The clinical presentations of ocular syphilitic chorioretinitis include uveitis, optic neuritis, and nonnecrotizing retinitis. Patients may also experience dermatologic 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). Exudative retinal detachment can also be seen. Some HIV-positive patients with syphilis may present with dense vitritis without clinical evidence of chorioretinitis. In these patients, vitritis can be the first manifestation of syphilis. (See also Chapter 7.)
The course of syphilis may be more aggressive in patients with AIDS. 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 the quantitative rapid plasma reagin (RPR) test is recommended, as symptomatic disease can recur.
. 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.2000;107(11):2015–2023.