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Ocular syphilis among HIV-infected patients: a systematic analysis of the literature

Joseph D Tucker1, Jonathan Z Li, Gregory K Robbins

  • 1Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA. jtucker4@partners.org

Sexually Transmitted Infections
|August 28, 2010
PubMed

Insights

Ocular syphilis is a concern in HIV patients, sometimes leading to HIV diagnosis. Treatment with penicillin or ceftriaxone improved vision in most cases, though tests can be negative.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • HIV/AIDS

Background:

  • Ocular syphilis remains a significant concern for individuals with HIV, even during the highly active antiretroviral therapy (HAART) era.
  • Limited data exists on the clinical, laboratory, and treatment outcomes for HIV-infected patients with ocular syphilis outside of small case studies.

Purpose of the Study:

  • To systematically review and analyze the existing literature on HIV-infected patients diagnosed with ocular syphilis.
  • To determine the clinical characteristics, diagnostic findings, and treatment outcomes in this patient population.

Main Methods:

  • A systematic review was conducted on case series and case reports of HIV-infected individuals with ocular syphilis.
  • Studies published in languages other than English and reports prior to 1980 were excluded.
  • The impact of CD4+ T-cell count and virological suppression on clinical presentation and diagnostic laboratory values was assessed.

Main Results:

  • The review identified 101 HIV-infected individuals with ocular syphilis.
  • Ocular syphilis was the initial indicator for HIV diagnosis in 52% of cases, including those with CD4+ counts above 200 cells/mm³.
  • Posterior uveitis was more prevalent in patients with CD4+ counts below 200 cells/mm³ (p=0.002).
  • Three patients with confirmed ocular syphilis presented with negative non-treponemal tests.
  • Visual impairment improved in 97% of patients following treatment with intravenous penicillin or ceftriaxone.

Conclusions:

  • Non-treponemal syphilis tests may yield false-negative results in HIV-infected patients.
  • Ocular syphilis is a critical clinical manifestation that can serve as an early diagnostic sign for HIV infection.
Abstract

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