Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response.
OBJECTIVE
To determine the relative frequencies of signs in posterior segment ocular syphilis, the response to a neurosyphilis regimen of penicillin, and differences in findings between human immunodeficiency virus (HIV)-coinfected and -noncoinfected patients in a community setting.


METHODS
Retrospective, noncomparative, consecutive case series.


METHODS
Fourteen consecutive patients with posterior segment ocular syphilis over a 14-year period within or during the acquired immune deficiency syndrome era.


METHODS
Neurosyphilis intravenous penicillin regimen.


METHODS
Initial and final visual acuity; treponemal and nontreponemal serologic analyses; cerebrospinal fluid cell count, protein, and Venereal Disease Research Laboratory analyses; posterior segment signs; and relapses and recurrences.


RESULTS
Blacks and males were predominantly affected. Five (36%) of patients were HIV coinfected, and ocular syphilis led to the HIV infection diagnosis in three. Four (29%) patients had received previous antibiotic therapy for primary or secondary syphilis, raising the suspicion of relapse. Two patients had negative nontreponemal serologic results. All patients responded rapidly to neurosyphilis therapy. One patient subsequently relapsed after neurosyphilis therapy, and a second was reinfected with recurrence of ocular involvement. One previously undescribed retinal manifestation was discovered: a sectorial retinochoroiditis with delayed retinal circulation in the involved area.


CONCLUSIONS
Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection. Conventional syphilis staging is of little use in understanding ocular syphilis. A high suspicion for this diagnosis is appropriate, especially in poorer black males with posterior segment inflammatory disease. Human immunodeficiency virus coinfection with ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term. Awareness of the multiple presentations of posterior segment ocular syphilis will aid ophthalmologists in averting misdiagnosis or delayed diagnosis.
Browning
D J
DJ
Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina, USA. djbrowning@compuserve.com
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015862:Choroid Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D010406:Penicillins / Q000627:therapeutic use*; D012164:Retinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D013588:Syphilis Serodiagnosis; D014792:Visual Acuity
D010406:Penicillins