What are the cutaneous manifestations of syphilis in HIV disease?

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
  • Print


Co-infection with syphilis (as well as other sexually transmitted diseases) may be found in HIV-infected patients, particularly those who are homosexual or bisexual or who use illicit drugs. Syphilitic ulcers are believed to increase HIV transmission.

Most cases of syphilis that occur in HIV disease are clinically and serologically typical, [40] but some are not. [41] A high rate of reinfection was noted in one French study, with less severe cutaneous manifestations. [40] However, syphilis seroconversion may be delayed, and standard serologic tests that aid in diagnosing syphilis may be unreliable. Also, in primary syphilis, presentation with multiple ulcers is more common in HIV-infected patients. Rapid progression of secondary syphilis to tertiary syphilis and syphilis maligna has been reported in patients infected with HIV. The Jarisch-Herxheimer reaction should be anticipated in patients neurosyphilis and coexistent HIV encephalitis. [42]

Appropriate serologic follow-up to ensure an adequate response to treatment is important in patients infected with HIV.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!