Prognosis of ocular syphilis in patients infected with HIV in the antiretroviral therapy era

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.

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“…2 Delay in diagnosis of ocular syphilis has been associated with increased ocular complications and poorer visual outcomes. 7,8 …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Antibacterial agents were used in combination with systemic corticosteroids in some patients in 11 studies involving 245 patients [15, 19, 21, 24, 25, 28, 29, 32, 33, 36, 38]. The mean age of the patients ranged from 38 to 57.7 years.…”

Section: Resultsmentioning

confidence: 99%

“…Recurrence of ocular inflammation was assessed in the follow-up period in 13 studies involving 210 patients [14, 15, 24, 27, 28, 31–33, 36, 37, 39, 40, 43]. The mean follow-up time ranged from 1 to 29.4 months in these studies.…”

Section: Resultsmentioning

confidence: 99%

Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis

Zhang

Zhu

2017

Journal of Ophthalmology

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Purpose To investigate the clinical features and efficacies of treatments for syphilitic uveitis. Methods PubMed was searched for studies of syphilitic uveitis published between January 1990 and October 2016. The clinical features were summarized and appraised. The pooled success rate was defined as an improved or maintained final visual acuity and was calculated with 95% confidence intervals (CIs). Heterogeneity, subgroup analysis, sensitivity analysis, and publication bias were assessed. Results Thirty-two studies involving 670 patients were analyzed. The most common type of syphilitic uveitis was papillitis. The pooled success rate was 0.91 (95% CI 0.84–0.97) for antibacterial agents alone (15 studies, 286 patients); 0.95 (95% CI 0.91–0.98) for antibacterial agents and systemic corticosteroids combined (11 studies, 245 patients); and 0.91 (95% CI 0.80–0.98) for antibacterial agents, systemic corticosteroids, and other immunosuppressants combined (3 studies, 73 patients). Subgroup analyses revealed no correlations of the efficacy of antibacterial agent monotherapy with study characteristics, such as human immunodeficiency virus coinfection status. Conclusions This systematic review and meta-analysis revealed the efficacy of antibacterial agents for treating syphilitic uveitis. Coadministration of systemic corticosteroids or immunosuppressants did not elicit further improvements in the clinical outcomes of antibacterial agents.

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“…Our patient was treated with penicillin G 4 million units intravenously every 4 h for 14 days along with oral prednisolone 1 mg/kg daily, and his skin lesions and visual disturbance gradually improved. As delayed diagnosis can lead to irreversible visual loss, early assessment and treatment is of paramount importance [5] .…”

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confidence: 99%

Ocular involvement with secondary syphilis in a non-HIV infected man

Matsuo

Mori

Furukawa

et al. 2017

IDCases

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Prognosis of ocular syphilis in patients infected with HIV in the antiretroviral therapy era

Cited by 47 publications

References 24 publications

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

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

Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis

Ocular involvement with secondary syphilis in a non-HIV infected man

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