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This study highlights the challenges in distinguishing between secondary and tertiary syphilis bone lesions in adults with human immunodeficiency virus. Due to the rarity, optimal treatment and outcomes remain unclear.

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Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Radiology

Background:

  • Syphilis, a sexually transmitted infection, can affect bone tissue.
  • Human immunodeficiency virus (HIV) co-infection can alter the presentation of syphilis.
  • Bone involvement in syphilis presents diagnostic challenges.

Purpose of the Study:

  • To document bone involvement in two adult patients with syphilis and HIV.
  • To discuss the difficulties in differentiating secondary and tertiary syphilis bone lesions.
  • To highlight the lack of consensus on treatment for these rare presentations.

Main Methods:

  • Case documentation of two adult patients.
  • Clinical and radiological assessment of bony lesions.
  • Review of syphilis staging and HIV co-infection implications.

Main Results:

  • Two distinct stages of bone involvement due to syphilis were observed in HIV-infected adults.
  • Clinical and radiological features did not reliably differentiate secondary from tertiary syphilis bone lesions.
  • The rarity of this presentation complicates treatment decisions.

Conclusions:

  • Differentiating secondary and tertiary syphilis bone involvement in HIV-positive individuals is challenging based on current clinical and radiological data.
  • Further research is needed to establish consensus on treatment duration and expected outcomes for these rare cases.