Syphilitic uvula ulcer

A 42-year-old sexually active man with HIV on ART (antiretroviral therapy) who has a history of syphilis presented with fever and severe sore throat for which he could not eat or drink. He admitted to high-risk sexual intercourse with multiple partners 10 days prior. Physical examination revealed an injected throat and uvula ulcer. PCR for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum from pharynx and rapid group A streptococci test were negative. No significant bacteria were grown from the throat swab culture. The RPR (rapid plasma reagin) titer, which had previously been negative, increased to 1:2. From these results, uvula ulcer was thought to be caused by primary syphilis. He was treated with one shot of benzylpenicillin 2.4 million units intramuscularly, and his ulcer completely disappeared in seven days.