Ocular syphilis: case series (2016-2023) from 2 tertiary care centres in Montreal, Canada

Theme: Uveitis
What: Uveitis
Part of: Uveitis II: Advancements in Uveitis Diagnosis and Management / Uvéite II: Avancées dans le diagnostic et la prise en charge de l’uvéite
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 B

Abstract

Purpose : To describe the demographic characteristics, clinical presentation, prevalence of co-infection with the Human Immunodeficiency Virus (HIV), and treatment of patients with ocular syphilis who were treated at the ophthalmology department of two university hospitals in Montreal, Canada, and to examine the use of oral prednisone in the treatment of patients with ocular syphilis.

Design : Retrospective case series

Methods : Review of records of  95 patients from 2016 to 2023, with a positive syphilis treponemal serology and a likely ophthalmological diagnosis associated with syphilis.

Results : Mean age of onset was 57 years, with a predominance of 82% of male subjects. The average visual acuity was 0.22 [0.04, 0.70] logMAR (approx. 20/40) at the initial examination and 0.10 [0.00, 0.40] logMAR (approx. 20/25) at the final examination (p<0.01). HIV serological status was known for 74% of the subjects, with an HIV infection rate of 20%. Among the ocular diagnoses, 45% of patients had anterior uveitis, 18% had intermediate uveitis, 8% had posterior uveitis, 24% had panuveitis, 14% had optic nerve involvement, and 5% had episcleritis/scleritis. Both eyes were affected in 57% of patients. A lumbar puncture was performed in 54% of subjects, among whom 18% had a positive result in cerebrospinal fluid examination. Regarding treatment, 78% of patients were treated with the neurosyphilis antibiotic regimen, while 20% received oral prednisone.

Conclusions : Syphilis continues to be prevalent in Montreal, and it should always be considered in the differential diagnosis of ocular inflammation. In our cohort of patients treated at a tertiary care ophthalmology clinic, there was a statistically significant improvement in logMAR acuity between the first and last ophthalmology visits. It remains important to diagnose syphilis and co-infection with HIV, and to initiate treatment promptly.

 

Presenter(s)

Presenting Author: Adam Hocini

Additional Author(s):

Mélanie Hébert, Laval University

Erdit Celo, University of Montreal

Simon Trottier, University of Montreal

Laurence Jaworski, University of Montreal

Marie-Josée Aubin, Université de Montreal

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