Syphilis is reemerging globally, particularly in association with HIV coinfection. The clinical presentations of ocular syphilis include scleritis; anterior, intermediate or posterior uveitis; and even optic neuritis. Patients may also experience mucocutaneous and CNS symptoms A classic manifestation of syphilis in patients with AIDS is unilateral or bilateral, pale-yellow, placoid retinal lesions that preferentially involve the macula (syphilitic posterior placoid chorioretinitis). Patients with AIDS may also present with discrete creamy yellow superficial retinal precipitates overlying areas of syphilitic retinitis as a very suggestive finding, although they can occur regardless of HIV status. In patients with AIDS, vitritis without chorioretinitis can be the first manifestation of syphilis. For discussion of other manifestations, refer to Chapter 10.
The course of syphilis may be more aggressive in HIV-infected patients. These patients require treatment with 18–24 million units of intravenous penicillin G administered daily for 10–14 days, followed by 2.4 million units of intramuscular benzathine penicillin G administered weekly for 3 weeks. Monitoring of results from the quantitative rapid plasma reagin (RPR) test is recommended, as symptomatic disease can recur.
Browning DJ. Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. Ophthalmology. 2000;107(11):2015–2023.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.