Purchase this article with an account.
Archana Seethala, Nicole Siegel, Steven Ness, Deeba Husain; Demographics and Clinical Characteristics of Patients Presenting with Ocular Manifestations of Systemic Syphilis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2919.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate clinical characteristics, demographics, and visual outcomes in patients with ocular syphilis.
The medical records of patients diagnosed with syphilis at Boston University Medical Center from to 2004 to 2012 were reviewed. Characteristics evaluated included age, gender, race, symptoms, existing medical conditions, immune status, risk factors and treatment.
Ocular syphilis was diagnosed in 38 eyes of 22 patients; 16 patients had bilateral disease and 6 had unilateral involvement. The mean age at presentation was 62 years (range 38 - 88). Most patients were African American or Haitian (68%). Fourteen patients (67%) were female. The most common referring diagnosis was uveitis (52%) and the presenting symptoms included decreased vision (47%) and pain (25%). The stage of syphilis at presentation was latent in 68%. Three patients (14%) had HIV with CD4 counts greater than 600 cells/µL. Lab work was significant for a reactive rapid plasma reagin test (RPR) in 59%, a reactive fluorescent treponemal antibody absorption test (FTA-ABS) in 73% and a reactive Treponema pallidum particle agglutination test (TP-PA) in 69% of patients. Venereal Disease Research Laboratory test (VDRL) tested from the cerebrospinal fluid (CSF) was negative in 91% of patients, in which it was tested. Non-granulomatous, anterior uveitis was the most common presentation of ocular syphilis in our series. Posterior findings of vasculitis, acute syphilitic posterior placoid chorioretinitis and neovascularization were also observed. Patients were treated with topical steroids (46%) and intramuscular and/or intravenous penicillin (64%) or a combination of both. Four patients (18%) had recurrence of their disease, all of who had been previously treated. Nine patients (41%) experienced a one or more line decrease in vision throughout their course.
Ocular syphilis in our population affected primarily African American Females, presenting most commonly as anterior uveitis. A concurrent diagnosis of HIV is not always present, and lab work -- while helpful, is not always conclusive. Even with appropriate treatment with systemic penicillin, patients may have recurrent disease and require repeat treatment. With the prevalence of systemic syphilis increasing worldwide, the need to recognize and appropriately treat ocular syphilis becomes increasingly more important.
This PDF is available to Subscribers Only