Background Ocular syphilis is reemerging in the last decade in several countries around the world. However, little is known about the clinical and Cerebrospinal fluid (CSF) characteristics in HIV-negative individuals.

Methods We retrospectively reviewed the clinical records of 20 ocular syphilis patients presenting to Shanghai Clinical Center who completed CSF examination during the period from Jan 2011 to Nov 2012. Chief complaint, demographic data, syphilis serology, HIV serology and CSF examination results were collected. Factors that influenced the abnormal CSF results were explored.

Results The interval between ocular disease onset and the first visit at our hospital ranged from 2 weeks to 20 years (median 4 months). The mean age was 52.4 years, 14 patients were male and 6 were female. All patients tested negative for HIV infection. Median serum TRUST titer was 1:16 (ranged from 1 to 512). 14 (70%) of the 20 patients had abnormal CSF (elevated WBC or protein levels or reactive VDRL results). Of which, 11(55%) had elevated WBC cells, 11 (55%) had elevated protein level, 8 (40%) had reactive VDRL results. Patients with higher serum TRUST titer (≥ 8) were more likely to have an abnormal CSF results.

Conclusion Unlike most of the ocular syphilis reports in recent years, the co-infection of syphilis and HIV was less commonly observed in China. Most (70%) of these HIV-Negative patients had an elevated CSF WBC or protein level even with a moderate serum TRUST titer. Reactive CSF VDRL rate is not very high in our study.