Features of clinical manifestations of secondary syphilis in a HIV infected patient

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Syphilis and human immunodeficiency virus (HIV) infection are diseases of an infectious nature with a predominantly sexual route of infection. Despite the decrease in the incidence of syphilis in recent years in Russia, there is an increase in HIV infection.

The combination of several infections in one patient leads to changes in clinical manifestations, which sometimes significantly complicates their diagnosis, leading to a late start of treatment. Syphilis against the background of HIV infection proceeds in stages, but usually it has a malignant, aggressive and severe course, often with the development of atypical forms and complications.

The primary syphilis against the background of HIV infection is characterized by the appearance of ulcerative-necrotic character of the hard chancre, such severe complications as phagedenism and gangrenization, the frequent addition of a secondary infection, severe soreness of the hard chancre. Secondary syphilides in HIV-infected patients are characterized by the appearance of ulceration with the formation of necrotizing vasculitis, extraordinary infectiousness of the elements. The disease progresses rapidly and over a few months from the moment of infection, manifest neurosyphilis or tertiary syphilis may develop due to immunodeficiency.

The authors describe the features of the manifestations of syphilis in its different periods against the background of HIV infection. A clinical case of a 35-year-old woman who was diagnosed with secondary syphilis and HIV infection is presented. The patient had numerous skin rashes, which were interpreted differently by doctors of different specialties for 2 months. The patient was diagnosed with pyoderma, "allergy", infectious exanthema, however, against the background of the treatment, there was a negative dynamics of the skin process. The authors have demonstrated the effectiveness of specific therapy: complete resolution of skin rashes.

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Elena Serdyukova

Volgograd State Medical University

编辑信件的主要联系方式.
Email: eas171@yandex.ru
ORCID iD: 0000-0002-2109-3723
SPIN 代码: 3974-3787

MD, Cand. Sci. (Med.), Associated Professor

俄罗斯联邦, 13 Angarskaya street, 400120 Volgograd

Svetlana Shchava

Volgograd State Medical University

Email: snchava@rambler.ru
ORCID iD: 0000-0002-4946-6624
SPIN 代码: 7449-7277

MD, Cand. Sci. (Med.), Associated Professor

俄罗斯联邦, 400120, Волгоград, ул. Ангарская, д. 13

参考

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  2. Sokolova EV, Pokrovsky VV, Ladnaya NN. The HIV infection situation in the Russian Federation. Ther Arch. 2013;85(11):10-15. EDN: RTKZBH
  3. Bastos TC, Maia DC, Gomes NM, et al. Syphilis associated with paretic neurosyphilis mimicking Reiter´s syndrom in HIV-infected patients. An Bras Dermatol. 2015;90(3):212-215. doi: 10.1590/abd1806-4841.20153625
  4. Vasudevan B, Verma R, Pragasam V, et al. A rare case of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient. J Int Assoc Provid AIDS Care. 2013;12(6):380-383. doi: 10.1177/2325957413488833
  5. Krasnoselskikh TV, Manasheva EB, Gezei MA. Comorbidity of syphilis and HIV infection: negative epidemiological and clinical synergism. HIV Infection Immunosuppression. 2018;10(3):7-16. EDN: YNJWWL doi: 10.22328/2077-9828-2018-10-3-7-16
  6. Krasnoselskikh TV, Sokolovsky EV. Neurosyphilis on the background of HIV infection. Bulletin Dermatol Venereol. 2015;(2):49-57. EDN: TYJEHV
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  11. Eyer-Silva WA, Souza VP, Silva GA, et al. Secondary syphilis presenting as a corymbiform syphilide: Case report and review. Rev Inst Med Trop Sao Paulo. 2018;20(60):40. doi: 10.1590%2FS1678-9946201860040
  12. Fustà-Novell X, Morgado-Carrasco D, Barreiro-Capurro A, et al. Syphilis maligna: A presentation to bear in mind. Actas Dermosifiliogr. 2019;110(3):232-237. doi: 10.1016/j.ad.2018.02.024
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  14. Yelkin VD, Kolomoytsev AV, Snycheva MA. Case of syphilitic resuperinfection in an HIV-infected person. Russ J Skin Venereal Dis. 2012;15(6):66-67. EDN: PUHTAN

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2. Fig. 1. Patient V., 35 years old, with secondary syphilis on the background of HIV infection: rashes in the back and neck (a); syphilitic roseola, papular, pustular syphilides on the trunk (b); papular, pustular rashes on the face and neck (c).

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3. Fig. 2. After treatment: pigmented spots on the abdomen (a); pigmented spots and superficial scars facial area (b).

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