Current ophthalmology practice patterns for syphilitic uveitis

Abstract

BackgroundSyphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.Methods103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.ResultsMembers managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10–14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.ConclusionThis comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.

Augenbeteiligung bei venerischer Syphilis – Update

“…Eine anteriore Uveitis ist bei Syphilis eher selten [34]. In einer Serie von 11 Uveitispatienten mit Syphilis hatte nur einer eine anteriore Uveitis [18], in einer weiteren Serie waren es 3 von 50 betroffenen Augen [31].…”

“…Syphilis tritt häufig mit einer Panuveitis oder posterioren Uveitis auf [22,34,37]. In der Studie von Lee et al war eine Panuveitis häufiger bei HIV-positiven und eine posteriore Uveitis häufiger bei HIV-negativen Patienten zu finden [20].…”

“…Die antimikrobielle Therapie sollte interdisziplinär mit einem darin erfahrenen Internisten erfolgen [34]. Sie sollte den Guidelines der Centers for Disease Control (CDC) Prevention [2,54] Die additive entzündungshemmende Therapie mit Kortikosteroiden ist nicht exakt definiert.…”

Taking care to correctly diagnose viral anterior uveitis

“…Anterior uveitis may be caused by non‐viral microbes. Over the past decade, syphilitic uveitis has become a more frequent presentation in most inflammatory eye disease clinics . The widespread availability of highly active antiretroviral therapy for human immunodeficiency virus, and subsequent reduction in societal fear associated with the sequelae of acquired immunodeficiency syndrome, has resulted in an increased incidence of all sexually transmitted infections.…”

“…Over the past decade, syphilitic uveitis has become a more frequent presentation in most inflammatory eye disease clinics. 14 The widespread availability of highly active antiretroviral therapy for human immunodeficiency virus, and subsequent reduction in societal fear associated with the sequelae of acquired immunodeficiency syndrome, has resulted in an increased incidence of all sexually transmitted infections. The exponential rise in syphilis, an infection caused by the spiral-shaped bacteria Treponema pallidum, has perplexed clinicians with a wide range of presentations and the tendency to mimic many non-infectious conditions.…”