Ocular syphilis among HIV-infected patients: a systematic analysis of the literature

Abstract

Background Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients. Objective To examine the literature on HIV-infected patients and determine the results of treatment. Methods Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated. Results A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm3. Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm3 (p=0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone. Conclusions Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.

Clinical Manifestations and Outcome of Syphilitic Uveitis

“…This re-emphasizes the risk of coinfection with other sexually transmitted diseases in this patient group, and the desirability to test for HIV in case of ocular syphilis. Previously, HIV positivity has been associated with a worse visual outcome in syphilitic uveitis, a finding we and other recent studies [9][10][11]24,25 could not confirm. Also, previous studies described that HIV-positive patients tended to have a higher proportion of posterior and panuveitis and neurosyphilis than HIV-negative patients.…”

Posterior Uveitis

“…While the presentation may be similar to that in immunocompetent patients, relapses are more frequent, as is bilaterality. Patients with HIV infection may have a higher prevalence of posterior uveitis ( [ 256 ], EBM: 2++ B), which may present in as a more severe and atypical form. Treatment will require more prolonged therapy with higher doses of antibiotics.…”

Syphilitic Optic Neuropathy: Re-emerging Cases Over a 2-Year Period

“…2 Although the ocular manifestation of syphilis can affect any structures of the eye, including keratitis, scleritis, episcleritis, anterior and posterior uveitis, optic nerve involvement is not a common presentation and can be found in only 20%. 3 During the 2003-2012 period, only 1 case of syphilitic optic neuropathy had been diagnosed in our institution, a tertiary medical centre in Bangkok, Thailand. However, in the last 2 years, the number of patients had significantly increased.…”