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Secondary syphilis: lest we forget it
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    Secondary syphilis in the context of HIV-related immunosuppression

    The secondary syphilis we see today is potentially different from the secondary syphilis which belongs to the era antedating the presently high incidence and prevalence of human immunodeficiency virus (HIV) infection. Sexually active subjects who harbour the coexistence of HIV infection (with attendant immune suppression) and syphilis are also at risk of opportunistic infections such as tuberculosis and cryptococcosis (1)(2)(3). In one HIV-positive patient aged 43, neurosyphilis coexisted with both cryptococcal meningitis and tuberculous meningitis. The cerebrospinal fluid (CSF) was characterised by lymphocyte predominance low glucose and high protein. Furthermore, in the CSF, cryptococcal antigen amounted to 1;640, and the VDRL from the CSF was also reactive. CSF culture grew M. tuberculosis, and this was confirmed by the polymerase chain reaction (1). In another instance, a 37 year old man with past medical history of HIV infection had neurosyphilis coexisting with cryptococcal meningitis. The CSF was characterised by lymphocyte predominance, positive fluorescent treponemal antibody test and cryptococcal antigen titre of 1:640 (2). Another report involved a 40 year old man with coexisting neurosyphilis and cryptococcal meningitis. The CSF showed lymphocyte predominance and high protein concentration. Cryptococcus was cultured from the CSF and both serum serology and CSF were positive for syphilis (3). These anecdotal reports might underestimate the true prevalence of coe...

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