Reported Neurologic, Ocular, and Otic Manifestations Among Syphilis Cases—16 States, 2019

Abstract

Neurologic, ocular, and otic manifestations were infrequently reported overall, but prevalence increased with age and was higher among human immunodeficiency virus–infected persons reporting injection drug use and staged as unknown duration/late syphilis.

All Eyes and Ears: A Case of Neurosyphilis Presenting With Simultaneous Ocular and Otic Involvement

“…Neurosyphilis and its subtypes of ocular syphilis and otosyphilis are rare among patients with syphilis, though true prevalence may be underestimated due to under-reporting. A 2019 analysis of syphilis cases from 16 states found that ocular syphilis made up around 1% of cases, while otosyphilis made up 0.4% of cases [ 6 ].…”

“…Otosyphilis typically presents with hearing loss, tinnitus, and vertigo [ 5 ]. Both ocular and otologic forms of neurosyphilis are rare manifestations of syphilis, together encompassing less than 2% of reported cases [ 6 ]. Here, we present a particularly unusual case of concurrent ocular and otologic neurosyphilis in an immunocompetent young adult.…”

A Cluster of Ocular Syphilis Cases with a Common Sex Partner — Southwest Michigan, 2022

“…This ocular syphilis cluster is the first documented with epidemiologic linkage among cases attributable to heterosexual transmission. In 2019, a study of 41,187 syphilis cases from 16 jurisdictions with complete reporting, including Michigan, found that incidence of systemic manifestations were rare (neurosyphilis, 1.1%; ocular syphilis, 1.1%; and otosyphilis, 0.4%) ( 1 ). A cluster of ocular syphilis was reported in Seattle in 2015 among four men who have sex with men, three of whom were HIV-positive and two of whom were sex partners ( 2 ).…”

“…Although ocular and neurosyphilis can occur at any stage of syphilis, a 2019 U.S. prevalence estimate found that these clinical manifestations occurred more commonly during late-stage syphilis, and were most prevalent among persons aged ≥65 years and those reporting injection drug use ( 1 ). In contrast, among cases in the current reported cluster, all patients had early-stage disease, and were aged 40–60 years, and none reported injection drug use or transactional sex.…”

A rare case report of bilateral vestibulopathy due to otosyphilis

“…Upon infection, syphilis can invade the nervous system and result in a wide array of nonspecific symptoms, contributing to a strong potential for misdiagnosis. [ 3 ] Otosyphilis is a form of audiovestibular dysfunction due to syphilis, [ 4 ] and this condition is very rare. Prior reports pertaining to otosyphilis have primarily focused on hearing impairment, with peripheral vestibulopathy having only been reported only in a few cases.…”