Association Between Syphilitic Posterior Uveitis, VDRL Titer and HIV Co-Infection

Our primary goal is to study the relationship between Venereal Disease Research Laboratory (VDRL) testing and posterior segment involvement by syphilis. Secondary goals include characterizing the epidemiological and clinical features of syphilitic posterior uveitis in a national multicenter cohort, and assessing the impact of HIV co-infection on disease presentation.

Retrospective, observational, multicenter study of syphilitic posterior uveitis with serologic confirmation. A review of medical records was conducted to facilitate statistical analysis, collecting epidemiologic, clinical and laboratorial results.

Eighty-three patients with syphilitic posterior uveitis were included (75.9% male, mean age 48.8 years). HIV co-infection was present in 24.1% of patients. The mean VDRL titer was 149.18. Posterior uveitis phenotypes comprised 48 (57.9%) acute syphilitic posterior placoid chorioretinitis, 41 (49.4%) papillitis, 21 (25.4%) retinitis/choroiditis, 7 (8.4%) vasculitis, 5 (6.0%) neurosyphilis and 4 (4.8%) scleritis. Patients with retinitis/choroiditis had higher VDRL titers than those with other phenotypes (p = 0.055). Among HIV-infected patients, those with papillitis had higher CD4+ lymphocyte count, and this difference was close to being statistically significant (p = 0.069).

In summary, our study identified a borderline significant association between higher VDRL titers and retinitis/choroiditis and, in HIV-infected individuals, between elevated CD4+ counts and papillitis. These findings suggest that patients presenting with elevated VDRL titers and/or higher CD4+ lymphocyte counts may be at increased risk for more severe posterior uveitis phenotypes.