Syphilitic Uveitis Is a Growing Concern in the United States

While syphilitic uveitis is generally rare, it has been increasing in the United States (US) in recent years.

Study Design

This was a retrospective cross-sectional study of 2010–2019 data from the Nationwide Inpatient Sample of all US inpatient admissions where there was a diagnosis of syphilitic uveitis. A total of 5581 hospitalizations for syphilitic uveitis were identified.

Outcomes

Men comprised 79% of patients with syphilitic uveitis–related hospitalizations. Thirty-two percent of patients were African American, a disproportionate number relative to the US population. There was an increasing trend of hospitalizations over the decade, with the lowest incidence occurring in 2011 (0.08 per 100,000 population) and the highest incidence occurring in 2019 (0.23 hospitalizations per 100,000 population). This increase affected all 4 geographic regions of the US. Nearly 25% of patients had comorbid AIDS.

Limitations

Although the study had a large sample size, due to the switch from the ICD-9 to ICD-10 coding system during the study period there was the potential for misdiagnosis and miscoding of syphilitic uveitis. Investigators did not assess whether patients received inpatient treatment with intravenous (IV) penicillin G during their hospitalization or as an outpatient course, nor did they identify which patients had anterior uveitis and which had posterior uveitis. Worse outcomes are associated with syphilitic uveitis with posterior involvement.

Clinical Significance

Clinicians in the US should continue to be aware of the rising incidence of syphilitic uveitis when formulating a differential diagnosis and treatment plan for patients with intraocular inflammation. The increasing cost of hospitalization and treatment for syphilitic uveitis, as well as a recent nationwide shortage of IV penicillin G, add additional complications.

Financial Disclosures: Dr. Sherveen Salek discloses no financial relationships.