title: Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy.
abstract: BACKGROUND
  From October 2001 to October 2002, we have observed a surprisingly high incidence of ocular syphilis in human immunodeficiency virus-positive (HIV+) patients receiving highly active antiretroviral therapy at our clinic.
  
  
  METHODS
  We conducted a retrospective chart and patient database review.
  
  
  RESULTS
  From 1997 to 2002, 455 patients in our clinic were screened for syphilis; 320 were screened from 2001 to 2002; 7.3% of patients (33/455) were diagnosed with syphilis. During the past year, syphilis was diagnosed in 7.5% of patients (24/320), of whom 13% (3/24) had ocular syphilis. We estimate the prevalence of ocular syphilis in HIV+ patients on highly active antiretroviral therapy screened for syphilis to be 9% (3/33). Presenting symptoms included blurred vision, loss of vision, central scotomas, and bilateral ocular involvement. The most common ocular manifestation of syphilis was posterior chamber uveitis; one patient also had a retinal detachment. All patients demonstrated reactive rapid plasma reagin and fluorescent treponemal antibody absorption test results, cerebrospinal fluid pleocytosis, and elevated total protein. Each patient received a 21-day course of intravenous penicillin G (24 million units daily) with improvement of visual symptoms.
  
  
  CONCLUSIONS
  Our data demonstrate an unexpectedly high incidence of ocular syphilis in our HIV+ patients receiving highly active antiretroviral therapy during the past year. A diagnosis of ocular syphilis should be considered in any HIV+ patient who presents with visual symptoms, irrespective of the patient's CD4 count.
authors.affiliation: Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA. phadungg@gunet.georgetown.edu
authors.forename: Gayle P
authors.initials: GP
authors.lastname: Balba
authors.forename: Princy N
authors.initials: PN
authors.lastname: Kumar
authors.forename: Andrea N
authors.initials: AN
authors.lastname: James
authors.forename: Anurag
authors.initials: A
authors.lastname: Malani
authors.forename: Allan G
authors.initials: AG
authors.lastname: Palestine
authors.forename: James N
authors.initials: JN
authors.lastname: Welch
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Timpone
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D005128:Eye Diseases / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D013587:Syphilis / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D014605:Uveitis / Q000209:etiology / Q000821:virology