Ocular syphilis is very rare, equivalent to 1-2% of uveitis, however, is a simulator disease that can be confused, especially in immunocompetent individuals, as HIV-positive patients are more likely to acquire it. HIV co-infection with syphilis increases the risk of central nervous system disease, patients with AIDS who do not receive antiretroviral therapy, have bilateral disease and the posterior segment. There are many ways to manifest eye level, most of the publications mentioned isolated cases of secondary syphilis in stage chronic phase, and the majority in the neurosyphilis. In the cornea is suspected when there is a bilateral stromal keratitis, which may be associated with closed- angle glaucoma. In the iris can be expressed as granulomatous uveitis. In a series of cases of Barile was shown 9% of posterior uveitis and 27 % of panuveitis. Chao JR and colleagues reported four patients with neurosyphilis by positive VDRL and increasing of leukocytes in the cerebrospinal fluid. Two patients had placoid chorioretinitis, a homosexual patient presented bilateral papilledema and a heterosexual man presented anterior uveitis and bilateral papilledema. The condition of the posterior pole can vary as much as vasculitis, macular edema, neuroretinitis and even retinal necrosis. Neuro-ophthalmological manifestations of syphilis include Argyll-Robertson pupil, oculomotor nerve palsy and optic neuritis. Treatment of ocular syphilis should be as neurosyphilis, recommended 12 MU of penicillin G intravenously daily for 10-14 days or 2.4 MU procaine penicillin intramuscularly daily with oral probenecid for two weeks. Penicillin G benzathine can be applied after the treatment of penicillin G or procaine, It should not be applied as a first option, since it does not reach sufficient levels in the cerebrospinal fluid. In case of resistance, can be applied ceftriaxone, 1 g 2 times a day for seven days. We present two cases treated in our services in Cuba. Case 1. This 31 years old male patient referred to the Service of Infectious Diseases for being HIV positive and probable neurosyphilis by bilateral papilledema, was under medical treatment with penicillin G procaine. The reason for the consultation is low vision in Right eye (RE) since two weeks ago. Physical examination: AV 20/80 in RE and 20/25 in LE (Left Eye). IOP of 10 mm Hg in both eyes. RE with fine keratic precipitates, cells in CA 1 +, there are no changes in anterior segment of the LE. In the fundus papilledema is observed in RE and peripheral posterior vitreous detachment in LE. The retinal fluorangiography (FAG) shows active lesions of peripheral vasculitis and bilateral papilledema. Report is sent to the Service of Infectious Diseases where a antiretroviral therapy is indicated, in addition to completing his studies, resulting positive FTA-abs test. Returns three months later his vision improved to 20/25 in both eyes, in the fund of the eye is not observed the edema of the optic nerve previously affected. Case 2. Male patient, 32 years old, referred to the Service of Infectious Diseases for diagnosis of neurosyphilis in HIV-positive FTA-abs test positive. During his hospital stay was diagnosed with bilateral papilledema and paralysis of the fourth right nerve. Admitted by the presence of headache and diplopia of two months before to the first review. Visual acuity is 20/30 right eye and 20/25 left eye. His refraction is -0.75 sphere RE and -0.25 to - 0.75X 0 ° LE, improved to 20/20 RE and 20/15 LE. On examination of ocular motility is observed hiperhipotropia with limitation to the depression of RE and Bielchowski test positive. Conjunctive, cornea and lens of the normal characteristics. Fundus in both eyes and optic disc with excavation 1 / 10, hyperemia and Raised edges, tortuous vessels since the emergency. FAG requested and quoted with results, the patient does not return. The importance of health officials from a country to insist on control of sexually transmitted diseases stems from the increased incidence of these kind of diseases such as syphilis, considered as a "great imitator" of many other infectious diseases and some autoimmune diseases. Dermatological tests are insensitive in the primary or secondary syphilis, because it has reduced levels of normal lymphocyte blastogenesis. In the case of HIV, it can cause a polyclonal expansion of inmunoglobuline IgG, resulting in activation of B cells with a side effect of CD8, complicating HIV infection. Opposite can also happen: there is a decrease of B cells, giving false positive serological tests. T. pallidum increases HIV replication and may also damage the mucosa by increasing the number of cells receptive to HIV. Patients with genital ulcers have an increased excretion of HIV RNA in seminal fluid. In conclusion, ocular syphilis remains a cause of diverse and complex eye conditions. We should suspect this diagnosis in patients without other infectious cause or autoimmune feature. Do not forget the background of sexual transmission risk that patients often deny.

Conflict of Interest:

None declared