Ocular Syphilis in an HIV-Positive Transgender Female: A Case Report

This is a case of a 56-year-old transgender female with a history of HIV who presented to the emergency department with visual disturbances and bilateral papilledema. Initially, intracranial abnormalities were ruled out through imaging studies. However, a lumbar puncture later confirmed the presence of syphilis in the cerebral spinal fluid (CSF), and the patient was diagnosed with bilateral syphilitic uveitis by a retina specialist. Treatment with intravenous and intramuscular penicillin led to significant improvement in her visual symptoms and resolution of optic nerve edema. This case underscores the importance of early screening for syphilis and other sexually transmitted infections (STIs) in transgender patients living with HIV presenting with visual symptoms. The delayed syphilis screening and treatment in this patient highlight the impact of healthcare barriers on transgender individuals. Prompt diagnosis and treatment are critical to prevent serious complications, such as permanent vision loss. Healthcare providers must maintain a high index of suspicion for syphilis in HIV-positive patients with visual symptoms, irrespective of their cluster of differentiation 4 (CD4) count or viral load. Addressing barriers to healthcare for transgender individuals is essential to ensure timely diagnosis and treatment to improve patient outcomes.