• Written By: J. Fernando Arevalo, MD, FACS

    This review of syphilitic uveitis cases seen over a 12-year period in northern Spain found that patients were usually middle-aged men and frequently HIV-positive. Although most patients showed posterior segment involvement, visual prognosis was good.

    These findings are similar to published series from other geographic areas in terms of demographic and clinical characteristics.

    An increase in the incidence of syphilis has been observed in recent years. It is thought that risky sexual behaviors among men who have sex with men may be related to greater disease transmission rates. Some reports have suggested that syphilis-associated uveitis (SAU) may have been more frequently diagnosed in recent years due to this ‘‘new epidemic’’ of syphilis.

    The current study’s researchers reviewed clinical records from eight general uveitis referral centers in northern Spain.

    Between January 2000 and September 2012, 50 patients were diagnosed with SAU, 31 of whom were men. The median age of all patients was 41 years. A total of 34% were co-infected with HIV and 24% presented systemic manifestations of syphilis. Median initial visual acuity and vision at last visit in 93 affected eyes was 20/50 (20/20 to 20/2000) and 20/22 (20/20 to 20/2000), respectively.

    The most frequent manifestation was papillitis (33.3%). Fifty percent of eyes with macular edema on admission showed worsening visual acuity at the last visit, compared to 7.1% in eyes without edema .

    They conclude that despite this study’s limitations–which include its retrospective nature, univariate analysis, and potential referral bias–the data may contribute to better awareness, recognition, understanding and management of patients with intraocular inflammation secondary to syphilis.

    Question: Syphilis-associated uveitis may have which of the following characteristics?

    a. Anterior uveitis, vitritis, retinal vasculitis, retinochoroiditis

    b. Co-infection with HIV

    c. Macular edema, serous retinal detachment and papillitis

    d. Good prognosis

    e. All of the above

    Answer: e