(P95) CONTACT SYPHILIS TESTING IN A TEXAS SEXUAL HEALTH CLINIC LEADS TO CRITICAL INTERVENTIONS IN A PATIENT'S MEDICAL CARE

Introduction:
From January 2023 thru December 2023, 14,254, patients were seen at the Dallas County Sexual Health Clinic (SHC).  The diagnosis and treatment of concomitant STIs is a frequent occurrence. Kaposi sarcoma is seen in cases of uncontrolled HIV infection.  We present a case of HIV, syphilis and Kaposi sarcoma diagnosed in a patient not in medical care.  Critical steps taken by the SHC provider facilitated essential medical care for this patient.

Case Description:
The patient, a male who has sex with males, was referred to the SHC for testing after exposure to syphilis.  The patient initially denied previous STI diagnoses.  On physical examination, flat macular violaceous colored lesions were noted on both arms/legs, lower back and chest. Rapid HIV testing was reactive and rapid syphilis testing was reactive with titer of 1:1024, done in the STAT Lab located in the SHC.  Confirmatory STI testing was done.  The patient was informed of STAT STI testing results and treatments needed.  The patient disclosed that he was informed of HIV diagnosis in the past, but never received HIV treatment because the patient “didn’t believe the diagnosis”.  The SHC provider counseled the patient providing needed education and empathetic support.  The patient received the 1st of 3 Bicillin injections for syphilis, with weekly appointments for the 2nd and 3rd Bicillin injections with the same SHC provider

Discussion:
The patient’s refusal to acknowledge HIV diagnosis led to non-treatment, uncontrolled HIV infection and the development of Kaposi sarcoma.  The SHC provider focused on establishing a relationship with the patient, where the patient would feel comforted and protected, allowing arrangement for HIV care at an outside clinic and the patient returning to the SHC to complete syphilis treatment.  Health care providers must acknowledge the interventions necessary for the 

individual patient in need, even in a busy urban public health clinic.