China. BMC Infectious Diseases 2014; 14:658-68.
Piraccini BM, Broccoli A, Starace M, Gaspari V, D'Antuono A, Dika E, et al. Hair and scalp manifestations in secondary syphilis: epidemiology, clinical features and trichoscopy. Dermatology 2015; 231(2):171-6.
Waugh MA. Syphilis. In: Katsambas AD, Lotti TM, Dessinioti C, D'Erme AM, editors. European handbook of dermatological treatments. 3rd ed. New York: Springer; 2015. p. 931-48.
Centers for Disease Control and Prevention. Syphilis. Sexually Transmitted Diseases Treatment Guidelines 2015. MMWR 2015; 64(3):34-48.
Kinghorn GR, Omer R. Syphilis and Congenital Syphilis,. In: Griffifths CEM, Barker J, Bleiker T, Chalmer R, editors. Rook's Textbook of dermatology. 9th ed. London: Wiley blackwell; 2016.
Lukehart SA Sparling PF, Swartz MN, Musher DM, Healy BP. Clinical manifestations of syphilis. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, Cohen MS, Watts DH, editors. Sexual transmitted disease. 4th ed. New York: Mc Graw Hill Medical; 2008. p. 661-84.
Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, et al. UK national guidelines on the management of syphilis 2015. Int J STD AIDS 2015; 27(6):421–46.
James WD, Berger T, Elston DM. Syphilis, yaws, bejel, and pinta. James WD, Berger T, Elston DM. Andrews' Diseases of the Skin, Clinical Dermatology. 12th ed. Philadelphia: Elsevier; 2016. p. 343-55.
- Copyright of the article is transferred to the journal, by the knowledge of the author, whilst the moral right of the publication belongs to the author.
- The legal formal aspect of journal publication accessibility refers to Creative Commons Atribusi-Non Commercial-Share alike (CC BY-NC-SA), (https://creativecommons.org/licenses/by-nc-sa/4.0/)
- The articles published in the journal are open access and can be used for non-commercial purposes. Other than the aims mentioned above, the editorial board is not responsible for copyright violation
The manuscript authentic and copyright statement submission can be downloaded ON THIS FORM.
