Utility of Treponemal Testing from Aqueous Fluid in the Diagnosis of Ocular Syphilis in Patients with HIV/AIDS

Nair, Nivedita; Sridharan, Sridha; Anand, Appakkudal R.; Biswas, Jyotirmay; Therese, K Lily

doi:10.1080/09273948.2020.1803362

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…Screening by RPR test will miss 11% of ocular syphilis patients. Therefore, for patients suspected of syphilitic uveitis, a specific TP test needs to be used for screening [15] . High serum RPR titer is related to severe uveitis and poor vision.…”

Section: Resultsmentioning

confidence: 99%

Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

Xu¹,

Dai²,

Yuan³

et al. 2023

Int J Ophthalmol

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AIM: To report the clinical characteristics, treatment and outcomes of active syphilitic uveitis in human immunodeficiency virus (HIV) positive patients and compare them with the previously published data. METHODS: Retrospective analysis of the case series from an infectious disease center in southern China was conducted. Comprehensive review of previously published cases of HIV positive syphilitic uveitis was conducted using the PubMed and Web of Science databases and the references listed in the identified articles. RESULTS: Twelve HIV positive patients with active syphilitic uveitis were collected. All were male, with age of 36.3y (range 27 to 53y). Five (41.7%) had a history of syphilis, and three of them had received anti-syphilis treatment. Ocular manifestations included corneal epithelial defect (13%), complicated cataract (17.4%), vitreous opacity (82.6%), optic disc edema (26.1%), macular edema (30.4%), neuro-retinitis (43.5%), and retinal hemorrhage (26.1%). After standardized syphilitic treatment, intraocular inflammation was reduced and vision improved in all cases. The literature review summarizes 105 previously reported cases of HIV positive syphilitic uveitis. High serum rapid plasma regain (RPR) titers may be associated with severe uveitis and poor vision. Treatment with penicillin, ceftriaxone sodium, or penicillin plus benzylpenicillin instead of using benzylpenicillin alone can significantly improve best-corrected visual acuity (BCVA) in HIV positive ocular syphilis patients. CONCLUSION: For HIV positive syphilitic uveitis patients, prompt diagnosis and appropriate treatment and follow-up are paramount. In our series, the clinical manifestations are diverse. Syphilis patients treated by penicillin G or long-acting penicillin before may still develop syphilitic uveitis. Patients who relapse after long-term penicillin treatment can still benefit from penicillin G.

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Section: Resultsmentioning

confidence: 99%

Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

Xu¹,

Dai²,

Yuan³

et al. 2023

Int J Ophthalmol

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“…T. pallidum antibody and DNA testing of aqueous humour, if obtained, could help confirm the diagnosis, or be part of testing for a differential diagnosis when patients present with ocular symptoms and signs. 56 A lumbar puncture is not routinely indicated to diagnose ocular syphilis as it does not have therapeutic consequences.…”

Section: Diagnostic Testing For Syphilismentioning

confidence: 99%

Southern African HIV Clinicians Society Guideline for the clinical management of syphilis

Peters,

Nel,

Sadiq

et al. 2024

Southern African Journal of HIV Medicine

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Syphilis, ‘the great imitator’, caused by Treponema pallidum infection, remains a complex and multifaceted disease with a rich history of clinical diversity. This guideline aims to be a comprehensive guide for healthcare workers in Southern Africa, offering practical insights into the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, therapeutic principles, and public health responses to syphilis. Although the syphilis burden has declined over the years, recent data indicate a troubling resurgence, particularly among pregnant women and neonates. This guideline highlights the diagnostic challenges posed by syphilis, stemming from the absence of a single high-sensitivity and -specificity test. While treatment with penicillin remains the cornerstone of treatment, alternative regimens may be used for specific scenarios. We highlight the importance of thorough patient follow-up and management of sex partners to ensure optimal care of syphilis cases. In the context of public health, we emphasise the need for concerted efforts to combat the increasing burden of syphilis, especially within high-risk populations, including people living with HIV.

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Syphilitic scleritis and episcleritis: A review

Shields,

Furtado,

Lake

et al. 2024

Asia-Pacific Journal of Ophthalmology

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Utility of Treponemal Testing from Aqueous Fluid in the Diagnosis of Ocular Syphilis in Patients with HIV/AIDS

Cited by 5 publications

References 23 publications

Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

Southern African HIV Clinicians Society Guideline for the clinical management of syphilis

Syphilitic scleritis and episcleritis: A review

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