Ocular manifestations of syphilis: recent cases over a 2.5-year period.
BACKGROUND
The ocular manifestations of syphilis are protean and can affect every structure of the eye. There has been a recent increase of syphilis infection in Europe. We report recent cases of ocular syphilis infection in a tertiary center.


METHODS
During a 2.5-year period (2005-2007) we collected the medical records of eight male patients with ocular syphilis. The diagnosis was based on serological tests on blood samples and cerebrospinal fluid. All patients underwent a check-up to rule out another etiological diagnosis and to detect the presence of any other sexually transmitted infections.


RESULTS
The ocular lesions included: chorioretinitis (one case), retinitis (two cases), panuveitis with macular edema (two cases), episcleritis (one case), anterior optic neuritis (one case), and retrobulbar optic neuropathy (one case). Infection of the cerebrospinal fluid was detected in three of the five patients tested. In six cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent at the 6-month follow-up visit. Co-infection with human immunodeficiency virus was reported in five patients, with a CD4 T lymphocyte count greater than 300/mm(3). Most of the patients were treated with parenteral ceftriaxone (1 g daily) for 3 weeks with good tolerance. One patient was treated with intravenous penicillin G (18 MUI daily). Only one patient with anterior optic neuritis required systemic steroid therapy associated with antibiotics. Sequelae included sectorial atrophy of the optic nerve with visual field loss (n = 1) and abnormalities of the retinal pigment epithelium (n = 3).


CONCLUSIONS
All patients with ocular syphilis exhibited functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. As a great imitator, syphilis should be considered in all patients with uveitis, scleritis, episcleritis, or optic neuritis, especially in men with high-risk sexual behavior.
Puech
Cindy
C
Department of Ophthalmology, University Hospital of Grenoble, Joseph Fourier University, Grenoble, France.
Gennai
Stéphane
S
Pavese
Patricia
P
Pelloux
Isabelle
I
Maurin
Max
M
Romanet
Jean-Paul
JP
Chiquet
Christophe
C
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002443:Ceftriaxone / Q000627:therapeutic use; D002825:Chorioretinitis / Q000175:diagnosis / Q000188:drug therapy; D004318:Doxycycline / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D005455:Fluorescent Antibody Technique; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy; D015864:Panuveitis / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy; D013588:Syphilis Serodiagnosis
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D004318:Doxycycline