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April 1997

Syphilitic Uveitis in Human Immunodeficiency Virus—Infected Patients

Author Affiliations

From the Ocular Immunology Service, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, Md.

Arch Ophthalmol. 1997;115(4):469-473. doi:10.1001/archopht.1997.01100150471003

Objective:  To document the incidence and clinical features of syphilitic uveitis in patients coinfected with human immunodeficiency virus (HIV).

Design:  Retrospective chart review.

Setting:  Single tertiary uveitis referral center.

Patients:  The charts of HIV-infected patients with uveitis and a reactive fluorescent treponemal antibody absorption test seen between November 1983 and June 1995 were reviewed.

Results:  Syphilis was the most common bacterial cause of uveitis in this group. Thirteen patients (0.6% of the 2085 HIV-positive patients seen in the clinic during the study period) were dually infected. Twelve patients were male. Six patients (46%) had previously been treated for syphilis, 4 with intramuscular penicillin G benzathine only. Four patients (31%) had isolated anterior uveitis, 3 patients (23%) had anterior and intermediate uveitis, and 5 patients (38%) had panuveitis. One patient (8%) presented with optic nerve and retinal atrophy. Eight patients were treated with intravenous penicillin, 3 with intravenous and intramuscular penicillin, and 1 with intravenous ceftriaxone sodium. Of the 12 patients for whom follow-up examinations were available after treatment, ocular inflammation decreased in 11 (92%) and visual acuity improved in 8 (67%). Rapid plasma reagin titers decreased a median of 64-fold compared with pretreatment levels, and all patients with reactive cerebrospinal fluid who underwent pretreatment and posttreatment lumbar punctures normalized following therapy with intravenous antibiotics.

Conclusions:  Syphilis is an uncommon cause of uveitis in HIV-infected patients. Anterior uveitis is the most common ocular manifestation, but panuveitis is more common than isolated anterior uveitis. Intravenous penicillin is effective therapy.