Rani Handayani1, Iwan Purnawan2, Tintin Supriantin2, Arif Setyobudi2, Denti Rahmani Santihe3, Anandina Irmagita Soegyanto4

Oral Medicine Division, Tangerang City General Hospital, Banten, Indonesia

Voluntary and Conseling Testing Division, Tangerang City General Hospital, Banten, Indonesia

Dermatology and Venereology Division, Tangerang City General Hospital, Banten, Indonesia

Department of Oral Medicine, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

Abstract

Background: Syphilis is an opportunistic infection that affects the highest number of Indonesian patients living with HIV, particularly men who have sex with men (MSM). In the comprehensive management of these patients, there is a need for a multidisciplinary approach that includes oral medicine.

Objective: To describe the dentist's role in the comprehensive management of syphilis in MSM for patients with HIV and who are taking Antiretroviral Therapy (ART).

Case report: A 20 years-old HIV male patient was referred from the Voluntary Counselling and Testing (VCT) Division to the Oral Medicine Division for evaluation and management of a sore mouth that had started three days ago. The patient had taken anti- retroviral drugs for four months but still practised risky sexual behavior.

He also informed us that there were patches on the palms and feet which were sometimes itchy and sores in the genital area. Th patient had been referred for laboratory examinations to establish the cause of his symptoms, but this had not yet been implemented.

Intraoral examination showed poor oral hygiene and solitary superficial and irregular ulcers on labial and buccal mucosa. A provisional diagnosis was made of a syphilitic infection. The patient was given antiseptic mouthwash to treat the oral ulcerations and education about VDRL and TPHA. Patient was subsequently referred to Dermatology and Venereology Division for systemic management after the laboratory examination returned a positive diagnosis for syphilis. 

Conclusion: Dentists might be the first member of a healthcare team to detect syphilis infection in HIV patients. Dentists play an important role in the comprehensive management of patients livmng with HIV.