From the MMWR:  Morbidity and Mortality Report Centers for Disease Control, Atlanta

Recommendations for Diagnosing and Treating Syphilis in HIV-Infected Patients  THE CLINICAL manifestations, serologic responses, efficacy of treatment, and occurrence of complications of syphilis may be altered in patients coinfected with human immunodeficiency virus (HIV). Because syphilis is a disease with a broad range of manifestations and variable course, assessing reports of unusual clinical or laboratory findings in HIV-coinfected patients is difficult.¹ On March 21 and 22,1988, experts* from academic medical centers and state and local health departments met at CDC to discuss the diagnosis and treatment of syphilis in HIV-infected patients. The following recommendations were developed based on these discussions.

DIAGNOSIS OF SYPHILIS IN HIV-INFECTED PATIENTS  Most HIV-infected patients appear to have a normal serologic response in Treponema pallidum infection.² However, in some HIV-infected patients with biopsy-confirmed secondary syphilis, both nontreponemal and treponemal tests for syphilis are negative.³ In addition, some patients infected with both T. pallidum and HIV have had unusually high titers on nontreponemal serologic