Acquired ocular syphilis: diagnosis and treatment

TitleAcquired ocular syphilis: diagnosis and treatment
Publication TypeJournal Article
Year of Publication1992
AuthorsDeschenes J, Seamone CD, Baines MG
JournalAnn Ophthalmol
Pagination134 - 8
Date PublishedApr
ISSN0003-4886 (Print) 0003-4886 (Linking)
Accession Number1590633
KeywordsAdult, Aged, Eye Infections, Bacterial / cerebrospinal fluid / *diagnosis / drug therapy, Female, HIV Infections / diagnosis, HIV Seropositivity / diagnosis, Humans, Injections, Intramuscular, Injections, Intravenous, Male, Middle Aged, Penicillin G / *therapeutic use, Penicillin G Benzathine / *therapeutic use, Syphilis / cerebrospinal fluid / *diagnosis / drug therapy, Syphilis Serodiagnosis, Treatment Outcome

We present our findings in 14 patients with a serologically verified diagnosis of ocular syphilis. Although most patients had iridocyclitis, other ocular findings included episcleritis, scleritis, vitritis, retinitis, papillitis, panuveitis, cystoid macular edema, and retinal detachment. Most patients had only ocular manifestations of syphilis with no other definitive symptoms. Without the use of specific treponemal serologic tests, the diagnosis of ocular syphilis would have been missed in at least 20% of patients. Furthermore, 80% of patients were negative for antibody to syphilis in the cerebrospinal fluid, and therefore, this test should not be used to determine treatment for ocular syphilis. Currently, the most effective therapy for ocular syphilis is the same as that for neurosyphilis (i.e., high-dose intravenous penicillin G 12 to 24 million units/day for ten to 14 days). Human immunodeficiency virus-positive patients should receive a full 14 days of high-dose intravenous penicillin G plus intramuscular benzathine penicillin 2.4 million units weekly for three weeks because their immune defenses are likely to be impaired.

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