Ocular syphilis – a case series of four patients

Abstract

Summary Ocular manifestations of syphilis with visual impairment symptoms may occur already at the stage of secondary syphilis. They may also be the only manifestation of syphilis and mimic other diseases of the eye. Therefore, in all patients with uveitis, optic neuritis, optic atrophy, acute ocular muscle paresis, or loss of visual acuity, syphilis infection should be ruled out, even if the medical history does not initially raise suspicion. Ocular involvement should be treated as neurosyphilis. Delayed diagnosis and inadequate therapy are often associated with irreversible consequences for the affected patient. As with any syphilis infection, HIV infection should be considered and excluded, especially in the case of ocular manifestations.

Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China

“…Previous investigations revealed that ocular syphilis eyes with uveitis showed a good response to penicillin G treatment and better visual improvement than those with optic atrophy and that delay in treatment also indicated poor visual prognosis (3,5,(14)(15)(16). In our study, except ARN, most ocular syphilis with active inflammation responded well to standard penicillin G therapy, no matter what the initial BCVA, ocular disease type, and RPR titers were as long as it was diagnosed early and treated properly.…”

Syphilis

“…27 Ocular involvement of syphilis can be observed as early as stage II. 28 The most common clinical manifestation is uveitis. However, any part of the eye can be affected.…”

“…27,28 The typical and most common presentation is binocular posterior uveitis or panuveitis. 27,28 Ocular syphilis is significantly more prevalent in men (58-100%) than in women and can affect patients of any age, with an average age in the fifth decade of life. 27 The most common clinical manifestation is uveitis.…”

“…glaucoma, ocular hypertension, optic nerve atrophy, and/or macular edema. [27][28][29][30] However, with proper and early treatment, the prognosis of patients with ocular syphilis is very good. 27 Whether steroids are helpful remains controversial.…”

“…27 Whether steroids are helpful remains controversial. 27,28 The need for lumbar puncture is discussed differently in IUSTI Europe, CDC, and WHO guidelines and is handled differently in clinical centers. While the 2020 European IUSTI guideline, the 2020 AWMF guideline, and the 2018 ÖGSTD guideline recommend lumbar puncture in the management of ocular syphilis, the 2021 CDC guideline has a different assessment.…”