• HIV
• homosexual men
• syphilis
• HIV

Editor,—A 33 year old homosexual white male attended an HIV outpatient clinic as an urgent case. He was a healthcare worker involved at a senior level in the care of HIV positive clients and had himself received an HIV diagnosis in 1994. Antiretroviral therapy had commenced in 1998 with a combination of didanosine, stavudine, and nevirapine. This was well tolerated and brought about rapid and sustained viral suppression and a significant increase in CD4 count. The client had been an irregular attender and had often collected repeat prescriptions without medical review. Significantly, no details of his sexual history were recorded for the 6 years following diagnosis, although the existence of a partner was acknowledged in the month before his acute presentation.

He attended with a 2 week history of fever in the absence of any other symptoms. On examination he was pyrexial with a temperature of 38.8°C. A 1 cm raised nodule on the centre of the dorsum of the tongue was noted. There was no apparent regional lymphadenopathy.

Requests for viral and bacterial culture …