Syphilitic uveitis and optic neuritis in Sydney, Australia Luke C Northey, Simon E Skalicky, Avinash Gurbaxani, Peter J McCluskey ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bjophthalmol-2014-306168) Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, The University of Sydney, Sydney, Australia Correspondence to Professor Peter J McCluskey, Save Sight Institute, G.P.O. Box 4337, Sydney, NSW 2001, Australia; peter.mccluskey@sydney.edu.au Received 20 September 2014 Revised 12 January 2015 Accepted 4 March 2015 To cite: Northey LC, Skalicky SE, Gurbaxani A, et al. Br J Ophthalmol Published Online First: [ please include Day Month Year] doi:10.1136/ bjophthalmol-2014-306168 ABSTRACT Aims To describe ocular syphilis presentations to a tertiary referral eye hospital over a 5-year period and to document HIV coinfection frequency. Methods A retrospective chart review was conducted of consecutive ocular syphilis presentations to Sydney Eye Hospital from 2007 to 2012. Inclusion criteria were positive syphilis serology, ocular inflammation on clinical examination and appropriate syphilis treatment. Outcome measures were clinical features at presentation and best- corrected visual acuity (BCVA) at interval follow-up. Results Thirty-seven eyes of 25 patients were included in the series. Patients were predominantly male (92.0%, p<0.05) with mean age 43.7±14.0 years. Eight (32.0%) patients had confirmed HIV coinfection, three newly diagnosed with HIV. Twelve (32.4%) eyes demonstrated anterior segment involvement with anterior uveitis. Twenty-five (67.6%) eyes demonstrated posterior segment involvement, including panuveitis, acute syphilitic posterior placoid chorioretinitis, retinitis, necrotising retinitis, punctate retinitis and optic neuritis. There was a significant improvement in BCVA for involved eyes (p<0.05) at 1 month and 2–3 months follow-up. Conclusions The clinical findings of 37 eyes with ocular syphilis demonstrated a broad spectrum of clinical manifestations. Rates of HIV coinfection were high, with patients exhibiting both anterior and posterior segment inflammation. Visual outcome improved following syphilis treatment. INTRODUCTION Ocular syphilis is caused by infection with the Gram-negative spirochaete treponema pallidum. Its onset is often insidious, with reports of ocular involvement during all stages of syphilis. 1 2 The time course between initial infection and ocular presentation is variable. The clinical presentation of ocular syphilis is similarly broad, with involvement of any structure of the eye. 3 The complication of syphilitic uveitis, if untreated, has the potential to cause significant visual impairment. In addition, there is the need to exclude neurosyphilis in patients with ocular syphilis. The impact and clin- ical manifestations of ocular syphilis have been reported previously through numerous case reports and small case series. 24–6 There remains a need for ongoing reports of the clinical presentation, ocular signs and outcomes of syphilitic eye disease. Coinfection with HIV in patients with ocular syphilis is an important consideration. In parallel with the development of highly active antiretroviral therapy (HAART) and an increase in the number of HIV diagnoses, there has been a resurgence in reported syphilis cases throughout the world. 7 Data from the National Notifiable Diseases Surveillance System (NNDSS) report incidence rates in 2012 for Australia to be 6.9 cases per 100 000 population for syphilis of <2 years duration. 8 Men who have sex with men (MSM) have been identified to be at greater risk of primary syphilis infection. 9 In addition, a significant association has been found between recent or past syphilis infec- tion and HIV seroconversion. 10 HIV coinfection rates among this population have been reported to reach 27%. 11 This remains an important consider- ation within Sydney, Australia, due to its large MSM population. The purpose of this study was to describe ocular syphilis presentations to a tertiary referral eye hospital and to document frequency of HIV coinfection. MATERIALS AND METHODS Patient population A retrospective chart review was conducted of con- secutive presentations to Sydney Eye Hospital of ocular syphilis from January 2007 to November 2012. The Sydney Eye Hospital is a uveitis tertiary referral centre located within central Sydney. It is colocated with Sydney Hospital and the Sydney Sexual Health Clinic. A structured query language test was used within the South Eastern Area Laboratory Services’ database to identify all reactive cases of Treponema pallidum antibodies, Treponema pallidum particle agglutin- ation test and fluorescent treponemal antibody- absorption test at the Sydney Eye Hospital, Sydney Hospital and Sydney Sexual Health Clinic from January 2007 to November 2012. A database was subsequently created to identify all patients with positive syphilis serology who pre- sented to Sydney Eye Hospital over this period. This database consisted of all patients presenting to Sydney Eye Hospital where a diagnosis of syphilis was considered in the diagnostic workup and rele- vant serological investigation conducted. Medical records were subsequently reviewed of all patients testing positive for syphilis serology. Inclusion criteria were positive syphilis serology with evidence of ocular inflammation on clinical examination, in addition to systemic syphilis treat- ment. Syphilis serology was deemed positive if initial treponemal investigation was reactive in add- ition to either a positive non-treponemal investiga- tion or positive second treponemal investigation. Patients were excluded if there was insufficient clin- ical detail on systemic syphilis management. All patients underwent detailed ophthalmic history and examination at the time of presenta- tion. Investigations were directed by clinical Northey LC, et al. Br J Ophthalmol 2015;0:1–5. doi:10.1136/bjophthalmol-2014-306168 1 Clinical science BJO Online First, published on March 18, 2015 as 10.1136/bjophthalmol-2014-306168 Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on November 16, 2016 - Published by http://bjo.bmj.com/ Downloaded from