Case Reports
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https://doi.org/10.4081/dr.2026.10027

Secondary syphilis as first presentation of HIV: a case report

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Received: 22 April 2024
Accepted: 17 January 2025
Published: 17 February 2026
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Syphilis, HIV, sexually transmitted diseases, co-infection

Authors

Lamia Alakrash
Department of Dermatology, King Fahd Medical City, Riyadh, Saudi Arabia.
Asem Shadid
Department of Dermatology, King Fahd Medical City, Riyadh, Saudi Arabia.
Mohammed Aljughayman
Mohammed.aljughayman1@gmail.com
Department of Dermatology, King Fahd Hospital, Alhafouf, Saudi Arabia.
Malak Almutlq
Department of Dermatology, King Fahd Medical City, Riyadh, Saudi Arabia.
Faris Alhomida
Department of Dermatology, King Fahd Medical City, Riyadh, Saudi Arabia.

The simultaneous occurrence of HIV and syphilis poses an increasing difficulty due to the dynamic interplay between these two diseases. In recent years, the worldwide prevalence of co-infection between these two major global health issues has increased, partly because each infection can facilitate the acquisition of the other. We report a case of a 36-year-old diabetic male presenting to our clinic with scattered erythematous papules and plaques with a collarette of scale on the palms, soles, and genital area. The patient had geographic tongue with linear white plaques and fissuring. Virology showed positive herpes simplex virus IgG antibodies for types 1 and 2, and skin biopsy demonstrated vacuolar interface dermatitis, acanthosis, lymphocyte exocytosis, and thinning of the rete ridges. Additionally, the HIV serology test was positive. A diagnosis of secondary syphilis on top of HIV was established. Given the significant consequences that the co-infection of syphilis and HIV has on impacted individuals, it is crucial to allocate more time, effort, and resources to investigate this condition.

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Scopus
Google Scholar
Europe PMC
1. Arando Lasagabaster M, Otero Guerra L. Syphilis. Sífilis. Enferm Infecc Microbiol Clin (Engl Ed) 2019;37:398-404.
2. Tudor ME, Al Aboud AM, Leslie SW, Gossman W. Syphilis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
3. Tampa M, Sarbu I, Matei C, et al. Brief history of syphilis. J Med Life 2014;7:4-10.
4. Jackson-Best F, Edwards N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 2018;18:919.
5. van Heuvel Y, Schatz S, Rosengarten JF, Stitz J. Infectious RNA: Human Immunodeficiency Virus (HIV) Biology, Therapeutic Intervention, and the Quest for a Vaccine. Toxins (Basel) 2022;14:138.
6. Greene WC. A history of AIDS: looking back to see ahead [published correction appears in Eur J Immunol 2008;38:309]. Eur J Immunol 2007;37:S94-S102.
7. Roberts CP, Klausner JD. Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men. Expert Rev Anti Infect Ther 2016;14:1037-46.
8. Karp G, Schlaeffer F, Jotkowitz A, Riesenberg K. Syphilis and HIV co-infection. Eur J Intern Med 2009;20:9-13.
9. Salado-Rasmussen K. Syphilis and HIV co-infection. Epidemiology, treatment and molecular typing of Treponema pallidum. Dan Med J 2015;62:B5176.
10. Bezerra JMT, Castro PASV, Machado CJ, Carneiro M. Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019. Rev Soc Bras Med Trop 2022;55:e00102022.
11. Ren M, Dashwood T, Walmsley S. The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management. Curr HIV/AIDS Rep 2021;18:280-8.
12. World Health Organization. WHO guidelines for the treatment of Treponema pallidum (syphilis). Geneva: World Health Organization; 2016.
13. Fairley CK, Law M, Chen MY. Eradicating syphilis, hepatitis C and HIV in MSM through frequent testing strategies. Curr Opin Infect Dis 2014;27:56-61.
14. Lynn WA, Lightman S. Syphilis and HIV: a dangerous combination. Lancet Infect Dis 2004;4:456-66.
15. Friedman RF, Ganiban GJ, Liss RA, Friedel SD. Ocular syphilis and neurosyphilis in a patient with human immunodeficiency virus infection. Md Med J 1995;44:284-8.
16. Kassem Youssef H, Blind A, Chouta Ngaha F, et al. Secondary pulmonary syphilis: Case report and review of literature. Ann Dermatol Venereol 2018;145:278-87.
17. Liu H, Goh BT, Huang T, et al. Secondary syphilis presenting as erythema multiforme in a HIV-positive homosexual man: a case report and literature review. Int J STD AIDS 2019;30:304-9.
18. Rompalo AM, Joesoef MR, O’Donnell JA, et al. Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Sex Transm Dis 2001;28:158-65.
19. Dowell D, Polgreen PM, Beekmann SE, et al. Dilemmas in the management of syphilis: a survey of infectious diseases experts. Clin Infect Dis 2009;49:1526-9.
20. Lawrence D, Cresswell F, Whetham J, Fisher M. Syphilis treatment in the presence of HIV: the debate goes on. Curr Opin Infect Dis 2015;28:44-52.
21. Hobbs E, Vera JH, Marks M, et al. Neurosyphilis in patients with HIV. Pract Neurol 2018;18:211-8.

How to Cite



1.
Alakrash L, Shadid A, Aljughayman M, Almutlq M, Alhomida F. Secondary syphilis as first presentation of HIV: a case report. Dermatol Reports [Internet]. 2026 Feb. 17 [cited 2026 Apr. 18];. Available from: https://journals.pagepress.net/dr/article/view/10027
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