Introduction: Syphilis, a sexually transmitted disease is one of the oldest diseases caused by the bacterium Treponema pallidum, has been a major public health concern worldwide. The aim is to find out the prevalence of syphilis and its risk factors among people with HIV at Western Regional hospital in Nepal.
 Methods: A hospital-based cross-sectional study was conducted at one of the largest public hospitals in Western Region of Nepal. A consecutive 90 HIV-positive patients were recruited prospectively from December 2016 to February 2017. Blood samples and data on sociodemographic and risk factors were collected. Serum were diagnosed for syphilis using Rapid Plasma Reagin (RPR) test.
 Results: The prevalence of syphilis infection was 12.2% in HIV positive participants. Syphilis occurred exclusively in male 7 comparatively 4 in female. Seropositivity of syphilis was seen higher in married than unmarried HIV infected individuals. Syphilis prevalence seems to increase with increasing age, with the highest rate in the age group 35–50 years. A decreasing rate of syphilis was observed with increasing educational level, where illiterate HIV-positive participants had higher infection compared with those having at least a certificate.
 Conclusion: Higher prevalence of syphilis in people with HIV infection demands the need to target this people to prevent the transmission of both infections. Testing for all HIV-infected people for syphilis and management of the infected would have clinical and epidemiological importance.