Painless penile papule
The asymptomatic lesion on our HIV-positive patient’s penis suggested an STD, but the patient said he hadn’t had any sexual partners for many years.
What you’ll see on the labwork
Like other acute infections, syphilis may cause transient increases in viral load with decreases in the CD4 count that resolve after treatment.11-14 Also worth noting:
- RPR at titers of >1:32 and CD4 counts <350 cells/mm3 may be associated with neurosyphilis in patients with HIV.10
- High RPR titers have been linked to elevated liver function enzymes in patients with syphilis and HIV, although the clinical significance of this is
unknown.15
Treat with penicillin
All stages of syphilis can be treated with penicillin G, a standard benzathine penicillin.16 Adult patients with primary and secondary syphilis should receive a single intramuscular dose of 2.4 million units of benzathine penicillin G.16
Our patient responded well to the recommended course of penicillin therapy and no other systemic signs of the infection were noted. He was also counseled on safe sexual practices and barrier protection.
CORRESPONDENCE
Katherine Masterpol, 955 Main Street Suite G6, Winchester, MA 01890; drkasia@gmail.com
