The Rise of Syphilitic Placoid Chorioretinitis: A Literature Review with Data from 286 Published Cases

Area of Science:

• Ophthalmology
• Infectious Diseases
• Public Health

Background:

• Ocular syphilis is a re-emerging infectious disease.
• Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a specific manifestation of ocular syphilis.
• Understanding ASPPC trends is crucial for timely diagnosis and management.

Purpose of the Study:

• To review and analyze all published reports of ASPPC.
• To clarify demographic, clinical, and management trends in ASPPC.
• To evaluate diagnostic and outcome patterns of ASPPC.

Main Methods:

• Comprehensive literature review of ASPPC reports.
• Inclusion of case series and case reports on ocular syphilis.
• Analysis of 128 publications involving 286 patients.

Main Results:

• ASPPC is increasing in frequency, accounting for 26% of ocular syphilis cases since 2020.
• Most common in males, especially men who have sex with men (MSM), with a mean age of 47.
• 85% achieved good visual recovery (LogMAR 0.3 or better), with outcomes unaffected by HIV status.

Conclusions:

• ASPPC disproportionately affects men, particularly MSM, and is linked to otosyphilis.
• Visual outcomes are excellent with prompt treatment; IV penicillin, IM penicillin, and IV ceftriaxone are equally effective.
• Geographical disparities suggest a potential link between ASPPC and specific Treponema pallidum subclades.