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Early genital and anorectal lesions may resemble herpes simplex virus or syphilis, often causing diagnostic error and treatment delays. Lesion distribution can mirror transmission routes, complicating recognition. A 25-year-old male with PCR-confirmed mpox also had newly diagnosed HIV with marked immunosuppression and latent syphilis, emphasizing urgent comprehensive sexual-health screening.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/severe-anorectal-mpox-with-newly-diagnosed-hiv-and-syphilis-a-diagnostic-and-management-challenge/454902/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/severe-anorectal-mpox-with-newly-diagnosed-hiv-and-syphilis-a-diagnostic-and-management-challenge/454902.png","ImageObject",300,407,{"name":92,"@type":93},"eBook King","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is mpox difficult to diagnose in patients with possible STIs?","Question",{"text":112,"@type":113},"Early genital and anorectal mpox lesions often mimic herpes simplex virus or syphilis. Overlapping clinical features can lead to diagnostic error and treatment delay, especially in high-risk populations.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What confirmed the diagnosis in this case report?",{"text":117,"@type":113},"Polymerase chain reaction (PCR) testing confirmed mpox after the patient presented with extensive anorectal and genital involvement and diffuse pustular and vesicular eruptions.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional conditions were identified beyond mpox?",{"text":121,"@type":113},"Evaluation revealed a previously undiagnosed HIV infection with marked immunosuppression and latent syphilis, both of which increased diagnostic complexity and the need for multidisciplinary management.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},454902,1791109607,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Received 03/28/2025  \nReview began 09/19/2025  \nReview ended 12/03/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nSantos-Rivera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98708  \nOpen Access Case Report  \n Published via Florida International University  \nSevere Anorectal Mpox With Newly Diagnosed HIV and Syphilis: A Diagnostic and Management Challenge  \nJuan R. Santos-Rivera 1, Regina McPherson 2 , Guillermo Izquierdo-Pretel 3, 2  \n1. Internal Medicine, Ponce Health Sciences University, Ponce, PRI 2. Internal Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA 3. Hospital Medicine, Jackson Memorial Hospital, Miami, USA  \nCorresponding author: Juan R. Santos-Rivera, [jsantos23@stu.psm.edu](jsantos23@stu.psm.edu)  \nAbstract  \nMpox has re-emerged globally in non-endemic regions, challenging clinicians with diverse mucocutaneous manifestations that frequently mimic other sexually transmitted infections (STIs) . Early genital and anorectal lesions may resemble herpes simplex virus or syphilis, often resulting in diagnostic error and treatment delay. Lesion distribution frequently corresponds to the route of transmission, further complicating clinical recognition. We describe a 25-year-old male who presented with diffuse pustular and vesicular eruptions, including extensive anorectal and genital involvement, confirmed as Mpox by polymerase chain reaction (PCR) testing. Additional evaluation revealed previously undiagnosed HIV infection with marked immunosuppression and latent syphilis. This case underscores the diagnostic complexity and therapeutic urgency of Mpox in patients with concurrent STIs and highlights the necessity of comprehensive sexual-health screening, early antiviral initiation, and multidisciplinary management during ongoing outbreaks.  \nCategories: Public Health, Internal Medicine, Infectious Disease  \nKeywords: genital lesions, hiv, monkeypox, orthopoxvirus, stis, syphillis  \nIntroduction  \nIn 2022, Mpox re-emerged as a significant global health concern, with thousands of cases reported across non-endemic regions, including the United States [1,2] . Mpox is caused by a double-stranded DNA virus belonging to the Orthopoxvirus genus and is primarily transmitted through direct contact with infected body fluids, lesions, or contaminated materials such as clothing and bedding [2,3] . Additional transmission routes include close face-to-face interactions, skin-to-skin contact, and sexual activity, particularly among individuals with multiple partners. Recent outbreaks have shown a predominance of lesions in the anorectal and genital regions, complicating clinical recognition and raising concerns about sexual transmission pathways [3,4] .  \nThe clinical course of Mpox typically progresses through four cutaneous stages-macular, papular, vesicular, and pustular-culminating in crusting and resolution over two to four weeks [5] . These manifestations frequently overlap with those of sexually transmitted infections (STIs) such as herpes simplex virus and syphilis, making accurate diagnosis particularly difficult in high-risk populations [5,6] . Immunocompromised individuals, including those living with HIV, may present with more severe disease oratypical features, further blurring clinical distinctions. The anogenital distribution of lesions seen in recent outbreaks has highlighted the need for comprehensive sexual health evaluation in suspected cases [4,6] .  \nAlthough real-time PCR remains the diagnostic gold standard, Mpox presentations may vary substantially, especially in the setting of coinfection [7] . This case report describes a 25-year-old male with Mpox, newly diagnosed HIV infection, and latent syphilis. The case underscores the diagnostic c","cbCaimvYCOZb4REv","https://ap.wps.com/l/cbCaimvYCOZb4REv","pdf",7980996,"English","# Introduction\n# Case Presentation\n# How to Cite","[{\"question\":\"Why is mpox difficult to diagnose in patients with possible STIs?\",\"answer\":\"Early genital and anorectal mpox lesions often mimic herpes simplex virus or syphilis. Overlapping clinical features can lead to diagnostic error and treatment delay, especially in high-risk populations.\"},{\"question\":\"What confirmed the diagnosis in this case report?\",\"answer\":\"Polymerase chain reaction (PCR) testing confirmed mpox after the patient presented with extensive anorectal and genital involvement and diffuse pustular and vesicular eruptions.\"},{\"question\":\"What additional conditions were identified beyond mpox?\",\"answer\":\"Evaluation revealed a previously undiagnosed HIV infection with marked immunosuppression and latent syphilis, both of which increased diagnostic complexity and the need for multidisciplinary management.\"}]","Severe Anorectal Mpox With Newly Diagnosed HIV and Syphilis - A Diagnostic and Management Challenge | PDF",1790741678]