OCULAR MANIFESTATIONS OF SYPHILIS AND VISUAL OUTCOME AFTER TREATMENT: A 7-YEAR SINGLE- SITE REVIEW
Muhammad Khairuddin M.A., Daphne T.A.L., Roslin Azni A.A., Nor Fariza N. & Bastion M.L.C.
abstract
Ocular syphilis has various presentations, hence named ‘The Great Masquerader. This study aims to review the demographic, ocular manifestations, and visual outcomes of ocular syphilis. Retrospective review of patients treated for ocular syphilis in Hospital Shah Alam from 1st January 2017 till 31st December 2023. A total of 20 patients (36 eyes) were included. Mean age was 32.2 ± 8.154. Only two patients were female (10%). 15 patients (75.5%) had HIV co-infection, in which 11 (73.3%) were newly diagnosed. All cases had positive VDRL titres including 10.0% with prozone phenomenon. HIV patients had higher VDRL titres (p 0.029), Ocular manifestations include panuveitis (21 eyes, 58.3%), posterior uveitis (8 eyes, 22.2%), intermediate uveitis (5 eyes, 13.9%), and interstitial keratitis (2 eyes, 5.6%). HIV patients are more likely to present with panuveitis (p
references
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3. Moradi A, Salek S, Daniel E, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients with Ocular Syphilis. American Journal of Ophthalmology. 2015;159(2):334-343.e1. doi:10.1016/j.ajo.2014.10.030.
4. Mohd Fadzil NI, Abd Hamid A, Muhammed J, Hashim H. Ocular Syphilis: Our Experience in Selayang Hospital, Malaysia. Cureus. 14(7):e26655. doi:10.7759/cureus.26655.
5. Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The Laboratory Diagnosis of Syphilis. Journal of Clinical Microbiology. 2021;59(10):10.1128/jcm.00100-21. doi:10.1128/jcm.00100-21.
6. Papp JR. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep. 2024;73. doi:10.15585/mmwr.rr7301a1.
7. Centers for Disease Control and Prevention. Neurosyphilis, Ocular Syphilis, and Otosyphilis - STI Treatment Guidelines. Published July 22, 2021. Accessed September 11, 2024. https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm.
8. Fathilah J, Choo MM. The Jarisch-Herxheimer reaction in ocular syphilis. Med J Malaysia. 2003;58(3):437-439.
9. Sharma M, Rewari BB, Aditama TY, Turlapati P, Dallabetta G, Steen R. Control of sexually transmitted infections and global elimination targets, South-East Asia Region. Bull World Health Organ. 2021;99(4):304-311. doi:10.2471/BLT.20.254003.
10. World Health Organization. Syphilis. Accessed September 10, 2024. https://www.who.int/news-room/fact-sheets/detail/syphilis.
11. CodeBlue. Youths Below 21 Comprised 22% Of Gonorrhoea Cases In 2022 In Malaysia. Published June 30, 2023. Accessed September 10, 2024. https://codeblue.galencentre.org/2023/06/30/youths-below-21-comprised-22-of-gonorrhoea-cases-in-2022-in-malaysia/.
12. Gu X, Gao Y, Yan Y, et al. The importance of proper and prompt treatment of ocular syphilis: a lesson from permanent vision loss in 52 eyes. J Eur Acad Dermatol Venereol. 2020;34(7):1569-1578. doi:10.1111/jdv.16347.
13. Oliver SE, Cope AB, Rinsky JL, et al. Increases in Ocular Syphilis—North Carolina, 2014–2015. Clinical Infectious Diseases. 2017;65(10):1676-1682. doi:10.1093/cid/cix604.
14. Ueda P, Mercer CH, Ghaznavi C, Herbenick D. Trends in Frequency of Sexual Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US, 2000-2018. JAMA Network Open. 2020;3(6):e203833. doi:10.1001/jamanetworkopen.2020.3833.
15. Gani AH, Saleh NA, Selvam SB, Azwa I. Prevalence, risk factors and treatment outcomes of syphilis among people living with human immunodeficiency virus at primary care clinics in Malaysia: A retrospective study. Malays Fam Physician. 2024;19:13. doi:10.51866/oa.471.
16. Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238-243. doi:10.1016/j.annepidem.2017.02.003.
17. Department of Statistics Malaysia. P.108 Shah Alam Kawasanku | OpenDOSM. Accessed November 27, 2024. https://open.dosm.gov.my.
18. Yap SC, Tan YL, Chio MTW, Teoh SC. Syphilitic Uveitis in a Singaporean Population. Ocular Immunology and Inflammation. 2014;22(1):9-14. doi:10.3109/09273948.2013.829106.