Ocular syphilis

Area of Science:

• Infectious Diseases
• Ophthalmology
• Microbiology

Background:

• Syphilis, caused by *Treponema pallidum*, is a systemic inflammatory disease with potential ocular manifestations at any stage.
• Ocular syphilis presents with diverse symptoms, often mimicking other eye conditions, complicating clinical diagnosis.
• A global resurgence of syphilis necessitates increased awareness of its ocular manifestations among clinicians.

Purpose of the Study:

• To highlight the importance of considering ocular syphilis in the differential diagnosis of various ocular inflammatory conditions.
• To emphasize the diagnostic challenges and necessary workup for ocular syphilis.
• To underscore the curability of ocular syphilis with timely diagnosis and appropriate treatment, while warning against visual impairment from delayed diagnosis.

Main Methods:

• Review of clinical presentations, diagnostic strategies, and treatment guidelines for ocular syphilis.
• Emphasis on serological testing (treponemal and nontreponemal) for presumptive diagnosis.
• Recommendation for cerebrospinal fluid and human immunodeficiency virus co-infection testing.

Main Results:

• Ocular syphilis can affect any part of the eye and occur at any stage of the disease.
• Diverse presentations often lead to delayed diagnosis, increasing the risk of permanent visual impairment.
• Serological tests are key for diagnosis, and treatment follows neurosyphilis guidelines, with penicillin G as the preferred agent.

Conclusions:

• Ocular syphilis is a curable condition with prompt diagnosis and treatment.
• Clinicians must maintain a high index of suspicion for ocular syphilis, especially in patients with uveitis, high-risk behaviors, or treatment failures.
• Familiarity with the varied manifestations, diagnostic methods, and treatment protocols for ocular syphilis is essential due to its resurgence.