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Rashmi Mathew, Beng Goh, Mark C. Westcott; British Ocular Syphilis Study (BOSS): National Surveillance Study of Intraocular Inflammation Secondary to Syphilis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4397.
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Syphilis poses a significant public health problem. There has been a 1954% increase in the incidence of syphilis between 1996 and 2005 in the UK. There are currently no epidemiological studies looking at the incidence of ocular syphilis in the light of the increase in syphilis. The aim of the study was to ascertain the incidence of Intraocular Syphilis in the United Kingdom and to characterise the clinical presentation patterns of ocular syphilis.
A prospective study was conducted in the United Kingdom and Republic of Ireland, where cases of ocular syphilis were identified and reported through the national reporting system (British Ocular Surveillance Unit) over an 18 month period, from May 2009. Case definition was any adult patient who presented with intraocular inflammation and positive syphilis serology.
35 new cases of ocular syphilis were reported, making the annual incidence 0.46 per million. The mean age was 50, with a wide range (22-75 years). The majority were male (86%). 88% were white British or European and 11% were of African or Caribbean ethnicity. The mean duration of symptoms was 1.0 months prior to presentation (range 2 days to 4 months). 46% of patients had bilateral involvement, and the mean presenting logMAR visual acuity was 0.48 (20/60 Snellen; range -0.1 to 1.86). 54% had visual acuities of 20/40 Snellen or better at initial consultation. Logmar visual acuities of affected eyes of patients with bilateral disease was no worse than those with unilateral disease. Presenting acuity was not influenced by duration of visual symptoms. Intraocular pressure on presentation was elevated in only one patient (27mmHg). Although 68.4% had an anterior uveitis (AU), isolated AU was rare (1 case). 63% had vitritis. 61% had a form of posterior uveitis, (60% retinitis, 56% vasculitis, 50% macular oedema, 28% choroiditis). 32% of cases had optic nerve involvement.
This study is the largest prospective series of ocular syphilis in the post-penicillin era, and provides up to date Western European incidence, demographic and clinical data. Syphilitic uveitis affects mainly adult males of all ages. The uveitis is normotensive, posterior uveitis is common, and AU rarely presents in isolation. We conclude that clinician and public health awareness of ocular syphilis remains important.
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