Abstract
Purpose: :
To review the prevalence and clinical characteristics of ocular syphilis in Bascom Palmer Eye Institute from 2003 to 2009.
Methods: :
A retrospective review was undertaken to identify patients with ocular syphilis using ICD-9 billing codes as well as serology testing done in Bascom Palmer from 2003 to 2009. Patients were identified as having ocular syphilis if all of the following were present: clinical suspicion, positive serologies, resolution of symptoms after treatment with intramuscular or intravenous penicillin and no other attributable causes to ocular inflammation.
Results: :
Twenty patients were identified with ocular syphilis from 2003 to 2009. All patients were FTA-ABS positive. 18/20 patients were RPR positive. 16/18 of RPR positive patients (89%) had a titer ≥ 1:64. 6/11 patients (55%) who had lumbar punctures performed had RPR or VDRL positive CSF. 5/6 of these patients were HIV positive. 15/20 patients (75%) were male and 11/20 patients (55%) were HIV positive at the time of the diagnosis. All HIV positive patients had titers ≥ 1:64, with 7/11 patients (60%) having RPR titers ≥ 1:512. Only 5/9 HIV negative patients had RPR titers ≥ 1:64. All patients had intraocular inflammation at the time of the diagnosis ranging from mild to severe. 7/20 had synechiae and 9/20 had keratic precipitates. 17/20 patients had posterior segment involvement at the time of the diagnosis including optic nerve head edema, vascular abnormalities and retinal/subretinal infiltrates. All patients had visual improvement and/or resolution of ocular inflammation after treatment with IM or IV penicillin.
Conclusions: :
The prevalence of syphilis in the US is rising. However, by our criteria 20 patients with definite ocular syphilis could be identified at our tertiary care center over the preceding 7 years. A majority of these patients were young HIV positive males with posterior segment inflammation. Treatment with IV or IM penicillin is critical in symptom resolution.
Keywords: uveitis-clinical/animal model • AIDS/HIV • clinical laboratory testing