Exploratory Analysis of Ocular Syphilis Epidemiology in a Tertiary Center
DOI:
https://doi.org/10.48560/rspo.33225Keywords:
Eye Infections, Bacterial/diagnosis, Eye Infections, Bacterial/epidemiology, Syphilis/diagnosis, Syphilis/epidemiology, UveitisAbstract
INTRODUCTION: Syphilis incidence has been increasing and, consequently, so has ocular syphilis (OS), an uncommon cause of ocular inflammation with many disease phenotypes. We aimed to estimate the number of OS cases diagnosed in a tertiary centre in Portugal, to correlate with the increase in syphilis diagnosis and characterize the OS population.METHODS: We conducted a retrospective, observational, single-center study that included patients with OS, from 2015 to 2023 at Centro Hospitalar e Universitário de Coimbra (CHUC). Demographic data were collected and a complete ophthalmological examination was performed with multimodal imaging acquisition. Data on syphilis incidence from the European Center for Disease Prevention and Control (ECDC) and Portuguese National Healthcare Service (NHS), correlated with OS data.
RESULTS: In total, 49 patients with OS were observed. The mean age of 54.29±14.84 years, 36 (73.47%) were male and 16 (44.44%) were men who have sex with men. Considering syphilis diagnosis at our institution, the proportion of ocular syphilis in these patients per year ranged from 0% to 7.14%. Twelve patients (24.49%) were co-infected with HIV. Forty-five patients (91.84%) complained of decreased visual acuity. Ocular pain, hyperemia, photophobia, photopsias and floaters were also reported. Nineteen patients (38.78%) had systemic findings (mostly skin rash). In 33 cases (67.35%), the presentation was bilateral and 24 (48.98%) presented with anterior segment involvement. Forty-two patients (85.71%) had posterior segment involvement and the most common phenotypical presentation was posterior placoid chorioretinitis (21%-50.0%). Nineteen patients (38.78%) had optic nerve involvement. All patients were admitted and underwent 2-week treatment with endovenous penicillin. Visual acuity improved from logMAR 0.71 to logMAR 0.25 (p<0.001). Syphilis incidence gradually increased in the years considered and a peak of disease diagnoses was registered in 2022, after the COVID-19 pandemic.
CONCLUSION: Syphilis is a public health challenge. OS is a heterogeneous disease with a wide range of presentations. The incidence is on the rise and must be considered in every patient with uveitis or optic neuritis.
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