Neurosyphilis and ocular syphilis in patients with concurrent human immunodeficiency virus infection

Epidemiologic studies have demonstrated a strong association between human immunodeficiency virus (HIV) and syphilitic infection. Recent reports have suggested that concurrent HIV and luetic infection may lead to an accelerated and more fulminant course of syphilis. Specifically, neurosyphilis is encountered much earlier in such patients. We report two cases in which both neurosyphilis and ocular syphilis were present in HIV sero-positive patients. A review of the literature reveals that 11 of 13 (85%) HIV-infected patients with ophthalmic syphilis also had neurosyphilis. In patients who present with signs of ocular inflammation and pose a diagnostic dilemma, syphilis and possible concurrent HIV infection merit strong consideration. We wish to emphasize that patients should be evaluated for the presence of neurosyphilis if co-infection exists. Ophthalmologists should be aware that neuro-ophthalmic lues may prove to be the presenting feature of infection with HIV.