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Zaman K. Durani, Geeta Hitch, Eleanor Draeger, Beng T. Goh; Syphilis On The Rise: Ocular Presentations Seen At Moorfields Eye Hospital. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2783.
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The last decade has seen a rise in the incidence of syphilis in the UK. This has led to an increase in neuro-ophthalmic syphilis. The purpose of this study is to investigate the relationship between the type and stage of syphilis and ocular manifestations in patients with positive treponemal serology presenting to Moorfields Eye Hospital (MEH) in the past 46 years.
A retrospective study of 257 cases with positive treponemal serology with ocular signs seen between May 1965 - November 2011 was carried out. Exclusion criteria included patients with a past history of Yaws (85 cases).
Of 257 cases, 93 (36.2%) had congenital syphilis (CS) and 164 (63.8%) had acquired syphilis (AS). Of 93 cases with CS, 65 (69.9%) had interstitial keratitis, 19 (20.4%) had anterior uveitis and 6 (6.5%) had chorioretinitis. Other ocular signs documented included Argyll Robertson pupils. Of CS cases, 53 were female and 40 were males. Of AS cases, 45 were females and 119 were males (15.9% were homosexual men). Of 164 cases with AS, 30 (18.3%) were early syphilis (11 had non-ocular syphilitic lesions), 128 (78%) were late latent, and 6 (3.65%) were tertiary. Of 128 cases with late latent AS, 49 (38.3%) had anterior uveitis, 6 (4.7%) had iritis, 12 (9.4%) had posterior uveitis and other ocular signs were also documented. Of 164 AS cases, 40 (24.4%) had at least one other sexually transmitted infection including gonorrhoea, chlamydia, HIV, herpes and genital warts. The number of AS cases presenting increased from 5 cases between 2001-2005 to 38 cases between 2006-2011 (Figure 1). All patients were treated with a neurosyphilis regimen. The epidemiology of the patients will be presented.
Since 2005 there has been a seven-fold increase in the number of cases of acquired syphilis with cases of congenital syphilis remaining low. The majority of cases with ocular syphilis had no non-ocular signs of syphilis. Ophthalmologists need to be increasingly vigilant to syphilis as a cause of ocular problems. Partner notification and screening for other sexually tansmitted infections are essential.
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