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Vincent Cheng, Sun Young Lee, Narsing A Rao; Clinical characteristics of ocular syphilis in patients with and without HIV infection.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5787.
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© ARVO (1962-2015); The Authors (2016-present)
To compare clinical and laboratory findings of ocular syphilis between HIV positive and negative patients.
Medical records of patients diagnosed with ocular syphilis with serologic confirmation from 2008 to 2014 were retrospectively reviewed.
Sixteen consecutive patients (10 HIV-positive vs 6 HIV-negative) with 29 eyes were included. All patients were male and the mean age of onset was 43 (mean 42.65 ± 13.13). Regardless of HIV status, ocular findings of ocular syphilis were variable including anterior uveitis (4 eyes), posterior uveitis (8 eyes), panuveitis (13 eyes), isolated papillitis (4 eyes) and CN III and VII palsy (1 eye). However, panuveitis was the most common feature (12/18 eyes, 67%) in HIV-positive patients whereas posterior uveitis was the predominant feature (6/11 eyes, 55%) in HIV-negative patients. Significantly higher serum rapid plasma reagin (RPR) titers were found in HIV-positive patients (range 1:64-1:16,348 in HIV-positive vs 1:2-1.8 except 1 patient with 1:2,048 in HIV-negative, p = 0.019). A higher proportion of HIV-positive patients tested positive for cerebrospinal fluid fluorescent treponemal antibody absorbed (CSF FTA-ABS) or venereal disease research laboratory (VDRL) than HIV-negative patients (70% in HIV-positive vs 16% in HIV-negative). CD4 cell count in HIV-positive patients at onset was typically ranged from 127 to 535 (mean 237 ± 142). These patients responded to 10-14 days of intravenous penicillin with relatively good visual outcome.
HIV status in patients with syphilis plays a role in ocular manifestations, primarily presenting with pan uveitis associated with positive CSF FTA-ABS or VDRL and high serum RPR titers compared to non-HIV syphilis. These findings indicate that HIV positive individuals with ocular manifestations of syphilis should be treated for neuro-syphilis.
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