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Syphilitic retinitis and uveitis in HIV-positive adults


Mr Edward H Hughes, Sussex Eye Hospital, Eastern Road, Brighton BN2 5BF, UK.


Background:  The incidence of new infection with syphilis is increasing, particularly in men who have sex with men, with HIV co-infection common. There has been a corresponding increase in ophthalmic manifestations that can be varied in presentation.

Methods:  Thirteen consecutive patients with syphilitic uveitis presenting to two ophthalmic departments in Sydney are described.

Results:  Twelve patients were male, of whom 10 were homosexual and six HIV-positive. Peripheral retinitis with panuveitis was the commonest ophthalmic presentation (n = 7, 54%), and six cases were initially treated with vitreous tap and intravitreal foscarnet as a precaution in case of viral retinitis. Retinitis was present in six of six (100%) HIV-positive and only one of seven (14%) HIV-negative patients (χ210.6, P < 0.01). Other ophthalmic presentations included anterior uveitis, vitritis, multifocal choroiditis, scleritis and papillitis. All patients responded to 10–14 days' intravenous penicillin with good final visual outcomes (6/12 or better in all eyes).

Conclusions:  This case series reinforces the importance of considering syphilis in the differential diagnosis of many ocular presentations, but in particular retinitis. Retinitis appears to be the predominant presentation in HIV-infected individuals, suggesting that HIV infection may somehow modulate the disease.