CD4 and neurosyphilis: Treatment of syphilitic proctitis follows standard guidelines for late latent syphilis, with intramuscular benzathine penicillin (3 doses of 2.4 million IU weekly) remaining the regimen of choice, even in HIV-coinfected patients [2,9,11] Our patient tolerated therapy without adverse reactions and underwent lumbar puncture to exclude neurosyphilis, in accordance with recommendations for CD4 < 50 cells/μL [2,10].