Abstract
Recent reports from different world regions suggest ocular syphilis is re-emerging, in parallel with an increasing incidence of the systemic infection globally. We conducted a large observational study of 127 persons consecutively treated for ocular syphilis at public medical centers in Brazil over a 2.5-year period ending July 2015. Of 104 individuals serologically tested for human immunodeficiency virus (HIV), 34.6% were positive. Ophthalmological evaluations included measurement of Snellen visual acuity and intraocular pressure, and assessment of inflammation by slit lamp examination and dilated posterior eye examination. Involvements in 214 eyes were anterior (6.1%), intermediate (8.4%), posterior (76.2%) and pan- (8.4%) uveitis, and scleritis (0.9%). Multiple anterior and posterior eye complications were observed, including cataract in the anterior eye (incidence rate, 0.18/eye-year) and epiretinal membrane in the posterior eye (incidence rate, 0.09/eye-year); incidence rates of reduction in best-corrected visual acuity to ≤20/50 and ≤20/200 were 0.10 and 0.06/eye-year, respectively. Rates of complications and visual acuity loss did not differ significantly between HIV- positive and negative individuals. In an era of re-emergence, syphilis has ocular complications that may compromise vision, despite treatment with appropriate anti-microbial drugs.
Highlights
Recent reports from different world regions suggest ocular syphilis is re-emerging, in parallel with an increasing incidence of the systemic infection globally
Clinical data were collected for 127 patients who presented with inflammatory eye disease that was diagnosed as ocular syphilis on the basis of a combination of serological testing, cerebrospinal fluid (CSF) analysis and/or resolution following specific antibiotic treatment
There were no significant differences in results of luetic serological testing, presence of abnormalities in the cerebrospinal fluid (CSF), and treatment with antibiotics or corticosteroid between human immunodeficiency virus (HIV)-negative and HIV-positive patients
Summary
Recent reports from different world regions suggest ocular syphilis is re-emerging, in parallel with an increasing incidence of the systemic infection globally. Reports describing large groups of patients treated at tertiary referral inflammatory eye disease services in the 1990s and 2000s indicated ocular syphilis was a rare diagnosis, accounting for less than 2% of all cases managed at these times[12,13,14,15]. More recent reports describing cohorts of up to 85 patients with ocular syphilis in the US11,16,17, Europe[18,19,20,21,22,23] and Australasia[24,25,26,27] suggest the condition is re-emerging, consistent with the increasing incidence of the systemic infection. There are no current surveys of ocular syphilis in South American nations
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