Fifty one percent of ocular syphilis cases reported in 2014-2015 were HIV positive, according to a Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) Friday.

This funduscopic image reveals the effects of late neuro-ocular syphilis on the optic disk and retina/CDC
This funduscopic image reveals the effects of late neuro-ocular syphilis on the optic disk and retina/CDC

Although syphilis is nationally notifiable, ocular manifestations are not reportable to CDC. Because  of concerns about an increase in ocular syphilis, the CDC issued an advisory in Apr 2015 and eight jurisdictions (California, excluding Los Angeles and San Francisco, Florida, Indiana, Maryland, New York City, North Carolina, Texas, and Washington) reviewed syphilis surveillance and case investigation data from 2014, 2015, or both to ascertain syphilis cases with ocular manifestations.

A total of 388 suspected ocular syphilis cases were identified, 157 in 2014 and 231 in 2015.

Most patients with suspected ocular syphilis were male (93%), and 249 (69%) of those with information on sex partners were men who have sex with men (MSM).

Approximately one half of the cases met surveillance criteria for early syphilis (primary, secondary, and early latent syphilis).

Specific symptoms were reported by 326 (84%) persons suspected of having ocular syphilis; 54% of patients reported blurry vision, and 28% of patients reported at least some vision loss. Specific ocular diagnoses were available for 158 (41%) patients, and uveitis (n = 72) was the most common diagnosis.

More serious diagnoses were also recorded, including retinitis (n = 20), optic neuritis (n = 18), and retinal detachment (n = 6). Of 136 (35%) patients with available information on which eye was affected, one eye was involved in 64 (47%) patients, and both eyes were affected in 72 (53%) patients.

One half of patients with suspected ocular syphilis were HIV-positive (n = 198). Of those persons, 62 (32%) were first diagnosed with HIV at the time of their ocular syphilis diagnosis.

Public health interventions aimed at both providers and persons at risk are necessary to prevent ocular syphilis, and to ensure prompt diagnosis and treatment. All patients diagnosed with syphilis that exhibit ocular manifestations, such as eye pain, blurry vision, or vision loss, should immediately be treated for neurosyphilis, and be referred for expert ophthalmologic examination. Severe outcomes, including blindness, occur in both HIV-positive and HIV-negative patients.