Primary syphilitic proctitis associated with human immunodeficiency virus infection in a male patient who had sex with men: a case report

Background: Men who have sex with men (MSM) have frequent rectal infections. Although a large increase in incidence of syphilis has been reported in recent years, rectal chancre is a rare manifestation that can easily be neglected.

Methods: We describe a male patient who had sex with men and presented with protracted chronic proctitis and scaly rashes. A diagnosis of HIV infection and early syphilis with syphilitic proctitis (rectal chancre) was confirmed by the findings of ulcerative proctitis under colonoscopy, the presence of Treponema pallidum in rectal ulcer biopsy specimens by immunohistochemistry, and positive serologic test results for human immunodeficiency virus type 1 (HIV-1) and syphilis.

Results: Intramuscular benzathine penicillin G (2.4 million Units) given once a week for three consecutive weeks resulted in complete resolution of rectal and skin lesions. The patient also began regular anti-viral therapy against HIV infection.

Conclusion: Immunohistochemical detection of Treponema pallidum in the primary infection tissue is a useful complement to serologic tests for the diagnosis of syphilis by clinical laboratories. Healthy and protective sexual behavior is advocated to avoid possible infections in MSM.

Rectal chancre; Syphilis; Immunohistochemical detection; HIV infection

[1] World Health Organization, Department of HIV/AIDS. Global prevalence and incidence of selected curable sexually transmit-ted infections: overview and estimates. Geneva, 2001. Avail-able at: http://www.who.int/hiv/pub/sti/who_hiv_aids_ 2001.02.pdf (Accessed: 1 November 2001).

[2] Li JH, Cai YM, Yin YP, Hong FC, Shi MQ, Feng TJ, et al. Prevalence of anorectal Chlamydia trachomatis infection and its genotype distribution among men who have sex with men in Shenzhen, China. Japanese Journal of Infectious Diseases. 2011; 64: 143–146.

[3] Bassi O, Cosa G, Colavolpe A, Argentieri R. Primary syphilis of the rectum–Endoscopic and clinical features. Report of a case. Diseases of the Colon & Rectum. 1991; 34: 1024–1026.

[4] Torrone EA, Bertolli J, Li J, Sweeney P, Jeffries WL, Ham DC, et al. Increased HIV and primary and secondary syphilis diagnoses among young men-United States, 2004–2008. Journal of Acquired Immune Deficiency Syndromes. 2011; 58: 328–335.

[5] Voinchet O, Guivarc’h M. Syphilis of the rectum mimicking neoplastic disease (author’s transl). Gastroenterologie Clinique et Biologique. 1980; 4: 134–136. (In French)

[6] Song SH, Jang I, Kim BS, Kim ET, Woo S, Park MJ, et al. A case of primary syphilis in the rectum. Journal of Korean Medical Science. 2005; 20: 886–887.

[7] Javanbakht M, Murphy R, Harawa NT, Smith LV, Hayes M, Chien M, et al. Sexually Transmitted Infections and HIV Prevalence among Incarcerated Men who have Sex with Men, 2000–2005. Sexually Transmitted Diseases. 2009; 36: S17–S21.

[8] Bignell C; IUSTI/WHO. 2009 European (IUSTI/who) Guideline on the Diagnosis and Treatment of Gonorrhoea in Adults. International Journal of STD & AIDS. 2009; 20: 453–457.

[9] Martín-Ezquerra G, Fernandez-Casado A, Barco D, Jucglà A, Juanpere-Rodero N, Manresa JM, et al. Treponema pallidum distri-bution patterns in mucocutaneous lesions of primary and secondary syphilis: an immunohistochemical and ultrastructural study. Human Pathology. 2009; 40: 624–630.

[10] Surawicz CM, Goodell SE, Quinn TC, Roberts PL, Corey L, Holmes KK, et al. Spectrum of rectal biopsy abnormalities in homosexual men with intestinal symptoms. Gastroenterology. 1986; 91: 651–659.

[11] Katz DA, Dombrowski JC, Bell TR, Kerani RP, Golden MR. HIV Incidence among Men who have Sex with Men after Diagnosis with Sexually Transmitted Infections. Sexually Transmitted Diseases. 2016; 43: 249–254.

[12] Wu Z, Xu J, Liu E, Mao Y, Xiao Y, Sun X, et al. HIV and syphilis prevalence among men who have sex with men: a cross-sectional survey of 61 cities in China. Clinical Infectious Diseases. 2013; 57: 298–309.