5. Many men are aware of attraction to other men at an early age but – due to personal circumstances and/or societal constraint – initially follow a conventional heterosexual role model. Since the arrival of the internet, sexual contact between men has become easier to arrange.
6. Smartphone technology has greatly increased the facility for acquiring new anonymous contacts. Since apps were first developed in 2009, rates of syphilis and gonorrhoea in men who have sex with men have increased substantially in countries where these conditions are regularly reported.
7. Better communication between the dermatologist and gynaecologist might have helped in this case, but the sexual history of long-term monogamy blinded them both to the possibility of HIV as the cause of their patient’s immunosuppression. Only if HIV tests are routinely offered to women (and men) with conditions refractory to conventional treatment, will such late HIV presentation cases be prevented.