Clinical Features and Prognostic Outcomes in Ocular Syphilis with HIV Co-Infection
Overview
This study evaluated 31 patients with ocular syphilis and HIV co-infection, focusing on ocular manifestations and visual prognosis. Significant improvement in visual acuity was observed after standard anti-syphilitic treatment, with optic neuritis cases showing the poorest baseline and final vision.
Background
Syphilis, known as the 'great imitator,' can affect multiple organs including the eyes, presenting with diverse manifestations such as uveitis and optic retinitis. The incidence of ocular syphilis has risen alongside syphilis cases since 2014, often co-existing with HIV due to shared transmission routes. Ocular syphilis diagnosis and prognosis are challenging due to variable clinical presentations. This study investigates ocular subtypes and visual outcomes in patients co-infected with HIV.
All eyes had posterior segment involvement; mild anterior uveitis was present in 11 eyes, with no episcleritis or scleritis observed.
Significant improvement in mean LogMAR BCVA was noted after treatment (from 1.08 to 0.86, P=0.000).
Four ocular manifestation subgroups were identified: acute syphilitic posterior placoid chorioretinitis, confluent syphilitic retinochoroiditis, retinal vasculitis, and optic neuritis.
Eyes with optic neuritis had the worst baseline and final visual acuity compared to other subgroups (P<0.05).
Vitreous opacity was present in 88.1% of eyes, with no significant difference among subgroups.
Macular involvement was found in 69.0% of eyes but was significantly less frequent in eyes with optic neuritis (P<0.05).
Clinical Implications
Clinicians should be aware that ocular syphilis in HIV co-infected patients predominantly affects the posterior segment and presents with varied manifestations impacting prognosis. Early diagnosis and prompt standard anti-syphilitic treatment can improve visual outcomes, although optic neuritis cases may have poorer prognosis. Monitoring for vitreous opacity and macular involvement is important for comprehensive management.
Conclusion
Ocular syphilis in HIV co-infected patients presents with diverse posterior segment manifestations and generally shows visual improvement after treatment. Optic neuritis is associated with worse visual prognosis, highlighting the need for tailored clinical attention.
References
Pichi F et al. -- Classification of ocular syphilis manifestations
Beijing You’an Hospital Study (2022-2025) -- Clinical features and outcomes of ocular syphilis with HIV
The movement of immune cells through the retinal vasculature has long been inferred from laboratory models. Now, advances in imaging are allowing clinicians to observe these processes directly. At the 2026 meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Denver, Richard B. Rosen, MD, ScD(hon), FACS, FASRS, FARVO, described early clinical work using adaptive optics scanning laser ophthalmoscopy (AOSLO) to visualize leukocyte trafficking in vivo.
