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Meryl Sundy, Irina Kasarskis, Sean Schafer, Winthrop Kevin; Ocular Syphilis in Oregon, 2014 to 2016. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2184.
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© ARVO (1962-2015); The Authors (2016-present)
Recently San Francisco and Seattle reported an increase in syphilis cases with ocular involvement. Little is known about the incidence of syphilis with ocular involvement in Oregon, its natural history, molecular epidemiology related ocular morbidity, or associated characteristics of people affected. The purpose of this study is to estimate the current incidence of syphilis with ocular morbidity in Oregon and describe its epidemiology.
We queried Oregon Health Authority’s (OHA) comprehensive disease reporting system for all syphilis cases reported to OHA for which the public health case report included any of the terms “ophthal, opthal, ocular, vision, visual, uveitis, retinitis, blurred, eye, floater” between Jan 1, 2014 and March 21, 2016. We identified 79 occurrences suggestive of pertinent ocular symptoms. We collected serology and other syphilis-related laboratory results, clinical stage, treatment, sexual history and demographics from the public health case reports and reviewed medical records to further describe ophthalmologic and medical aspects of the clinical course. We defined probable cases as those that in our judgment had “clinical symptoms or signs consistent with ocular disease” with a confirmed or presumptive syphilis case. We used Oregon Health Authority criteria to stage syphilis cases.We recorded case onsets as the date of the first reported ocular symptom, or in the absence of symptom onset date, 6 weeks, 10 weeks or one year prior to the date of the first positive serology for primary, secondary and latent syphilis respectively. Follow-up intervals began with the collection date of the first positive syphilis serology and ended with the last available syphilis related chart annotation for ophthalmologic and infectious disease follow-up.
We identified 63 probable cases after exclusion for equivocal laboratory testing, loss to follow up and other identified etiologies for ocular inflammation. The population was 74% male, 33% HIV positive and 22% had prior diagnoses of syphilis. Of the 63, there were 2 considered early syphilis, 17 secondary, 18 latent and 20 late with symptomatic manifestations. 44% of cases has additional systemic manifestations and 46% had other neurologic complications.
Identifying and referring patients with ocular complaints may help reduce spread of the disease and ultimately reduce ocular morbidity.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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