Clinical features and incidence rates of ocular complications in patients with ocular syphilis

Am J Ophthalmol. 2015 Feb;159(2):334-43.e1. doi: 10.1016/j.ajo.2014.10.030. Epub 2014 Nov 5.


Purpose: To describe the clinical outcomes of ocular syphilis.

Design: 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Eye Infections, Bacterial / diagnosis*
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / epidemiology
  • Female
  • HIV Seropositivity
  • Humans
  • Incidence
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Panuveitis / diagnosis*
  • Panuveitis / drug therapy
  • Panuveitis / epidemiology
  • Penicillin G Benzathine / therapeutic use
  • Retrospective Studies
  • Syphilis / diagnosis*
  • Syphilis / drug therapy
  • Syphilis / epidemiology
  • Vision Disorders / epidemiology
  • Visual Acuity
  • Young Adult


  • Anti-Bacterial Agents
  • Penicillin G Benzathine