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M. L. Weber, K. J. Wroblewski; Ocular Syphilis in the Elderly Population. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2435. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To increase awareness of the diagnosis of ocular syphilis in elderly patients with uveitis.
Retrospective, observational case series of subjects with positive syphilis serology resulted during work-up of uveitis in military, retired military and military dependent populations at Walter Reed Army Medical Center from June 2006-November 2009. All patients with positive syphilis serology were referred to the infectious disease service for consultation. Data collection included age, type of uveitis, syphilis serology, and treatment.
Sixteen subjects [7 male (43.8%) and 9 female (56.2%)] with positive syphilis serology were included in the series. Eleven subjects (68.8%) were over the age of 60, seven were over age 70 (43.8%), and five were over age 80 (31.3%). Eight subjects (50%) had a prior history of a sexually-transmitted disease (STD). Two subjects were HIV-positive (12.5%). The presenting diagnosis was anterior uveitis in seven subjects (43.8%), retinopathy in five (31.3%), scleritis in three (18.7%), and panuveitis in one (6.2%). There were six subjects with false-positive results (37.5%), four of whom had a known history of a STD. All of the subjects with false-positive results had a positive fluorescent treponema antibody absorption (FTA-ABS) with negative reactive plasma reagin and treponema pallidum enzyme immunoassay (TP-EIA). Of the ten subjects with true-positive serology, seven (70%) were over the age of 60. Six subjects (60%) were treated with intravenous (IV) penicillin G for 10-14 days. Lumbar puncture (LP) was performed in all subjects before treatment with IV therapy. Cerebrospinal fluid was positive on FTA-ABS in one subject, who was HIV-positive. Four subjects declined LP and elected to be treated with an alternate therapy. Three subjects were treated with three intramuscular doses of 2.4 million IU of penicillin G. One patient was treated with a 28 day course of oral doxycycline, 200 milligrams twice a day.
The majority of the patients who were treated for ocular syphilis were over 60 years old. Given the recent reemergence of syphilis in the United States, we must not overlook this treatable disease as a potential cause of ocular inflammation in the mature population.
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