Background Syphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.
Methods 103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.
Results Members managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10–14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.
Conclusion This comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.
- eye, syphilis, uveitis
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GFO and RMS are joint first authors.
GFO and RMS contributed equally.
International Ocular Syphilis Study Group Members Massimo Accorinti, MD, PhD (Italy); Alfredo Adan, MD, PhD (Spain); Aniruddha Agarwal, MD (India); Rowayda Alieldin, MD,PhD (Egypt); Pia Allegri, MD (Italy); Carlos Alvarez, MD (Mexico); Sofia Androudi, MD,PhD (Greece); J. Fernando Arevalo, MD, FACS (USA); Marie-Josee Aubin, MD, MPH, MSc(Canada); Kalpana Babu, MBBS, DOMS, FMRF, MRCOphth (India); Talin Barisani-Asenbauer, MD (Austria); Zuly Barron, MD (Peru); Soumyava Basu, MD (India);Jyotirmay Biswas, MS, FAICO, FIC Path, FAMS (India); Bahram Bodaghi, MD, PhD, FEBO(France); Marcelo Bursztyn, MD (Argentina); Maria Jose Capella, MD (Spain); Laure Caspers, MD (Belgium); Soon-Phaik Chee, FRCOphth, FRCS(G), FRCS(Ed), MMed (Singapore);Luca Cimino, MD (Italy); Daniel Colombero, MD (Argentina); Luz Elena Concha del Rio, MD (Mexico); Andre L.L. Curi, MD, PhD (Brazil); Mark Dacey, MD (USA); Dipankar Das, MBBS, MS (India); Janet Davis, MD (USA); Lukman Edwar, MD (Indonesia); Marie-Helene Errera, MD (France); Luciana Peixoto Finamor, MD (Brazil); Alex Fonollosa, MD, PhD(Spain); Eric Fortin, MD (Canada); Samantha Fraser Bell, FRANZCO, MPH, MHA, PhD(Australia); Marion Funk, MD (Austria); Jose Luis Garcia Serrano, MD (Spain); Justus Garweg, MD(Switzerland); Manuel Garza-Leon, MD (Mexico); Amala George, MBBS, DNB(India); Debra Goldstein, MD (USA); Hiroshi Goto, MD, PhD (Japan); Chloe Gottlieb,MD, FRCSC (Canada); Marta Guedes, MD (Portugal); Yan Guex-Crosier, MD, FEBO(Switzerland); Avinash Gurbaxani, MBBS, DOMS, FRCS (UAE); Christopher Henry, MD(USA); Claire Hooper, FRANZCO (Australia); Tanja Hovland, MD (Norway); Yih-ShiouHwang, MD, PhD (Taiwan); Alessandro Invernizzi, MD (Italy); Hazlita Isa, MBChB, MSurg(Ophthal) (Malaysia); Margarita Jodar-Marquez, MD (Spain); Kashyap Kansupada, MD,FACS (USA); Ankush Kawali, MD, DNB, FICO (India); John H. Kempen, MD,MPH, MHS, PhD (USA and Ethiopia); Moncef Khairallah, MD (Tunisia); Susanne Krag, MD (Denmark); Robert Kuijpers, MD, PhD (The Netherlands); Jenny Laithwaite, FCOphth (SouthAfrica); Shelly T. Lee, MD (USA); Pierre Lefebvre, MD, FEBO (Belgium); Phuc Le Hoang, MD,PhD (France); Ann-Marie Lobo, MD (USA); Padmamalini Mahendradas, MBBS, DO,DNB (India); Peter McCluskey, FRANZCO, MD (Australia); Ilhem Mili-Boussen,MD (Tunisia); Manabu Mochizuki, MD, PhD (Japan); Marilita Moschos, MD, PhD(Greece); Heloisa Nascimento, MD (Brazil); John Nguyen, MD (USA); Quan Dong Nguyen, MD, MSc,FAAO (USA); Ghazala O'Keefe, MD (USA); Shelina Oli Mohamed, MD, MS (Malaysia);Pinar Ozdal, MD (Turkey); Maria Ines Menendez Padron, MD (Argentina); AlanPalestine, MD (USA); Maria Pia Paroli, MD (Italy); Carlos Pavesio, MD, MS, PhD (UK);Francesco Pichi, MD (UAE); Uwe Pleyer, MD, FEBO (Germany); Joanna Przezdziecka-Dolyk, MD, PhD (Poland); Narsing Rao, MD (USA); Sivakumar Rathinam, MBBS, DO, MD,MNAMS, PhD, FAMS (India); Miguel Ribeiro, MD (Portugal); Mili Roy, MD (Canada);Pablo Sabat O., MD (Chile); Harpal S. Sandhu, MD FRCSC (USA); Wantanee Sittivarakul, MD(Thailand); Justine Smith, FRANZCO, PhD (Australia); Wendy Smith, MD (USA); Thanapong Somkijrungroj, MD (Thailand); Arjun Sood, MD (USA); Ana Suelves, MD, PhD, FEBO (USA); Mei-Ling Tay-Kearney, FRANZCO (Australia); Barbara Teuchner, MD (Austria); JenniferThorne, MD, PhD (USA); Peter Trittibach, MD, FEBO (Switzerland); IlknurTugal-Tutkun, MD (Turkey); Jose Antonio Unzueta-Medina, MD (Mexico); Emiliana Dos Santos Valadares, MD (Brazil); Luc Van Os, MD (Belgium); JaneWells, FRANZCO (Australia); Bety Yanez Alvarez, MD (Peru); Stephanie Young, FRANZCO, FRACS (Australia);Manfred Zierhut, MD, PhD (Tuebingen, Germany).
Contributors GFO, JMF, TEA, PJM and JRS designed survey. GFO administered survey. RMS, JMM and JRS collated survey responses and drafted manuscript. GFO, JMF, TEA and PJM reviewed and edited draft. All authors approved submission.
Funding This work was supported in part by grants from the Australian Research Council (FT130101648, Dr. Smith) and the Foundation for Support of Teaching, Research & Assistance of the Clinical Hospital, Faculty of Medicine of Ribeirão Preto - University of São Paulo (1901/2017, Dr. Furtado).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.