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Wu LZ, Orlowski TM, Karunatilake M, Lee S, Mondal P, Kogilwaimath S, Bursztyn LLCD. Prognostic effect of HIV on visual acuity in ocular syphilis: a systematic review. Eye (Lond) 2023; 37:3271-3281. [PMID: 36944709 PMCID: PMC10564912 DOI: 10.1038/s41433-023-02504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND/OBJECTIVES Ocular syphilis is a vision-threatening disease that can lead to permanent blindness if left untreated. The global re-emergence of syphilis warrants greater investigations into the visual prognosis of eyes affected by this potentially devastating disease. This systematic review investigates the impact of HIV on visual acuity (VA) outcomes in ocular syphilis. METHODS A literature search of Medline, PubMed, Embase, Clinicaltrials.gov and Cochrane Reviews was conducted for studies published between 01 January 2011 and 19 March 2022, reporting non-aggregate initial and post-treatment VA data of eyes with ocular syphilis and corresponding HIV status in patients ≥ 18 years. RESULTS A total of 95 studies, including 364 patients and 568 eyes, were evaluated. Among people living with HIV with a diagnosis of ocular syphilis, affected eyes were more likely to have optic nerve involvement and panuveitis. However, HIV status, CD4 cell count, and HIV viral load were not predictive of VA outcomes of treated ocular syphilis. Prognostic factors of final VA worse than 1.00 logMAR were female sex, the presence of macular edema, and VA ≥ 1.00 at presentation. The strongest predictor of a worse final VA was VA ≥ 1.00 at presentation. CONCLUSIONS This systematic review demonstrates that HIV status, CD4 cell count, and HIV viral load are not significant factors impacting VA outcomes of eyes with ocular syphilis. While visual prognosis is generally good, poor visual outcome is most strongly predicted by poor VA at presentation. This underscores the importance of early recognition and treatment prior to permanent vision loss.
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Affiliation(s)
- Laura Z Wu
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Malshi Karunatilake
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephen Lee
- Division of Infectious Diseases, University of Saskatchewan, Regina, SK, Canada
| | - Prosanta Mondal
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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Chauhan K, Fonollosa A, Giralt L, Artaraz J, Randerson EL, Goldstein DA, Furtado JM, Smith JR, Sudharshan S, Ahmed AS, Nair N, Joseph J, Pavesio C, Westcott M, Trepatchayakorn S, Sallam AB, Elhusseiny AM, Tyagi M. Demystifying Ocular Syphilis - A Major Review. Ocul Immunol Inflamm 2023; 31:1425-1439. [PMID: 37307579 DOI: 10.1080/09273948.2023.2217246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
Syphilis, caused by the spirochaete, Treponema pallidum, continues to be a public health challenge globally with its rates steadily increasing in the past few years. The disease is transmitted through small breaks in the skin during sexual contact, or via congenital transmission in utero, either across the placenta or by contact with an active genital lesion during delivery. Estimated 5.7-6 million new cases are detected every year worldwide in the 15-49 years age group. An increased incidence has been reported in most populations with particular clusters in special groups like men who have sex with men, female sex workers, and their male clients. Ocular syphilis has a varied presentation and is considered a great mimicker in all cases of uveitis. The laboratory diagnosis of syphilis is predominantly based on serological tests including TPHA and VDRL. Parenteral penicillin is the cornerstone of treatment for all stages of ocular syphilis.
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Affiliation(s)
- Khushboo Chauhan
- Uveitis and Ocular Immunology Services, L V Prasad Eye Institute, Hyderabad, India
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - Lena Giralt
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Joseba Artaraz
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | - Debra A Goldstein
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, São Paulo, Brazil
| | - Justine R Smith
- Division of Ophthalmology, Ribeirão Preto Medical School, São Paulo, Brazil
- Flinders University College of Medicine & Public Health, Adelaide, Australia
| | - Sridharan Sudharshan
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Arshee S Ahmed
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Nivedita Nair
- Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India
| | | | | | | | - Ahmed B Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mudit Tyagi
- Uveitis and Ocular Immunology Services, L V Prasad Eye Institute, Hyderabad, India
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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3
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Mehta N, Bhari N, Gupta S. Asian guidelines for syphilis. J Infect Chemother 2022; 28:1084-1091. [PMID: 35527175 DOI: 10.1016/j.jiac.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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4
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Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, Gordon DL, Smith JR. Ocular syphilis. Surv Ophthalmol 2021; 67:440-462. [PMID: 34147542 DOI: 10.1016/j.survophthal.2021.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
Multiple studies around the world suggest that syphilis is re-emerging. Ocular syphilis - with a wide range of presentations, most of which are subtypes of uveitis - has become an increasingly common cause of ocular inflammation over the past 20 years. Its rising incidence, diagnostic complexity, and manifestations that have only recently been characterized make ocular syphilis relevant from the public health, clinical, and scientific perspectives. We review the demographics, epidemiology, clinical features, ocular imaging findings, diagnosis, and medical management of this condition.
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Affiliation(s)
- João M Furtado
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Milena Simões
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Daniel Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Genevieve F Oliver
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Mudit Tyagi
- Ocular Inflammation and Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Heloisa Nascimento
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia-IPEPO, São Paulo, Brazil
| | - David L Gordon
- Flinders University College of Medicine and Public Health, Adelaide, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, South Australia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
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5
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Concurrent Primary Chancre and Ocular Syphilis in an Human Immunodeficiency Virus-Negative Man. Sex Transm Dis 2019; 45:e109-e112. [PMID: 30044340 DOI: 10.1097/olq.0000000000000900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We believe this to be the first report of coexisting polymerase chain reaction (PCR)-confirmed primary genital and ocular syphilis in a patient with penicillin allergy treated with doxycycline. The case examines the use of nonpenicillin and corticosteroid treatment of ocular syphilis and highlights the risk of eye involvement early in the disease process.
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Watts PJ, Greenberg HL, Khachemoune A. Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations. Int J Dermatol 2016; 55:714-28. [PMID: 26756536 DOI: 10.1111/ijd.13206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/06/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
Syphilis is an ancient disease that has re-emerged in the last decade. It is prevalent among men who have sex with men and has increased in incidence with certain ethnic groups. It usually presents as primary or secondary syphilis and can progress to tertiary syphilis if not treated. Primary syphilis will classically manifest as a single, painless ulcer with smooth, clean, and raised borders on the genitals or less often on the oral mucosa. Unusual primary syphilis cases have been reported and can be easily misdiagnosed with a resulting delay of treatment. Secondary syphilis is a systemic disease, wherein the treponemes have disseminated to various organ systems, typically presenting with characteristic mucocutaneous lesions. Tertiary syphilis has a higher rate of morbidity and mortality; as such, the aim of this article is to provide the readers with tools to recognize early syphilis and prevent its progression to late stages. In this review, we present a likely case of unusual primary syphilis mimicking herpes progenitalis as well as a compilation of all atypical cases of primary syphilis from 1973 to 2015. We will also review the differential diagnosis, management, and recommendations for each stage of syphilis.
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Affiliation(s)
- Paula J Watts
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center Brooklyn and SUNY Downstate, Brooklyn, NY, USA
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Warner EJ, Chen Y. Reversal of Severe Visual Loss from Syphilitic Chorioretinitis Following Penicillin Treatment. Neuroophthalmology 2015; 39:263-265. [PMID: 27928366 DOI: 10.3109/01658107.2015.1077389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/25/2015] [Indexed: 11/13/2022] Open
Abstract
A 51-year-old Caucasian male was referred to neuro-ophthalmology clinic for an evaluation of acute onset of painless visual loss in the left eye. The ocular examination revealed subtle retinal changes suspicious for chorioretinitis. Laboratory workup revealed a reactive Treponema pallidum particle agglutination assay (TP-PA), confirming the diagnosis of ocular syphilis. The patient was treated with intravenous infusion of penicillin with complete recovery of vision and resolution of retinal abnormalities.
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Affiliation(s)
- Evan J Warner
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison , Madison, Wisconsin, USA
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