Ocular syphilis among HIV-infected patients: a systematic analysis of the literature.
BACKGROUND
Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients. Objective To examine the literature on HIV-infected patients and determine the results of treatment.


METHODS
Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated.


RESULTS
A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm(3). Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm(3) (p = 0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone.


CONCLUSIONS
Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.
Tucker
Joseph D
JD
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA. jtucker4@partners.org
Li
Jonathan Z
JZ
Robbins
Gregory K
GK
Davis
Benjamin T
BT
Lobo
Ann-Marie
AM
Kunkel
Jan
J
Papaliodis
George N
GN
Durand
Marlene L
ML
Felsenstein
Donna
D
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D013587:Syphilis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D055815:Young Adult
D012367:RNA, Viral
J Infect Dis. 2004 Feb 1;189(3):369-76
14745693
Clin Infect Dis. 2008 Jun 15;46(12):e142-5
18462103
Med J Malaysia. 2003 Aug;58(3):437-9
14750386
Am J Ophthalmol. 1998 Mar;125(3):306-11
9512147
Retina. 1989;9(3):175-80
2687992
Ophthalmology. 1990 Oct;97(10):1281-7
2243678
J Infect. 2009 Jan;58(1):32-6
19081634
Arch Ophthalmol. 1987 Nov;105(11):1486-7
3675274
MMWR Morb Mortal Wkly Rep. 2007 Jun 29;56(25):625-8
17597693
Am J Ophthalmol. 1988 Jul 15;106(1):1-6
3394758
Ophthalmology. 1989 Dec;96(12):1727-30
2622618
Ocul Immunol Inflamm. 2009 May-Jun;17(3):207-12
19585365
Surv Ophthalmol. 1999 Nov-Dec;44(3):247-52
10588443
Clin Infect Dis. 2001 Jun 15;32(12):1661-73
11360205
Neth J Med. 2004 Jun;62(6):206-8
15460502
Genitourin Med. 1989 Aug;65(4):244-7
2807282
J Clin Neuroophthalmol. 1983 Sep;3(3):197-203
6226720
Sex Transm Dis. 2007 Aug;34(8):553-6
17667532
Arch Ophthalmol. 1987 Nov;105(11):1485-6
3675273
J Clin Neuroophthalmol. 1987 Mar;7(1):1-5
2952672
Md Med J. 1995 Apr;44(4):284-8
7731357
Eye (Lond). 2006 Jun;20(6):703-5
15933744
Ophthalmology. 1990 Feb;97(2):196-203
2326008
AIDS. 2008 Jun 19;22(10):1145-51
18525260
Graefes Arch Clin Exp Ophthalmol. 2005 Sep;243(9):863-9
16158310
Arch Ophthalmol. 1997 Apr;115(4):469-73
9109754
Clin Infect Dis. 2000 Mar;30(3):479-85
10722431
J Dermatol. 1994 Feb;21(2):111-6
8182207
Clin Infect Dis. 2009 Nov 15;49(10):1505-11
19842977
J Clin Neuroophthalmol. 1987 Dec;7(4):191-5, 196-7
2963024
Clin Exp Ophthalmol. 2004 Oct;32(5):526-8
15498066
Herpes. 2007 Dec;14(3):66-71
18371289
Clin Infect Dis. 2009 Jan 1;48(1):83-5
19035775
Ophthalmology. 2000 Nov;107(11):2015-23
11054325
N Engl J Med. 1987 Jun 18;316(25):1587-9
3587291
J Infect. 2009 Nov;59(5):373-5
19766672
Am J Med. 2006 May;119(5):448.e21-5
16651059
Ann Ophthalmol. 1986 Sep;18(9):260-1
3767211
Clin Infect Dis. 2010 Aug 15;51(4):468-71
20604717
Int J STD AIDS. 2001 Nov;12(11):754-6
11589818