Ocular Syphilis: Clinical Manifestations and Treatment Course

We report 3 ocular syphilis cases that highlight the increasing incidence, variable presentation, diagnostic challenges, and treatment considerations of this potentially visionthreatening disease.

A 39-year-old woman with diabetes and intravenous (IV) drug use presented with 3 weeks of decreased vision, left-eye photopsia, and rash. A 52-year-old man who has sex with men (MSM), presented with a 1-month history of upper respiratory infection-like symptoms, right-eye scotoma, redness, headache, and muffled hearing. A 24-year-old man with a history of MSM presented with right-eye scotoma and a history of transaminitis, rash, and systemic symptoms months prior.

Syphilis rates are increasing. Each patient presented with nonspecific symptoms that, in retrospect, were early signs of infection. Vision recovery depends on the extent of ocular involvement, early recognition, and prompt initiation of appropriate therapy.

Ocular syphilis must be considered in at-risk groups, but systemic signs may precede vision changes. Diagnosis requires a high index of suspicion and treatment with IV penicillin is effective.