Ocular syphilis: the re-establishment of an old disease

Abstract

PurposeTo present the patient profiles, clinical presentations and visual outcomes in those diagnosed with ocular syphilis, attending a subspecialist uveitis service in northern England over a 15-year period.Patients and methodsRetrospective observational case series of patients presenting between January 2002 and December 2016.ResultsA total of 50 eyes of 34 patients had intraocular inflammation due to syphilis. Of these, 94% were male, and 75% were men who had sex with men. Ten (29%), all male, were HIV-positive. Presentations included isolated anterior non-granulomatous uveitis, intermediate uveitis, panuveitis, retinitis, placoid chorioretinitis and papillitis. Concurrent skin rash and/or headache were seen in 41%. Compliance with antibiotic treatment was complete, but there was a high rate of default from ophthalmological follow-up (38%). Visual improvement was seen in 92% of eyes, and at final assessment 71% had acuity of 6/9 or better.ConclusionsOcular syphilis is continuing to increase in incidence, in tandem with the continuing epidemic of early syphilis in the UK (the risk of ocular involvement being about 1%). Almost all are male, and most are men who have sex with men. Clinical presentation is variable; a high index of suspicion and a low threshold for serological testing is important; early treatment can reverse retinal changes and restore visual acuity.

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

“…It is colloquially known as ‘the great imitator’ for its ability to mimic many diseases due to its extensive range of clinical manifestations 7 . Therefore, a high index of clinical suspicion and a low threshold for serological testing can help with early detection and treatment of the disease, allowing us to reverse retinal changes and prevent permanent damage 8 . Posterior segment manifestations of ocular syphilis can include, among others, superficial retinal precipitates, exudative retinal detachment, acute syphilitic placoid posterior chorioretinopathy, papillitis, vasculitis, neuroretinitis, chorioretinitis, and retinitis 9 , 10 …”

Eyes As the Window to Syphilis: A Rare Case of Ocular Syphilis As the Initial Presentation of Syphilis

“…However, as highlighted by our case, a high index of suspicion and a low threshold for serological testing are important as early treatment can reverse retinal changes and restore visual acuity. Early treatment in patients with suspicious uveitis usually has good outcomes with regard to visual changes [12]. There have been studies showing a high CSF abnormal rate in HIV-negative patients with ocular syphilis [13].…”

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]. Von 241 Patienten mit akuter anteriorer Uveitis wiesen nur 2 eine Syphilis auf [35].…”

“…Von 241 Patienten mit akuter anteriorer Uveitis wiesen nur 2 eine Syphilis auf [35]. Die Entzündung kann unspezifisch sein, aber auch Irisgranulome mit Synechien und dichter Glaskörperinfiltration aufweisen [31,36].…”

“…Mittels der Spectral Domain optischen Kohärenztomografie (SD-OCT) lassen sich mehr oder weniger ausgeprägte subretinale Flüssigkeitseinlagerungen, eine unterbrochene und fehlende ellipsoide Zone, ein hyperreflektiv verdicktes retinales Pigmentepithel sowie punktförmige Hyperreflektivitäten in der korrespondierenden Choroidea nachweisen (▶ Abb. 6 e) [19,31,44,45]. Unter Umständen kann auch die gesamte Netzhautdicke betroffen sein [46].…”