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Bacterial STIs
P54 Ocular syphilis: lessons from 4 decades of experience
  1. E M Draeger1,
  2. Z K Durani2,
  3. G Hitch3,
  4. B T Goh1
  1. 1Barts and the London NHS Trust, London, UK
  2. 2St.Georges University, London, UK
  3. 3Moorfields Eye Hospital, London, UK

Abstract

Background Ocular syphilis can affect most eye structures and can be the result of congenital and acquired infection. Many ocular signs are not specific to syphilis and it can be difficult to make the diagnosis.

Aim This study aims to investigate the epidemiology of ocular syphilis presenting to an oculogenital clinic.

Method Retrospective case notes review of ocular syphilis cases seen between 1965 and 2011. Of 307 cases with ocular signs and positive treponemal serology, 85 cases with a history of yaws were excluded, leaving 222.

Results Of the 222 cases, 93 (42%) were late congenital (CS), and 129 (58%) were acquired (AS). Of the CS cases, the mean age was 47.5 (range 7–86), 37 (40%) were male, of whom 1 was MSM. 55 (59%) were from the UK, 19 (20%) from the Caribbean, 9 (10%) from Europe. Eye signs were as follows: interstitial keratitis 73, anterior uveitis 23, posterior uveitis 10, panuveitis 3, Argyll-Robertson pupils (ARP) 1 and optic neuritis (ON) 1. Of the AS cases, the mean age was 50.9 (range 17–85), 99 (77%) were male, of whom 15 were MSM. 31 (24%) were from the UK, 15 (12%) from Europe, 51 (40%) from the Caribbean and 16 (12%) from Africa. 17 (13%) were early syphilis (secondary/early latent) and 112 (87%) were late latent or tertiary syphilis. Eye signs were as follows: anterior uveitis 63, posterior uveitis 21, panuveitis 13, optic atrophy 9, ON 8 and ARP 5. 35 (38%) of CS cases and 8 (6%) of the AS cases had extra-ocular signs of syphilis. Treatment was with a neurosyphilis regimen. STI screen were offered to all patients. Concomitant STIs are shown in the abstract P54 table 1.

Abstract P54 Table 1

Number of patients presenting with concomitant STIs

Conclusions (1) Ocular syphilis has varied presentations. (2) Screening for other STIs is important even in late CS and AS. (3) Ocular syphilis can be the only sign of syphilis: clinicians should consider syphilis as a cause of undiagnosed eye signs.

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