Concurrent HSV and Syphilis — SCE Infectious Diseases MCQ

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ModerateSTIsConcurrent HSV and SyphilisSCE Infectious Diseases

A 30-year-old man with HIV (CD4 350, VL <50) presents with genital ulceration. HSV-2 PCR is positive. He also has concurrent primary syphilis (dark-field positive chancre on the same anatomical site). He is not allergic to any medications. What is the correct treatment approach?

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Correct answer: D — Treat BOTH infections simultaneously: Benzathine Penicillin G 2.4 MU IM (syphilis) PLUS Valaciclovir 500 mg BD for 5 days (first-episode HSV) — co-existing GUD is common and all identified pathogens must be treated

Multiple concurrent STIs are common, particularly in high-risk populations. All identified pathogens must be treated simultaneously. Co-existing genital ulcer disease (mixed GUD — HSV plus syphilis in this case) is well-documented and does not alter the treatment approach for either infection. Each pathogen is treated with its standard regimen. Additionally, the presence of genital ulceration from any cause increases HIV transmission risk (though this patient is virally suppressed). Comprehensive STI screening and partner notification for both infections are essential.

Reference: BASHH 2019 – Genital ulcer guidelines; WHO 2024 – STI management