Secondary syphilis with tuberculosis co-infection: A rare case

Syphilis is an infection that could be transmitted sexually and caused by certain bacteria called Treponema pallidum with almost 21.000 new cases in Indonesia. Regularly positive blood serologic tests and similar abnormalities in cerebrospinal fluid (CSF) examination, including a positive Venereal Disease Research Laboratory (VDRL) test, are typically observed in cases of syphilis, except in instances of burned-out or previously treated cases. Tuberculosis (TB) is also a common infectious disease in Indonesia with a prevalence of 759 per 100.000 persons, but co-infection of syphilis and TB is a rare finding. A 29-year-old female was diagnosed with syphilis and TB referred from a public health center with red rashes found on the palm and soles bilaterally a month before the visit. Dermatological examination of the palms and soles showed multiple violaceous macules with clear boundaries, with varying sizes between 0.5 cm x 1 cm. No abnormalities were found in the genitalia and oral mucosa. The result of the VDRL examination, the titer was 1:128 and the Treponema Pallidum Haemagglutination Assay (TPHA) result was 7,59. The patient was prescribed by single dose of Benzathine Penicillin injection 2.4 million IU IM. The patient experienced clinical improvement and decreased VDRL and TPHA titers after a month of evaluation. Co-infection of syphilis and tuberculosis is a rare finding. TB infection is found to have decreased interferon production and CD25 expression which causes immunosuppression as a risk for syphilis. Otherwise, treponemes may potentially contribute to reactivation in immunosuppression individuals.