Overlapping Primary and Secondary Syphilis in Human Immunodeficiency Virus (HIV) Patient

Nurul Laili Nahlia, Lita Setyowatie

Abstract

ABSTRACT

Coinfection between syphilis and Human Immunodeficiency Virus (HIV) could have varied clinical manifestations. Overlapping of syphilis stages is accounted for 25% of cases, attributable to the defect of the cellular and humoral immune response. We reported 55 years old man who was sexually active since 25 years ago via genito-genital, genito-anal, genito-oral routes, had multiple sexual partners both male and female, seldom used condom, and always being the insertive. Dermatological examination revealed alopecia non-scarring, a painless solitary ulcer on the collum penis, also multiple erythematous macules, patches, and plaques all over the body. Spirochaeta sp. was found from the base of the ulcer with a darkfield microscope. Histopathology examination revealed secondary syphilis lesion. Venereal Disease Research Laboratory (VDRL) 1:16, Treponema Pallidum Haemagglutination test (TPHA) reactive, HIV Determine rapid test reactive, and CD4 (Cluster of Differentiation 4) T-cell count 111 cells/ µL. He was treated with a single dose of benzathine penicillin G 2,4 million units intramuscular and antiretroviral drugs. On sixth month evaluation, VDRL was non-reactive, and CD4 T-cell count 325 cells/µL. This case shows that overlapping clinical manifestations of primary and secondary syphilis on HIV patients could occur with a good general condition. Immediate treatment of antibiotics for syphilis and antiretroviral could improve the clinical and serological conditions.

Keyword: primary syphilis, secondary syphilis, HIV

Correspondence: nurul.laili.nahlia@gmail.com

Keywords

primary syphilis, secondary syphilis, HIV, case report

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References

Ahn, Jin Young et al. (2016). Incidence of Syphilis Seroconversion among HIV-Infected Persons in Asia: Results from the TREAT Asia HIV Observational Database. Journal of the International AIDS Society 19(1): 1–8.

Carlson, J. Andrew, Ganary Dabiri, Bernard Cribier, and Stewart Sell. (2011). The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Felayed-Type Hypersensitivity. American Journal of Dermatopathol 33(5): 433–60.

Daili, Sjaiful Fahmi et al. (2013). Kementrian Kesehatan Republik Indonesia Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan Pedoman Tata Laksana Sifilis Untuk Pengendalian Sifilis Di Layanan Kesehatan Dasar. Jakarta: Kementrian Kesehatan Republik Indonesia Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan.

Frieden, Thomas R. et al. (2015). 64 Center for Disease Control and Prevention The Morbidity and Mortality Weekly Report (MMWR). Eds. William L. Roper et al. Washington: U.S. Department of Health and Human Services. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm?s_ cid=rr6403a1_w.

Hutchinson, Catherine M. et al. (1994). Altered Clinical Presentation of Early Syphilis in Patients with Human Immunodeficiency Virus Infection. Annals of Internal Medicine 121(2): 94–99.

Jackson, Adrianna J., and Vera H. Price. (2013). How to Diagnose Hair Loss. Dermatologic Clinics 31(1): 21–28.

Karp, Galia, Francisc Schlaeffer, Alan Jotkowitz, and Klaris Riesenberg. (2009). Syphilis and HIV Co-Infection. European Journal of Internal Medicine 20(1): 9–13. http://dx.doi.org/10.1016/j.ejim.2008.04.002.

Lukehart, Sheila A. (2008). Biology of Treponemes. In Sexually Transmitted Diseases 4th Edition, eds. King K Holmes et al. New York: Mc-Graw-Hill, 647–59.

Pialoux, Gilles et al. (2008). Effect of HIV Infection on the Course of Syphilis. Aids Reviews 10: 85–92.

Pisani, Elizabeth et al. (2004). HIV, Syphilis Infection, and Sexual Practices among Transgenders, Male Sex Workers, and Other Men Who Have Sex with Men in Jakarta, Indonesia. Sexually Transmitted Infections 80(6): 536–40.

Rowawi, R, T. S. Djayakusumah, and P. A Achdiat. (2018). Sifilis Pada Pasien HIV/AIDS. In Manifestasi Dan Tatalaksana Kelainan Kulit Dan Kelamin, eds. Afif Nurul Hidayati et al. Jakarta: Badan Penerbit FKUI, 19–50.

Solomon, Marc M., and Kenneth H. Mayer. (2015). Evolution of the Syphilis Epidemic among Men Who Have Sex with Men. Sexual Health 12(2): 96–102.

de Sousa, Isabel Cristina Valente Duarte. (2013). Simultaneous Primary and Secondary Syphilis Associated with Syphilitic Alopecia and Folliculitis in an HIV Positive Patient. Hair : Therapy & Transplantation 03(01): 108–10.

Szetela, Bartosz, and Jacek Gasiorowski. (2016). Rapid Progression and Overlapping of Skin Eruptions in a Patient with Secondary and Tertiary Syphilis Co-Infected with HIV. AIDS Research and Human Retroviruses 32(9): 874–75.

UNAIDS. (2020). Country Factsheets INDONESIA 2018. https://www.unaids.org/en/regionscountries/countries/indonesia (April 8, 2020).


DOI: http://dx.doi.org/10.30651/jqm.v4i2.4378