Malignant syphilis due to homosexual intercourse

Ho Chi Minh City , a 19-year-old man with a history of HIV infection, recently developed many oozing ulcers and swollen joints, and was diagnosed with malignant syphilis.

This rare case was clinically reported 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 21.

According to Dr. Tho, about 6 months ago, the young man saw many pus-filled ulcers on his skin in his mouth and chin, along with swollen joints. The patient went to a hospital in Dong Thap area and was treated with antibiotics, anti-inflammatory drugs, and painkillers, but they did not improve. The old ulcers turned black and many new ulcers appeared, making the patient worried and he went to the Ho Chi Minh City Dermatology Hospital for examination.

The patient had a history of homosexual intercourse and more than two sexual partners, was diagnosed with HIV 5 years ago and was on ARV treatment.

"We suspected the patient had syphilis on top of his existing HIV, so we instructed him to do screening tests for all sexually transmitted diseases," said Dr. Tho, adding that the results showed he had malignant syphilis. Malignant syphilis is a serious and rare form of secondary syphilis.

Now, 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 discovered and treated a 27-year-old patient in Binh Thanh District with a history of HIV infection and homosexuality. This person came to the clinic with a skin ulcer near the anus for a month. A full body skin examination revealed many deep ulcers, oozing foul-smelling, painless fluid, and was tested and diagnosed with malignant syphilis.

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

Malignant syphilis is very rare. 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, kidneys and urinary system, threatening life.

This disease often appears in patients with HIV infection, a history of homosexual intercourse, with ulcerative or necrotic lesions, accompanied by systemic symptoms. The prognosis is good when treated early, correctly and with adequate doses of antibiotics according to the regimen.

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