An Interesting Case of Triple Sti in an Immunocompetent MSM

Coexistence of multiple STIs is not uncommon. STIs are asymptomatic in their initial stages and coinfecting STI may be missed if not properly evaluated. Men having sex with men (MSM), because of their sexual behavioural, are at higher risk of acquiring STIs/ co-infections as compared to heterosexuals. A 33-year-old homosexual male had anogenital warts since 1 month and urethral discharge since 1 week. He had asymptomatic, red lesions restricted to palms and soles with red lesions over penis 1 year ago with spontaneous resolution. Investigations of the present complaint were no diplococci on Gram stain, urethral swab negative for Gonorrhea, no abnormality on urine examination, RPR 1:16 and HIV non-reactive. Diagnosis was urethritis with anogenital warts and early latent syphilis. Treatment given was Tab. Cexime 800mg, T. Azithromycin 1g (for gonococcal and non-gonococcal urethritis as follow up was not assured), 25% podophyllin in tincture benzoin and 70 % trichloroacetic acid and 1 injection of intramuscular Benzathine Penicillin 2.4 MU in divided doses with clinical improvement and fall in RPR (1:4) at 5 months. An optimized multi-STI co-testing strategy integrated with prevention, surveillance, and treatment is urgently needed to reduce the prevalence of sexually transmitted co-infections especially among MSM. A unique case of co-infection with HPV, syphilis and urethritis, a pattern of coinfection not reported in an immunocompetent MSM is highlighted.