Secondary syphilis as an initial presentation of HIV

Syphilis, a sexually transmitted infection caused by the spirochete Treponema pallidum, generally presents in distinct stages that sequentially progress in a predictable pattern. However, in the case of syphilis and HIV coinfection, the progression of the disease may be atypical, and syphilis may be the initial presentation of an underlying HIV infection in an undiagnosed patient. These patients can initially present with symptoms of secondary syphilis and can have a rapid and aggressive initial course. Here we describe a case of syphilis in a patient who presented in the secondary stage with a diffuse maculopapular rash, who was later found to have an underlying HIV coinfection.