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Ocular syphilis among HIV-infected patients: a systematic analysis of the literature
  1. Joseph D Tucker1,
  2. Jonathan Z Li2,
  3. Gregory K Robbins1,
  4. Benjamin T Davis1,
  5. Ann-Marie Lobo3,
  6. Jan Kunkel4,
  7. George N Papaliodis3,
  8. Marlene L Durand1,
  9. Donna Felsenstein1
  1. 1Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, USA
  2. 2Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, USA
  3. 3Massachusetts Eye and Ear Infirmary, Boston, USA
  4. 4Department of Medicine I, Campus Benjamin Franklin, Charité - University Medicine Berlin, Germany
  1. Correspondence to Dr Joseph D Tucker, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA; jtucker4{at}


Background Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients.

Objective To examine the literature on HIV-infected patients and determine the results of treatment.

Methods Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated.

Results A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm3. Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm3 (p=0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone.

Conclusions Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.

  • MeSH words
  • syphilis
  • eye
  • HIV
  • review
  • uveitis

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  • Funding Support from the National Institutes of Health (T32 AI07387, JL), US NIH Fogarty International Clinical Fellowship (R24TW007988, JT) and the American Society of Tropical Medicine and Hygiene (JT).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Partners Human Subjects Research Committee and the Massachusetts Eye and Ear Infirmary Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.