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Manifestations and Treatment of Ocular Syphilis During an Epidemic in France

Parc, Christine E. MD*; Chahed, Sadri MD*; Patel, Sanjay V. MD; Salmon-ceron, Dominique MD

Sexually Transmitted Diseases: August 2007 - Volume 34 - Issue 8 - p 553-556
doi: 10.1097/01.olq.0000253385.49373.1a
Article

Objectives: To review cases of ocular syphilis presenting to a tertiary uveitis clinic during a syphilis epidemic in France between January 2001 and January 2004.

Study Design: Retrospective chart and patient database review.

Results: Ten patients who presented with symptoms and signs of uveitis tested positive for active syphilis. Some of the patients also presented with a rash or headache. Human immunodeficiency virus (HIV) antibody testing was positive in eight of the 10 patients, with CD4 cell counts >200 cells/mm3 in seven of the patients. Ocular inflammation resolved and visual acuity improved in all patients after treatment.

Conclusions: A diagnosis of ocular syphilis should be considered in any patient with visual loss associated with a rash or headache, irrespective of the patient's CD4 cell count. Ocular syphilis in HIV-positive patients should be treated as neurosyphilis, whereas ocular syphilis in non-HIV patients can be treated as secondary syphilis.

A diagnosis of ocular syphilis should be considered whenever a patient with a rash and/or headache presents with visual loss. The treatment of ocular syphilis differs according to the HIV status of the patient.

From the *Department of Ophthalmology, Cochin Hospital, Paris V University, Paris, France; †Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota; and ‡Department of Internal Medicine, Cochin Hospital, Paris V University, Paris, France

Correspondence: Christine Parc, Service d'Ophtalmologie, Hôpital Foch, 40 rue Worth-BP 36-92151 Suresnes Cedex-France. E-mail: c.parc@hopital-foch.org.

Received for publication June 23, 2006, and accepted November 2, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association