Double Trouble: Challenges in the Diagnosis and Management of Ocular Syphilis in HIV-infected Individuals

Queiroz, Rafael de Pinho; Smit, Derrick; Peters, Remco P. H.; Vasconcelos-Santos, Daniel Vítor

doi:10.1080/09273948.2020.1772839

Cited by 9 publications

(6 citation statements)

References 79 publications

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“…In recent years, syphilis is markedly on the rise. 5,6 This is also our observation and here, we share and analyze the clinical data of cases with OS.…”

Section: Introductionsupporting

confidence: 62%

“…11,12 Alternative antibiotics are ceftriaxone and doxycycline/tetracycline. 5 Based on the 2020 European guideline on syphilis management, individuals with penicillin allergy and early syphilis (primary, secondary, and early latent) should be treated with oral doxycycline 200 mg daily for 14 days. For cases with late latent syphilis (acquired ≥1 year previously or of unknown duration), as well as cardiovascular and gummatous syphilis in patients with penicillin allergy, the recommended treatment is oral doxycycline 200 mg daily for 21-28 days.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Never forget ocular syphilis: A case series from a single tertiary centre

Köksaldı,

Nazlı,

Kaya

et al. 2023

Int J STD AIDS

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A retrospective analysis of 10 consecutive patients who had serologically confirmed ocular syphilis between June 2020 and February 2023 was performed. All cases presented with ocular manifestations. Eight patients were diagnosed with syphilis and two patients with syphilis/human immunodeficiency virus co-infection. Type and duration of antibiotic treatments were diverse among the patients. Four patients had intramuscular benzyl-penicillin G 2.4 million units (MU) weekly for three weeks; four, intravenous ceftriaxone for 14 days; one, intravenous penicillin G 24 MU/day for 14 days; and the remaining patient, intravenous penicillin G 24 MU/day for a week and then oral doxycycline for two weeks. As adjunctive therapy to systemic antibiotics, oral corticosteroids in three patients and intravitreal ceftazidime (2.25 mg/0.1 mL) injections in one patient were administered. In conclusion, ocular syphilis is a re-emerging phenomenon; prompt diagnosis and proper antibiotic treatment can prevent serious ocular complications.

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“…In recent years, syphilis is markedly on the rise. 5,6 This is also our observation and here, we share and analyze the clinical data of cases with OS.…”

Section: Introductionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Never forget ocular syphilis: A case series from a single tertiary centre

Köksaldı,

Nazlı,

Kaya

et al. 2023

Int J STD AIDS

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“…The results of this study show a high rate of neurosyphilis (84%) that was almost exclusively observed in HIV-infected patients. The prevalence of neurosyphilis reported earlier varied between 25 and 83%, depending on case selection and diagnostic criteria applied in each study 37 , 38 . The high proportion of HIV-infected patients with low CD4 counts and the high initial serum nontreponemal test titers in our patients are likely to be responsible for the high neurosyphilis rate observed 39 , 40 .…”

Section: Discussionmentioning

confidence: 91%

Clinical features and incidence of visual improvement following systemic antibiotic treatment in patients with syphilitic uveitis

Sittivarakul

Aramrungroj

Seepongphun

2022

Sci Rep

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To describe the clinical features, longitudinal pattern, and incidence rate of improvement of visual acuity (VA) following antibiotic therapy in patients with syphilitic uveitis. A total of 36 patients were included in this retrospective study from 2009 to 2020. The longitudinal patterns of mean VA values during follow-up were analyzed using a linear mixed model. Most patients were men with HIV coinfection (81%) and presented with panuveitis (49%). The mean VA at baseline improved from 0.97 to 0.39 logMAR at 6 months and remained stable thereafter. The cumulative incidence of VA ≥ 20/25 achieved by 2 years was 70%. Receiving antibiotic therapy within four weeks of the onset of ocular symptoms (adjusted hazard ratio [aHR] 3.4, P = 0.012), absence of HIV coinfection (aHR 8.2, P < 0.001), absence of neurosyphilis (aHR 6.5, P = 0.037), better presenting VA (aHR 5.0, P = 0.003), and intermediate uveitis as opposed to panuveitis (aHR 11.5, P = 0.013) were predictive of achieving VA ≥ 20/25. Men with HIV coinfection represented the majority of our patients. Visual outcomes, in response to antibiotics, were favorable. Delayed treatment, poor presenting VA, presence of HIV coinfection, and concomitant neurosyphilis decreased the likelihood of VA restoration.

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“…The prevalence of NS reported earlier varied between 25% and 83%, depending on case selection and diagnostic criteria applied in each study. [34,35] The high proportion of HIV-infected patients with low CD4 counts and the high initial serum nontreponemal test titers in our patients are likely to be responsible for the high NS rate observed. [36,37] It is notable that the presence of concomitant NS also decreased the likelihood of VA recovery after taking into account HIV status.…”

Section: Va Outcomes After Treatment With Systemic Antibioticsmentioning

confidence: 96%

“…Among the 62 eyes, 54 had a VA of < 20/25 at rst presentation and were then included in the incidence analyses. These 54 eyes had been followed over 561.9 EMs; among these, 35 e The events BCVA of ≥ 20/25 were achieved at 36 months after therapy.…”

Section: Va Outcomes After Treatment With Systemic Antibioticsmentioning

confidence: 99%

Clinical Features And Incidence Of Visual Improvement Following Systemic Antibiotic Treatment In Patients With Syphilitic Uveitis

Sittivarakul

Aramrungroj

Seepongphun

2022

Preprint

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Purpose: To describe the clinical features, longitudinal pattern, and incidence rate of improvement of visual acuity (VA) following antibiotic therapy in patients with syphilitic uveitis.Methods: A total of 36 patients were included in this retrospective study from 2009 to 2020. The longitudinal patterns of mean VA values during follow-up were analyzed using a linear mixed model.Results: Most patients were men with HIV coinfection (81%) and presented with panuveitis (49%). The mean VA at baseline improved from 0.97 to 0.39 logMAR at 6 months and remained stable thereafter. The cumulative incidence of VA ≥20/25 achieved by 2 years was 70%. Receiving antibiotic therapy within four weeks of the onset of ocular symptoms (adjusted hazard ratio [aHR] 3.4, P = 0.012), absence of HIV coinfection (aHR 8.2, P<0.001), absence of neurosyphilis (aHR 6.5, P = 0.037), better presenting VA (aHR 5.0, P = 0.003), and intermediate uveitis as opposed to panuveitis (aHR 11.5, P = 0.013) were predictive of achieving VA ≥20/25.Conclusions: Men with HIV coinfection represented the majority of our patients. Visual outcomes, in response to antibiotics, were favorable. Delayed treatment, poor presenting VA, presence of HIV coinfection, and concomitant neurosyphilis decreased the likelihood of VA restoration.

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Double Trouble: Challenges in the Diagnosis and Management of Ocular Syphilis in HIV-infected Individuals

Cited by 9 publications

References 79 publications

Never forget ocular syphilis: A case series from a single tertiary centre

Never forget ocular syphilis: A case series from a single tertiary centre

Clinical features and incidence of visual improvement following systemic antibiotic treatment in patients with syphilitic uveitis

Clinical Features And Incidence Of Visual Improvement Following Systemic Antibiotic Treatment In Patients With Syphilitic Uveitis

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