Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
This 20-year-old woman has been HIV-seropositive for a year and recently has had Pneumocystis carinii pneumonia. Her recent complaint was of cough, fever, and shortness of breath. Incidental findings on examination were these large, pale, papular lesions in the vulvar area. The patient stated that she was just recovering from a "yeast infection." Laboratory studies showed a positive reaction to the rapid plasma reagin test (titer, 1:32) as well as to the fluorescent treponemal antibody absorption test. On further questioning, the patient admitted that she had had previous treatment for syphilis, although she did not recall which antibiotic she had received.
Unlike the usual appearance of condyloma latum in secondary syphilis, some of these lesions were ulcerated. This may be a somewhat atypical presentation of syphilis in an HIV-seropositive patient.
(Case and photograph courtesy of William Bailey, MD, Leslie Trope, MD, and Celeste Grubin, MD.)