title: Clinical features and incidence rates of ocular complications in patients with ocular syphilis.
abstract: OBJECTIVE
  To describe the clinical outcomes of ocular syphilis.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The charts of patients with ocular syphilis (regardless of human immunodeficiency virus [HIV] status) seen in a uveitis referral center between 1984 and 2014 were reviewed.
  
  
  RESULTS
  The study included 35 patients (61 eyes). Panuveitis was the most common type of ocular inflammation (28 eyes), independent of HIV status. Thirty-three of 35 patients received systemic antibiotics with 24 patients treated with intravenous (IV) penicillin only. When compared to the HIV-positive patients, HIV-negative patients with ocular syphilis were older (P < .001), were more likely to be female (P = .004), and had poorer visual acuity at presentation (P = .01). During follow-up, the incidence rates of visual impairment were 0.29 per eye-year (EY; 95% confidence interval [CI]: 0.06/EY-0.86/EY) and 0.12/EY (95% CI: 0.01/EY-0.42/EY) among the HIV-negative and the HIV-positive patients, respectively. The incidence of blindness was 0.07/EY (95% CI: 0.009/EY-0.27/EY) and 0.06/EY (95% CI: 0.002/EY-0.35/EY) among the HIV-negative and the HIV-positive patients, respectively. Longer duration of uveitis prior to diagnosis and chorioretinitis in the macula at presentation were associated with ≥ 2 Snellen lines of visual loss (P < .01) and visual acuity loss to 20/50 or worse (P = .03) in HIV-negative patients, respectively.
  
  
  CONCLUSIONS
  Syphilis is an uncommon cause of ocular inflammation in both HIV-negative and HIV-positive patients. Visual loss and ocular complications were common among HIV-negative patients even with systemic antibiotic treatment. Delay of diagnosis and chorioretinitis in the macula were associated with visual loss in these patients.
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: amoradi1@jhmi.edu.
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Moradi
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sherveen
authors.initials: S
authors.lastname: Salek
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sapna
authors.initials: S
authors.lastname: Gangaputra
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Trucian A
authors.initials: TA
authors.lastname: Ostheimer
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bryn M
authors.initials: BM
authors.lastname: Burkholder
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Theresa G
authors.initials: TG
authors.lastname: Leung
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Butler
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: James P
authors.initials: JP
authors.lastname: Dunn
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015864:Panuveitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D012189:Retrospective Studies; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine