Clinical manifestations and outcomes of ocular syphilis in Asian Indian population: Analysis of cases presenting to a tertiary referral center

Abstract

Purpose: To describe disease manifestations and outcomes of ocular syphilis in Asian Indian population. Methods: Retrospective analysis of patients diagnosed with ocular syphilis at a tertiary referral center in India. Demographics, history, extraocular and ocular manifestations, ocular and systemic investigations, treatment and visual acuity outcomes were noted. All patients were diagnosed after necessary laboratory investigations including HIV ELISA (Human immunodeficiency virus, enzyme-linked immunosorbent assay), VDRL (venereal disease research laboratory), and TPHA (treponema pallidum hemagglutination). Results: Totally, 20 patients with mean age at presentation 38.25 ± 9.76 were analyzed. 9/20 patients had bilateral involvement. 8/20 had concurrent HIV at presentation with an average CD4 counts of 592.25 ± 411.34 cells/microliter. The mean duration of symptoms at time of presentation was 15.45 ± 35.15 weeks. VDRL test was reactive in 45% (9/20) patients whereas, all patients had a reactive TPHA test. Clinical manifestations included outer retinal placoid chorioretinitis lesions (8/20, 40%), followed by retinitis mimicking acute retinal necrosis as the second most common phenotype (4/20, 20%). Other presenting manifestations noted were panuveitis, miliary retinitis lesions, retinal vasculitis, intermediate uveitis, and anterior uveitis. The clinical phenotypes in immunocompromised included panuveitis, acute retinal necrosis and isolated anterior uveitis. Mean follow up duration was 6.32 ± 6.15 months. An improvement in mean best corrected visual acuity (BCVA) of (0.63 LogMAR, approximately 6 Snellen lines, P < 0.02) was noted at last follow-up. Conclusion: Phenotypic manifestations of ocular syphilis are varied. Non-treponemal tests like VDRL may be unreliable when compared with treponemal tests in diagnosing ocular syphilis. Syphilitic uveitis is considered equivalent to neurosyphilis and is treated similar to neurosyphilis.

Characteristics of Ocular Syphilis in Human Immunodeficiency Virus-Positive Patients in Tertiary Eye Care Center : A Two-Year Observational Study

“…Patients must receive repeat therapy if the VDRL titer does not decrease fourfold within one year or if the previously non-reactive VDRL results become reactive again. [10][11][12][13] In this study, the degree of visual impairment before and three months after therapy showed improvement. The same results were also found in a study by Tsuboi et al, where 89% of eyes showed an increase in best corrected visual acuity (BCVA) after 21 months of therapy.…”

“…Tyagi et al His research also showed that 54% of ocular syphilis manifestations were bilateral. 6,13 A total of 14 (93%) of the research subjects were male. These results are in accordance with various studies in other countries, where syphilis sufferers are male, ranging from 56-89%.…”

Bilateral Hemorrhagic Optic Disc Edema in a Middle-aged Man

“…The treatment of neurosyphilis is with intravenous aqueous penicillin G for 10 to 14 days; in the case of a penicillin allergy, desensitization (recommended), ceftriaxone, doxycycline, or tetracycline are alternatives . The visual outcome after treatment is variable, with syphilis uveitis having the most improvement and optic neuritis having poor visual prognosis …”

“…3,4 The visual outcome after treatment is variable, with syphilis uveitis having the most improvement and optic neuritis having poor visual prognosis. 3,5,9 Patient Outcome Fundus autofluorescence did not reveal a classic placoid lesion, but his rapid plasma reagin test and syphilis antibody test results were both positive. HIV testing was negative.…”

“…On positive fluorescent treponemal antibody absorption test results and signs of ocular syphilis (especially with retinal or optic nerve involvement), an infectious disease specialist should be consulted and lumbar puncture should be performed with cerebral spinal fluid VRDL testing with repeated lumbar puncture to monitor for successful treatment. 5,9,10 The treatment of neurosyphilis is with intravenous aqueous penicillin G for 10 to 14 days; in the case of a penicillin allergy, desensitization (recommended), ceftriaxone, doxycycline, or tetracycline are alternatives. 3,4 The visual outcome after treatment is variable, with syphilis uveitis having the most improvement and optic neuritis having poor visual prognosis.…”