Ocular Syphilis — Eight Jurisdictions, United States, 2014–2015

Oliver, Sara E.; Aubin, Mark R.; Atwell, Leah; Matthias, James; Cope, Anna B.; Mobley, Victoria; Goode, Alexandra; Minnerly, Sydney; Stoltey, Juliet; Bauer, Heidi M.; Hennessy, Robin R.; DiOrio, Dawne; Fanfair, Robyn Neblett; Peterman, Thomas A.; Markowitz, Lauri E.

doi:10.15585/mmwr.mm6543a2

Cited by 121 publications

(105 citation statements)

References 7 publications

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“…The predominance of ocular syphilis in men, particularly men aged >40 years, is consistent with what has been reported recently in the United States [14], and elsewhere [6, 7]. The high proportion of cases in men and MSM is also consistent with the epidemiology of syphilis in the United States [1].…”

Section: Discussionsupporting

confidence: 88%

“…This investigation found a higher prevalence of ocular syphilis among HIV-infected syphilis cases, compared to syphilis cases without HIV. However, in this investigation and another US-based investigation, only half of patients diagnosed with ocular syphilis were HIV infected [14]. In previous studies of ocular syphilis, HIV-infected patients were more likely to be diagnosed with posterior uveitis [4, 19], and have findings in follow-up suggesting possible treatment failure [20, 21].…”

Section: Discussionmentioning

confidence: 65%

“…Since then, many states have received reports regarding severe visual symptoms among patients diagnosed with syphilis. A review of ocular syphilis in 8 US jurisdictions found ocular manifestations from syphilis in 0.61% of total syphilis cases, increasing from 0.53% in 2014 to 0.65% in 2015 [14]. Molecular typing of Treponema pallidum strains was performed on samples from US patients with ocular syphilis; 5 strains were identified in 14 patients, suggesting there is not a single type responsible for this increase [15].…”

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confidence: 99%

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Increases in Ocular Syphilis—North Carolina, 2014–2015

Oliver

Cope

Rinsky

et al. 2017

Clinical Infectious Diseases

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Background Ocular syphilis is an inflammatory eye disease due to Treponema pallidum infection. In the United States, syphilis rates have increased since 2000; clusters of ocular syphilis were reported in 2015. We investigated ocular syphilis in North Carolina to describe the epidemiology and clinical course of disease. Methods We reviewed syphilis cases reported to North Carolina during 2014–2015 and abstracted information from health department interviews for cases with ocular symptoms and no other defined etiology. To assess duration and severity of ocular symptoms, we also reviewed medical records and conducted structured interviews. We compared the prevalence of ocular manifestations among reported syphilis cases by demographic and clinical characteristics. Results Among 4232 syphilis patients, 63 (1.5%) had ocular syphilis: 21 in 2014 and 42 in 2015, a 100% increase. Total syphilis cases increased 35% through 2015. No patient with ocular syphilis named another ocular syphilis patient as a sex partner. Patients presented in all syphilis stages; 24 (38%) were diagnosed in primary or secondary syphilis. Ocular manifestations were more prevalent among syphilis patients who were male, aged ≥40 years, white, and infected with human immunodeficiency virus. No risk behaviors were associated with ocular syphilis. Among 39 interviewed patients, 34 (87%) reported reduced vision during infection; 12 (31%) reported residual visual symptoms posttreatment. Conclusions In North Carolina, ocular syphilis increased from 2014 to 2015 and may be due to increased recognition of ocular manifestations, or a true increase in ocular syphilis. Many ocular syphilis patients experienced vision loss; however, most improved posttreatment.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 65%

mentioning

confidence: 99%

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Increases in Ocular Syphilis—North Carolina, 2014–2015

Oliver

Cope

Rinsky

et al. 2017

Clinical Infectious Diseases

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“…The authors of the British Ocular Syphilis Study (BOSS) estimated that ocular syphilis occurred in 0.6% of cases of early syphilis 7. This figure is similar to that reported in the USA 8. Optic neuritis was diagnosed in 24% of patients in the BOSS study, although panuveitis was the most common diagnosis, affecting 41.3% of patients.…”

Section: Discussionsupporting

confidence: 69%

Syphilitic jaundice: a rare manifestation of the secondary stage presenting a missed opportunity to prevent ocular syphilis

Curran¹,

Higgins

2018

BMJ Case Reports

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The classical presentation of secondary syphilis comprises skin rashes, mucosal ulceration and lymphadenopathy. However, this disseminated stage can also present with symptoms and signs of ocular, neurological, pulmonary, renal, musculoskeletal and digestive tract disease. We report the case of a gay man who presented with icteric hepatitis. Although he underwent an exhaustive series of investigations (some of which were invasive), syphilis was not initially considered in the differential diagnosis. His jaundice resolved spontaneously, but he subsequently developed an acute optic neuritis. Early syphilis is relatively common in men who have sex with men (MSM). Prompt diagnosis and treatment in this case would have prevented ocular involvement. Syphilis testing should be considered in all MSM presenting with unexplained symptoms and signs.

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“…Between 2014 and 2015, 388 suspected ocular syphilis cases were identified from eight US jurisdictions, with 93% of cases in MSM, and 51% in HIV positive people. 2 The rise in syphilis is also concerning given syphilis may facilitate HIV transmission, as highlighted by data from the iPrEx study, where syphilis infection was associated with subsequent HIV acquisition. 3 What is driving these increases in syphilis rates?…”

mentioning

confidence: 99%

Increasing syphilis rates among men who have sex with men and screening to detect asymptomatic infection

Chen

Guy

2017

Sex. Health

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Abstract. With reports of increasing syphilis rates among men who have sex with men in various countries and complications such as ocular syphilis and neurosyphilis, greater efforts for promoting frequent syphilis screening of higher risk men are required. This should include serological testing for syphilis every time HIV testing is undertaken and each time HIV viral load testing is performed in HIV-positive men who have sex with men. Systems-based approaches tailored to particular contexts should be explored, evaluated and, if shown to be effective, implemented. Recent reports from a growing number of countries indicate that syphilis rates among men who have sex with men (MSM) are on the rise and have, in some cases, reached levels not seen for more than 20 years.

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Ocular Syphilis — Eight Jurisdictions, United States, 2014–2015

Cited by 121 publications

References 7 publications

Increases in Ocular Syphilis—North Carolina, 2014–2015

Increases in Ocular Syphilis—North Carolina, 2014–2015

Syphilitic jaundice: a rare manifestation of the secondary stage presenting a missed opportunity to prevent ocular syphilis

Increasing syphilis rates among men who have sex with men and screening to detect asymptomatic infection

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