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This case study reported on a 55-year-old HIV-positive man with overlapping primary and secondary syphilis, highlighting the varied clinical manifestations due to compromised immune responses. The patient, with a history of multiple sexual partners and infrequent condom use, presented with non-scarring alopecia, a painless ulcer, and various skin lesions. Diagnostic tests confirmed syphilis and HIV, with a low CD4 T-cell count of 111 cells/µL. Treatment with benzathine penicillin G and antiretroviral drugs led to significant improvement, as evidenced by a non-reactive VDRL test and an increased CD4 count of 325 cells/µL after six months. This case demonstrated that prompt antibiotic and antiretroviral treatment could effectively improve both clinical and serological outcomes in HIV patients with syphilis co-infection.

A 22-year-old homosexual man presented with symptoms including red scaly patches, hair loss, and genital lumps, leading to a diagnosis of coinfection with secondary syphilis, condyloma acuminata, and HIV. Examination revealed nonscarring alopecia, erythematous plaques, and verrucous lesions. Tests showed a CD4 count of 112 cells/µl, reactive VDRL/RPR at 1:256, and TPHA at >1:5,120. Histopathology confirmed skin syphilis and condyloma acuminata, with immunohistochemistry showing Spirochaeta. The case highlights the increased risk of STIs in MSM, particularly the coexistence of HPV and HIV, which facilitate syphilis infection.