Clinical Profile and Visual Outcomes of Ocular Syphilis: A Five-year Review in Hospital Universiti Sains, Malaysia

Abstract

Introduction Ocular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia. Methodology This was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed. Results A total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes. Conclusions Posterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.

Neurosyphilis Presenting with Optic Neuritis

“…Previous case reports published in Malaysia had similar presentations; however, they were associated with HIV positive [6], [7], in contrast to our patient who was HIV negative and otherwise well. Previous case reports of neurosyphilis involving the eye in Malaysia had other findings such as panuveitis, anterior or posterior uveitis [7], [8], while our patient had signs of optic neuritis only with no other ocular features. This made the diagnosis challenging for us.…”

An Eye-Opening Presentation of Syphilis

“…Ocular syphilis occurs in about 0.6%-2% of all patients at any stage of the disease. The most common presentations of ocular syphilis are posterior uveitis or panuveitis [ 4 , 5 ]. It occurs more often during the late-latent stage in the immunocompetent elderly population, and may also occur in conjunction with HIV coinfection in younger patients [ 4 , 5 ].…”

“…The most common presentations of ocular syphilis are posterior uveitis or panuveitis [ 4 , 5 ]. It occurs more often during the late-latent stage in the immunocompetent elderly population, and may also occur in conjunction with HIV coinfection in younger patients [ 4 , 5 ]. In a study of 143 patients with syphilitic uveitis, patients with isolated anterior uveitis had a 14.5 times higher likelihood of being HIV-positive.…”

“…In a study of 143 patients with syphilitic uveitis, patients with isolated anterior uveitis had a 14.5 times higher likelihood of being HIV-positive. They also noted that almost 62% of ocular syphilis in HIV-negative patients presented with posterior uveitis [ 5 ]. It has been shown that there is visual loss and worsening visual acuity as well as possible blindness with a longer duration of uveitis; therefore, making a prompt diagnosis and treatment is essential [ 4 ].…”

Clinical and Ophthalmological Characteristics of Ocular Syphilis in a Retrospective Tertiary Hospital Cohort

“…Ocular syphilis is a form of syphilis that can occur in all stages of the disease and often manifests with visual impairments as the only clinical symptom 4,5 . It affects every section of the eye, 6 and it manifests in different forms, with panuveitis 7,8 and posterior uveitis 9,10 the most commonly reported. Data on the incidence of OS are rare, but some studies report OS in less than 5% of all cases of infectious syphilis 4,11,12 …”