Sustained Mpox Proctitis with Primary Syphilis and HIV Seroconversion, Australia

Area of Science:

• Infectious Diseases
• Public Health
• Viral Hepatitis

Background:

• Co-infections with sexually transmitted infections (STIs) are increasingly recognized in men who have sex with men (MSM).
• Mpox (formerly monkeypox) and Human Immunodeficiency Virus (HIV) co-infections have been associated with severe clinical presentations.
• Syphilis can increase the risk of HIV acquisition and transmission.

Observation:

• A 26-year-old Australian MSM presented with severe perianal ulceration, proctitis, and skin lesions.
• Diagnostic testing confirmed concurrent primary syphilis, mpox, and primary HIV infection.
• The patient's severe symptoms suggest a complex interplay between the infections.

Findings:

• The co-occurrence of severe mpox, syphilis, and primary HIV infection in this individual is notable.
• Mpox-associated mucosal lesions may facilitate HIV transmission by compromising the integrity of the skin and mucous membranes.
• Conversely, HIV infection might exacerbate mpox severity or alter its clinical course.

Implications:

• This case highlights the critical need for comprehensive STI screening and testing in individuals presenting with severe symptoms, particularly among MSM.
• Clinicians should consider co-infections when managing patients with mpox, syphilis, or primary HIV.
• Understanding the synergistic effects of these infections is crucial for effective prevention and treatment strategies in public health.