Neuro-ophthalmologic manifestations of syphilis in a Canadian cohort of patients
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Author Disclosure Block: Z. Khan: None. J. Vadboncoeur: None. Y. Rabia: None. B. Serhir: None. C. Fortin: None. A. Labbé: 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: Rates of syphilis are increasing both globally and in Canada. This is accompanied with an increase in ocular syphilia. The purpose of this study was to describe the neuro-ophthalmic clinical presentations found in a cohort of patients diagnosed with ocular syphilis.
Study Design: Retrospective, descriptive and non-comparative observational study.
Methods: All patients with positive syphilis serology (including at least one positive treponemic serology test result) from two tertiary eye-care centers in Montreal, Quebec (Hôpital Maisonneuve-Rosemont and CHUM-Notre-Dame) between 2000 and 2015 were included in this study. Patient demographics and clinical presentations were analyzed. A concurrent review of the existing literature on syphilitic optic neuropathy was carried out.
Results: There were 115 patients (169 eyes) with ocular syphilis. The diagnosis and treatment were done at 2 tertiary-care centers in Montreal between 2000 and 2015. The mean follow-up period was 19 months. Overall, 19% (22) had neuro-ophthalmologic involvement. The most common neuro-ophthalmic manifestation was optic neuropathy (19 patients or 86%) followed by oculomotor involvement (3 patients or 14%).
The mean age at presentation of optic neuropathy was 52 years. All 22 patients (100%) with optic neuropathy were male. HIV status was available (previously know to be positive or requested at the time of syphilis diagnosis) in 68% (13); of these, 62% (8) were co-infected with HIV. Bilateral disease was found in 53% (12). The clinical manifestations of syphilitic optic neuropathy were: 42% (9) with optic atrophy, 11% (2) with posterior optic neuritis and 47% (10) with anterior optic neuropathy or disc edema. The latter group may have represented anterior optic neuropathy, perineuritis or neuroretinitis cases (distinguishing between these is often difficult due to the overlap in subjective and objective clinical presentation). 37% (8) had concurrent anterior and/or intermediate uveitis. The mean initial vision was 20/80 in all optic neuropathy patients and final vision after follow-up and treatment was 20/40. Visual outcome was good when treated as neurosyphilis. 55% (12) were treated with IV penicillin, 18% (4) with IM pencillin, and 5% (1) with IV ceftriaxone. 9% (2) patient were lost to follow-up and it is unknown whether they completed their course of treatment.
Conclusions: Optic neuropathy is a common presentation of ocular syphilis. HIV co-infection with ocular syphilis is frequent. It is therefore important to assess for both when considering either diagnosis. With the rates of syphilis on the rise globally, it is imperative to consider this diagnosis and to treat ocular syphilis as neurosyphilis.
