Serpiginous plaques: An atypical presentation of secondary syphilis in human immunodeficiency virus

Syphilis is known to run its natural course unless intervened, and the severity of clinical presentation in human immunodeficiency virus (HIV) co-infection is well established. Here, we report the case of a 47-year-old male on antiretroviral therapy for 9 years, who presented with a persistent serpiginous plaque over the neck, along with painless genital ulcers and painful oral ulcers. These lesions resolved rapidly after three doses of benzathine penicillin with subsequent follow-up showing declining Venereal Disease Research Laboratory titers. This case highlights the atypical presentation of syphilis and the need for a high index of suspicion while approaching cutaneous manifestations in HIV.