Contracting malignant syphilis through homosexual relations.

Ho Chi Minh City – A 19-year-old man with a history of HIV infection recently developed numerous oozing sores on his skin accompanied by joint swelling and was diagnosed with malignant syphilis.

This rare case was presented clinically by Dr. Nguyen Thi Thanh Tho, Deputy Head of Clinical Department 3, Ho Chi Minh City Dermatology Hospital, at the 19th Annual Scientific Conference of the Ho Chi Minh City Dermatology Association on the afternoon of May 21st.

According to Dr. Tho, about six months ago, the young man noticed several pus-filled ulcers on his skin around his mouth and chin, accompanied by swollen joints. He sought treatment at a regional hospital in Dong Thap province, where he received antibiotics, anti-inflammatory drugs, and painkillers, but his condition did not improve. Old ulcers had scabbed over, and many new ulcers appeared, causing the patient concern, leading him to seek treatment at the Ho Chi Minh City Dermatology Hospital.

The patient has a history of same-sex relationships with more than two partners, was diagnosed with HIV 5 years ago, and is currently receiving ARV treatment.

"We suspected the patient had syphilis on top of pre-existing HIV, so we advised him to get screened for all sexually transmitted diseases," Dr. Tho said, adding that the results showed he had malignant syphilis. Malignant syphilis is a severe and rare form of secondary syphilis.

Currently, the young man's health has recovered, and his skin has healed after 6 months of treatment.

In 2017, the Ho Chi Minh City Dermatology Hospital also detected and treated a 27-year-old patient from Binh Thanh District with a history of HIV infection and same-sex sexual activity. The patient presented with perianal skin ulcers a month prior to examination. A general skin examination revealed multiple deep ulcers with foul-smelling oozing, painless discharge. Tests confirmed a diagnosis of malignant syphilis.

Malignant syphilis has a short incubation period, beginning with systemic symptoms such as fever, chills, muscle pain, and joint pain. Skin manifestations progress from nodules and pustules to ulcers and ulcerated plaques with oozing, forming a thick, shell-like crust on the surface, brown or black in color.

Malignant syphilis is rare, but if not diagnosed and treated early, the disease can progress throughout the body, affecting the cardiovascular system, central nervous system, vision, hearing, musculoskeletal system, digestive system, and urinary system, posing a life-threatening risk.

This condition commonly occurs in HIV-infected patients, those with a history of homosexual activity, and those with ulcerative or necrotic lesions, accompanied by systemic symptoms. The prognosis is good with early, correct, and complete antibiotic treatment according to the prescribed regimen.

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