Syphilis in HIV Positive Individuals and the Importance of a Skin Exam: A Case Report

Among HIV-positive patients, co-infection with syphilis is estimated to be as high as 20%. The diagnosis of syphilis is often missed due to its asymptomatic nature during its primary stages. A 68-year-old HIV-positive male presented with perianal lesions to his primary care physician twice. He was then referred to two different specialists before a proper physical exam was conducted after which he was diagnosed with otosyphilis and neurosyphilis. Physicians should have a higher index of clinical suspicion for syphilis in HIV-positive patients to allow for prompt diagnosis given the propensity of these patients to develop more severe neurological and ophthalmologic manifestations. This case highlights the importance of a thorough skin exam by a primary care physician when examining patients to allow for an earlier and accurate diagnosis and thus avoiding unnecessary referrals to specialists.