Abstract
Purpose :
In October 2015, the CDC released a clinical advisory on rising cases of ocular syphilis, and in November 2015, the American Academy of Ophthalmology (AAO) released a clinical update on ocular syphilis. We examined the association between eye disease and syphilis infection among primary and sexually transmitted infection (STI) clinic patients attending an urban LGBTQ health center.
Methods :
We conducted a retrospective medical record review of all patients who underwent syphilis testing at Howard Brown Health between January 1, 2010 and December 31, 2015. Confirmed eye diagnosis was based on ICD-9 diagnosis codes for conjunctivitis, uveitis, keratitis, retinitis, and red eye. Demographic information, syphilis treatment, HIV status and high-risk behaviors were abstracted. Syphilis diagnosis was defined by available laboratory data (EIA, RPR titer, FTA-Abs, Treponema pallidum Ab). Multivariable logistic regression with robust variance was used to identify independent associations.
Results :
During the study period, 71,299 syphilis tests were performed on 30,422 patients. There were 2,288 (7.5%) positive syphilis tests. Seventy-seven patients had a confirmed eye diagnosis (0.25%). Patients with eye disease had a higher probability of at least one positive syphilis test (33%) compared to those without eye disease (8%) in the bivariate analysis (Chi-square p<0.001). Of patients with eye disease, 77% were men who had sex with men (MSM) and 65% were HIV positive. Patients with eye disease had 2.15 (95% CI: 0.99,4.68) higher odds of having syphilis compared to patients without eye disease. When adjusted for age, race, gender identity/sexual orientation (MSM, Male not MSM, Female, Transgender), insurance, and HIV status, there was no association between positive syphilis test and eye disease (OR 0.82, 95% CI 0.37, 1.84).
Conclusions :
Patients who present with an eye diagnosis to STI/primary care clinic have a higher probability of positive syphilis tests. These results are confounded by risk factors for syphilis. High-risk patients with eye symptoms should have routine STI testing and in keeping with CDC and AAO recommendations, full ophthalmologic examination.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.