Non-human Immunodeficiency Virus-related Ocular Syphilis in a Korean Population: Clinical Manifestations and Treatment Outcomes

Abstract

PurposeTo describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection.MethodsA total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed.ResultsThe mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis.ConclusionsVisual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.

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

“…All patients were also noted to be older than 50, with a mean age of 69.8 ± 6.4. A retrospective study conducted in Korea of ocular syphilis in HIV-negative patients shows similar findings [5]. Shen et al found the median age of ocular syphilis presentation to be 50.3 ± 5.9 years in their study, which is comparable to the results of our study even though their study included one HIV patient [16].…”

“…Increased ocular syphilis cases in male were postulated to be attributed to the increased incidence of male patients with HIV and the practice of homosexuality [2,4,6]. This gender discrepancy finding was rarely exhibited in populations of HIV-negative patients where the rate of ocular syphilis was equal amongst males and females [4-5,7]. In our study, ocular syphilis was actually more common in female (70.0%).…”

“…This high incidence of posterior uveitis amongst HIV-negative patients mirrors our findings, in which posterior uveitis accounts for 53.8% (seven eyes) of the eyes involved. Other studies of HIV-negative patients have similar findings, with the exception of one study in which higher incidence of posterior and anterior uveitis [5,7,16]. It is interesting to note that if HIV status is not taken into consideration, panuveitis exhibits the most common presentation [4,6].…”

“…Ocular syphilis, which can manifest at any stage of the syphilis infection, occurs more frequently during the latent stage of syphilis infection than during the primary stage [4-5]. In immunocompetent patients, ocular syphilis presents more often in the elderly, while in younger patients, it is usually a result of HIV coinfection [6].…”

Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection

“…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 – 15 . In contrast, more recent reports describing cohorts of up to 85 patients with ocular syphilis in the US 11 , 16 , 17 , Europe 18 – 23 and Australasia 24 – 27 suggest the condition is re-emerging, consistent with the increasing incidence of the systemic infection. However, there are no current surveys of ocular syphilis in South American nations.…”