Association between eye diagnosis and positive syphilis test results in a large, urban sexually transmitted infection/primary care clinic population

Abstract

In 2015, the Centers for Disease Control and Prevention (CDC) and the American Academy of Ophthalmology (AAO) released clinical advisories on rising cases of ocular syphilis. We examined the association between eye disease and syphilis infection among primary care and sexually transmitted infection (STI) clinic patients attending an urban lesbian, gay, bisexual, transgender (LGBT) health center. We conducted a retrospective medical record review of all patients who underwent syphilis testing at Howard Brown Health between 1 January 2010 and 31 December 2015. Confirmed eye diagnosis was based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for conjunctivitis, uveitis, keratitis, retinitis, and red eye. Demographic information, syphilis treatment, HIV status, and high-risk behaviors were abstracted. Syphilis diagnosis was defined by available laboratory data (enzyme immunoassay [EIA], rapid plasma reagin [RPR] titer, fluorescent treponemal antibody absorption [FTA-Abs], Treponema pallidum Ab). Multivariable logistic regression with robust variance was used to identify independent associations. During the study period, 71,299 syphilis tests were performed on 30,422 patients. There were 2288 (3.2%) positive syphilis tests. Seventy-seven patients had a confirmed eye diagnosis (0.25%). Patients with eye disease had higher probability of at least one positive syphilis test (33%) compared to those without eye disease (8%) (p <0.01). Of patients with eye disease, 77% were men who had sex with men (MSM) and 65% were HIV-positive. Patients with eye disease had 5.97 (95% CI: 3.70, 9.63) higher odds of having syphilis compared to patients without eye disease. When adjusted for age, race, gender/sexual orientation, insurance status, and HIV status, this association between positive syphilis test and eye disease decreased but was still significant (OR 2.00, 95% CI 1.17, 3.41). Patients who present with an eye diagnosis to STI/primary care clinic have a higher probability of positive syphilis tests even after adjusting for other risk factors for syphilis. High-risk patients with eye symptoms should have routine STI testing and in keeping with CDC and AAO recommendations, full ophthalmologic examination.

Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China

“…Compared to systemic syphilis, ocular involvement is rare. In this study, ocular syphilis occurs in only 5.1% of total syphilis cases based on a 6 year case series study, which is similar to previous studies reported in literature (1,5,6). Although ocular syphilis mainly occurs in secondary and tertiary syphilis, our study demonstrated that 95.4% of syphilis cases (125/131) had no past medical history, or systemic manifestation of syphilis at presentation, which indicates that most ocular syphilis may present as the only clinical manifestation of syphilis, i.e., most ocular syphilis may occur in latent syphilis (7,8).…”

“…Although ocular syphilis mainly occurs in secondary and tertiary syphilis, our study demonstrated that 95.4% of syphilis cases (125/131) had no past medical history, or systemic manifestation of syphilis at presentation, which indicates that most ocular syphilis may present as the only clinical manifestation of syphilis, i.e., most ocular syphilis may occur in latent syphilis (7,8). Different from ocular syphilis in developed western countries which frequently occur in HIV positive patients (ranged from 22% to 65%), ocular syphilis was mostly found in HIV negative patients in China and other East-Asian countries (5)(6)(7)(8)(9)(10)(11)(12). In our study, only 2.9% (2/70) of ocular syphilis cases were HIV positive, the prevalence of concurrent ocular syphilis and HIV was similar to that reported in previous investigation from China, indicating that despite a high risk of co-infection in syphilis cases, concurrent HIV infection rate might be low in China (5).…”

A case series with literature review on adjunctive usage of intravitreal ceftazidime in ocular syphilis with human immunodeficiency virus infection

“…The incidence of syphilis, including ocular syphilis, has been on the rise, particularly in men who have sex with men (MSM) and HIV-positive patients. 3 Much of this trend is probably due to the resumption of sexual behaviour since the arrival of ART. 4 When safe-sex practises are used, this is often confined to genital and anal contact; it is widely believed that oral sex is ‘safe’.…”