Ocular syphilis: case series (2000-2009) from two tertiary care centers in Montreal

Abstract

 

Purpose

 

To review ocular syphilis cases diagnosed and treated between 2000 and 2009 at Maisonneuve-Rosemont Hospital and Notre-Dame Hospital, Montreal, and to describe the demographics, clinical presentations, proportion of co-infection with HIV, treatment and outcome.

 

Methods

 

Medical records of patients who had positive treponemic serologic testing and who visited the ophthalmology department at Maisonneuve-Rosemont Hospital and Notre-Dame Hospital for ocular manifestations related to syphilis between the years 2000 to 2009 were retrospectively reviewed. Several data were compiled and included: patient demographics; clinical presentation and examination; past syphilis history; syphilis serology results and cerebrospinal fluid analysis results; HIV status; ophthalmological diagnosis; medical and surgical treatment; follow-up serology results and final best-corrected visual acuity (BCVA).

 

Results

 

Ninety-one patients (80% males) were included in the study. The majority of cases were found in men aged 51-60 years old (26%) and 41-50 years old (17%). Around 30% of the patients were men who have sex with men (MSM). Snellen BCVA was converted to logMar notation. Pre-treatment mean was 0.42 (BCVA around 20/50) while post-treatment mean was 0.34 (BCVA around 20/40). The most common ophthalmological diagnoses were all types of uveitis (anterior being the most frequent one with a proportion of 31%). Coinfection with HIV was found in 34 % of patients. Lumbar puncture was done in 55% of patients and VDRL serology was positive in 11% of those patients. The mainstay of treatment was intravenous penicillin in 75% of the patients. In about 85% of patients treated, no history of reinfection was noted.

 

Conclusions

 

Syphilis is known as the great masquerader with a diversified presentation and has seen a significant increase in the past ten years. In this context, it is primordial to keep this diagnosis in mind, especially since the treatment is readily available and has an excellent outcome.

 

Keywords: 746 uveitis-clinical/animal model • 557 inflammation • 433 bacterial disease