All patients with ocular syphilis exhibited functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. As a great imitator, syphilis should be considered in all patients with uveitis, scleritis, episcleritis, or optic neuritis, especially in men with high-risk sexual behavior.

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Purpose: to report ocular inflammation secondary to syphilis infection in a tertiary center. Methods: Within a prospective study (2 years, 2005‐2007), we collected data on 7 male patients with ocular syphilis. Diagnosis was based on serology tests on blood sample and/or cerebrospinal fluid. All patients underwent a check up for ocular inflammation to rule out another etiological diagnosis and to detect another sexually transmitted infection. Results: Coinfection with human immunodeficiency virus was reported in 4 patients, with a CD4 T lymphocyte count greater than 300/mm3 in all cases. The ocular lesions were variable ; chorioretinitis (1 eye), retinal necrosis (2), panuveitis with macular edema (1), episcleritis (1), anterior optic neuropathy (1), and retrobulbar optic neuropathy (1). Infection of the cerebrospinal fluid was detected in 4/4 cases. The lumbar puncture was refused in 3 cases. In all cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent. Only one patient with the anterior optic neuropathy required systemic steroid therapy associated with antibiotics. Sequelae were a sectorial atrophy of the optic nerve (1 eye), and abnormalities of the retinal pigment epithelium (3 eyes). 6/7 patients were treated with ceftriaxone 2g/day during 3 weeks, with a good tolerance. One patient was treated with penicillin G. Conclusions: All patients with ocular syphilis exhibited a functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. In our area, the incidence of syphilis increases in immunocompetent and immunocompromised patients. As a great imitator, syphilis should be considered in all patients with uveitis or optic neuritis, especially in men with unprotected sexual behavior.