SHORT COMMUNICATION
Genital Ulcer Signaling Recent Syphilis in an HIV
Infected Patient: the Diagnosis Challenge
Úlcera Genital Sinalizando Sífilis Recente em um Paciente Infectado pelo HIV: o Desafio do
Diagnóstico
Eliane de Dios Abad1, Ana Beatriz A Queiroz2, Aline DT Oliveira3, Fernanda S Cavalcante4,
Hercília Regina A Montenegro5, Márcia Ribeiro6, Dennis C Ferreira7
CASE REPORT
A 38 years old male patient, infected by human immunodeficiency virus (HIV) for six years and six months, without adhering
to antiretroviral therapy since diagnosis he presented the main
complaint as “the presence of a wound on his penis” for 30 days.
Initially it was diagnosed as “candidiasis” in a service, and was treated with ketoconazole 200 mg/day and nystatin 100.000 IU (units
per gram) cream for 10 days without clinical improvement.
Then in another service it was requested VDRL(1) (Venereal Disease Research Laboratory) and FTA-Abs (fluorescent treponemal
antibody absorption) with negative results, diagnosed with HSV
(Herpes simplex virus) infection he used acyclovir 200 mg, 5 x/
day, PO, for 7 days, with no difference to the same lesion. In another appointment with a dermatologist, after anamnesis the patient
stated that he did not have an exclusive steady partner, he had a
sporadic use of condoms and his last sexual intercourse had occurred 20 days before the onset of the lesion. His CD4 (CD4 lymphocytes) count was 250 mm3 and HIV viral load 90,000 copies/
mm3 of and he was under use of Highly Active Antiretroviral Therapy (tenofovir, lamivudine and efavirenz).
Clinical examination showed a lesion in the glans of the penis involving the urethral meatus, with raised edges, well defined, measuring about 3.0 cm in diameter and clean background,
odorless, with right inguinal lymphadenopathy, suggestive of
“syphilitic hard chancre” (Figure 1 – A and B). VDRL titling was
conducted with 1/8 and value of 1/16 after 10 days. Benzathine
penicillin was prescribed and the patient refused the treatment.
However, the patient was seen by another professional who
prescribed after diagnosis doxycycline 100 mg PO 12/12 h for
1 MD, Doctoral student of Clinical Medicine of Federal University of Rio
de Janeiro – UFRJ.
2 RN, Associate Professor of Department of Maternal-Child Nursing – Anna
Nery School of Nursing – EEAN-UFRJ. Coordinator of Multidisciplinary
Residency in Women’s Health HESFA/UFRJ. Professor of Post-graduate
stricto sensu EEAN/UFRJ.
3 DDS, Master Student of Dentistry of School of Dentistry, Veiga de
Almeida University – UVA, Rio de Janeiro, Brazil.
4 PhD Student of Microbiology of Institute of Microbiology Paulo de Goes
– IMPPG-UFRJ.
5 Professor of Nursing Graduation – UNIABEU.
6 Professor of Medical Genetics of Instituto de Puericultura e Pediatria
Martagão Gesteira – IPPMG-UFRJ.
7 Professor of School of Dentistry of Veiga de Almeida University – UVA.
Professor of Pharmacy, Nursing and Physiotherapy Graduate Courses –
UNIABEU.
DST - J bras Doenças Sex Transm 2013;25(1):46 - ISSN: 0103-4065 - ISSN on-line: 2177-8264
A
b
Figure 1 – Images A and B – regular plaque with erythema and scales
in the edge, around the urethral meatus.
14 days(2), which was followed showing complete regression of
the lesion in 3 weeks. Even without making use of penicillin and
azithromycin, he performed control of cure with no treponemal
serology quantitative test for 3 in 3 months during the first year
and then was discharged(3).
REFERENCES
1.
2.
3.
Meyer MP, Baughn RE. Whole-blood hemagglutination inhibition test for
venereal disease research laboratory (VDRL) antibodies. J Clin Microbiol. 2000;38(9):3413-4.
Centers for Disease Control and prevention (CDC). Sexually transmitted disease. Treatment guideline 2010. MMWR Morb Mortal Wkly Rep.
2010;59 RR-12.
Passoni LFC, Menezes JA, Ribeiro SR, Sampaio ECO. Lues maligna in
an HIV-infected patient. Rev Soc Bras Med Trop. 2005;38(2):181-184.
Address to correspondence:
DENNIS DE CARVALHO FERREIRA
Avenida Carlos Chagas Filho, 373 CCS, Bloco I, Sala 12-010
Cidade Universitária, Rio de Janeiro, RJ, Brazil
CEP: 21941-902
E-mail: [email protected]
Phone: +55 (21) 2560-8344
Fax: +55(21) 2560-8028
Received in: 16.06.2013
Approved in: 28.08.2013
DOI: 10.5533/DST-2177-8264-201325110