Authors: Zainab Khan, Julie Vadboncoeur, Yasmine Rabia, Bouchra Serhir, Annie-Claude Labbé, Claude Fortin, Kinda Najem, Laurence Jaworski, Marie-Josée Aubin
Author Disclosure Block: Z. Khan: None. J. Vadboncoeur: None. Y. Rabia: None. B. Serhir: None. A. Labbé: None. C. Fortin: None. K. Najem: None. L. Jaworski: None. M. Aubin: Grant/research support; Name of Commercial Company(s); AbbVie. Employment/honoraria/consulting fees; Name of Commercial Company(s); Gilead. Membership on an advisory panel, standing committee or board of directors; Name of Commercial Company(s); AbbVie.

Abstract Body:

Purpose: In recent years, the rates of syphilis are globally on the rise. Syphilis is one of the most prevalent infections in patients with HIV. The purpose of this study was to describe the demographics, ocular clinical presentations, management and visual outcomes of patients with ocular syphilis who are co-infected with HIV.

Study Design: Retrospective, descriptive and non-comparative observational study.

Methods: All patients with positive syphilis serology (including at least one positive treponemal test result) and co-infection with HIV were included in this study. Patients were recruited from two tertiary eye-care centers in Montreal, Quebec (Hôpital Maisonneuve-Rosemont and CHUM-Notre-Dame) between 2000 and 2015. Ophthalmic manifestations, demographics, management and outcomes were analyzed.

Results: 37 patients were included in this study. All patients had at least one positive treponemal serology test. 10 (27%) had a known diagnosis of HIV at the time of presentation. The remainder were found to be positive upon serology testing in our clinic. The mean age at presentation was 43 years. All patients (100%) were male. 24 (65%) were men who were sexually active with men, 2 (5%) were heterosexual, 1 (3%) was bisexual and the sexual orientation of 10 (27%) was unknown. Of the 37 patients, hepatitis C status was positive in 3 (8%), negative in 26 (70%) and unknown in 8 (22%). All patients were assessed by an infectious disease team. The mean presenting best-corrected visual acuity was 20/50. Ocular presentations included the following: 11 (30%) with anterior segment disease including isolated anterior uveitis (24%) and anterior uveitis combined with intermediate uveitis (6%); 24 (65%) with posterior segment disease including isolated intermediate uveitis (11%), posterior uveitis (22%) and panuveitis (32%); 16 (43%) with neuro-ophthalmic manifestations including 14 (38%) with optic neuropathies and 2 (5%) with cranial neuropathies; and 4 (11%) with other ocular diseases including scleritis and macular edema. Lumbar puncture was performed in 31 patients (84%) and it was abnormal in 27 of these patients (87%). It yielded a positive Veneral Disease Research Laboratory (VDRL) value in 7 patients (23%). 22 (71%) had an elevated white blood cell count and 23 (74%) had elevated protein concentrations. 33 of the 37 patients (89%) were treated. 29 (78%) patients received intravenous penicillin (as monotherapy or in combination with intramuscular), 3 (8%) received intramuscular penicillin and 1 (3%) received other antibiotics (ceftriaxone, azithromycin or doxycycline). The treatment status of 4 (11%) patients was undetermined because 3 (8%) were lost to follow-up and the treatment dosages for 1 (3%) was unclear upon chart review. Mean final best-corrected visual acuity was 20/30. The duration of follow-up was 12.6 months.

Conclusions: All patients presenting with ocular syphilis should be screened for HIV. Given the high rates of cerebrospinal fluid abnormalities, all ocular syphilis patients should be screened by a lumbar puncture regardless of HIV status. Visual outcomes are good when treated with intravenous penicillin as neurosyphilis.