[Acquired syphilis and HIV infection]

The currently observed increased prevalence of syphilis in subjects with human immunodeficiency virus (HIV) infection could be an expression of an increase in sex-related risks or could result from facilitated viral transmission via ulcerations of the genital organs. In addition, viral-immunological interactions related to HIV infection could affect the natural history of syphilis suggesting that the clinical pictures of the past may be making a comeback due to modified response to syphilis infection. These observations would suggest revising a certain number of the classical diagnostic and therapeutic criteria for syphilis in HIV positive patients. The consequence of these interactions on response to treatment may be the key to the increased number of unsuccessful treatments observed recently and to the increased frequency of early neurological and ocular manifestations of syphilis. Clinicians should revise their therapeutic schemes which have become unadapted to the new situation caused by HIV infection.