# Case Report: Concomitant presence of two STIs in a male patient

## TL;DR

A young man with risky sexual behavior was diagnosed with two sexually transmitted infections, syphilis and genital warts, highlighting the need for better prevention and treatment strategies.

## Contribution

This case report highlights the co-occurrence of two STIs in a behaviorally vulnerable individual and emphasizes the importance of preventive measures.

## Key findings

- A 21-year-old man was diagnosed with primary syphilis and genital warts.
- The patient showed complete healing of the ulcer and significant wart reduction after treatment.
- Behaviorally vulnerable individuals are at higher risk of acquiring multiple STIs.

## Abstract

Background: The spirochaete
Treponema pallidum subsp. pallidum, which causes the infectious disease syphilis, can be spread through sexual contact or perinatal transmission. In recent years, cases of syphilis have increased, especially among individuals engaging in behaviour that makes them more vulnerable (condomless sex and multiple sexual partners) and in men who have sex with men. Condylomata acuminata (external genital warts) is one of the most common viral sexually transmitted infections (STIs). Individuals who are behaviourally vulnerable are also highly prone to be exposed to one or more STIs. Our case exemplifies the occurrence of two STIs in a young man who was behaviourally vulnerable to acquiring STIs.

Case: We report a case of a 21-year-old year old heterosexual man presenting with concomitant primary syphilis and genital warts. He presented with a painless genital ulcer and warty growths on his glans penis. Examination showed a painless indurated ulcer and multiple genital warts. Serology was positive for quantitative serological disease research laboratory test (1:16 titre). The patient was diagnosed with two concomitant STIs. He was treated as per the latest Centers for Disease Control and Prevention (CDC) guidelines for primary syphilis and podophyllin resin for genital warts. After four weeks, the genital ulcer showed complete healing and there was a significant reduction of genital warts.

Conclusions: Individuals with multiple sexual partners engaging in sexual activity without the use of prevention tools are at a greater chance of acquiring two or more STIs. To reduce concomitant transmission, preventive measures against genital ulcer diseases caused by human papilloma virus, syphilis, herpes, and chancroid, such as early identification and treatment, and condom distribution, must be strengthened as part of national STI prevention. Patients with two or more STIs should be followed regularly to assess the progress of infection and should be offered timely medical treatment.