Increases in Ocular Syphilis—North Carolina, 2014–2015

Abstract

Background Ocular syphilis is an inflammatory eye disease due to Treponema pallidum infection. In the United States, syphilis rates have increased since 2000; clusters of ocular syphilis were reported in 2015. We investigated ocular syphilis in North Carolina to describe the epidemiology and clinical course of disease. Methods We reviewed syphilis cases reported to North Carolina during 2014–2015 and abstracted information from health department interviews for cases with ocular symptoms and no other defined etiology. To assess duration and severity of ocular symptoms, we also reviewed medical records and conducted structured interviews. We compared the prevalence of ocular manifestations among reported syphilis cases by demographic and clinical characteristics. Results Among 4232 syphilis patients, 63 (1.5%) had ocular syphilis: 21 in 2014 and 42 in 2015, a 100% increase. Total syphilis cases increased 35% through 2015. No patient with ocular syphilis named another ocular syphilis patient as a sex partner. Patients presented in all syphilis stages; 24 (38%) were diagnosed in primary or secondary syphilis. Ocular manifestations were more prevalent among syphilis patients who were male, aged ≥40 years, white, and infected with human immunodeficiency virus. No risk behaviors were associated with ocular syphilis. Among 39 interviewed patients, 34 (87%) reported reduced vision during infection; 12 (31%) reported residual visual symptoms posttreatment. Conclusions In North Carolina, ocular syphilis increased from 2014 to 2015 and may be due to increased recognition of ocular manifestations, or a true increase in ocular syphilis. Many ocular syphilis patients experienced vision loss; however, most improved posttreatment.

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

“…A complex aspect of these cases is cost [35, 36]. As was apparent in our study, prolonged hospitalizations for rIE are common as these infections are severe and parenteral therapy is standard of care for IE [29, 30].…”

“…Conceptually, the most effective intervention to reduce morbidity and mortality as well as the economic costs of rIE would be to address the root cause of these infections, which is substance use disorder [16, 26, 36]. In response to this crisis, our institution is working to expand its addiction treatment capabilities.…”

Current ophthalmology practice patterns for syphilitic uveitis

“…Syphilitic uveitis is re-emerging internationally, in parallel with the increasing incidence of the systemic infectious disease. 6,8,25 We present a description of current practice patterns by collating the experience of a group of 103 clinicians -members of the International Ocular Syphilis Study Group -who specialize in the management of uveitis, and evaluate an average of approximately 700 cases of uveitis annually. In keeping with recently published, detailed surveys of individual practices, [25][26][27] Syphilitic uveitis causes long-term visual disability in a significant number of persons:…”

“…[4][5][6] However, the vision is frequently impacted in this condition: in the largest series published to date, including 85 persons from The Netherlands, 58.8% presented with reduction in vision to a level that typically limits driving (Snellen visual acuity < 6/12) and 29.4% suffered blindness (Snellen visual acuity < 6/60). 7 Current studies from the United States, 6,8 Western Europe 9,10 and Brazil 11 suggest syphilitic uveitis is increasing in prevalence and incidence, in parallel with the systemic infection.…”

Redefining the Team in Team-Based Care

“…Partnerships between clinicians and public health officials have led to the identification of several recent emerging communicable disease concerns, including emerging multidrug-resistant organisms, perinatal and ocular syphilis, and injection drug-associated endocarditis [6][7][8]. Communicable disease nurses and others at public health departments also work in partnership with clinicians to investigate and control outbreaks of communicable diseases.…”