Syphilitic Posterior Uveitis: Correlative Findings and Significance

• Published in: Clinical infectious diseases Vol. 32; no. 12; pp. 1661 - 1673
• Main Authors: Ormerod, L. David, Puklin, James E., Sobel, Jack D.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.06.2001; University of Chicago Press
• Subjects: Acute Disease; Adult; Aged; Bacterial diseases; Bacterial diseases of the eye and orbit; Biological and medical sciences; Chronic Disease; Eye diseases; Eyes; Female; Human bacterial diseases; Humans; Infectious diseases; Major Articles; Male; Medical sciences; Middle Aged; Neurosyphilis; Neurosyphilis - complications; Neurosyphilis - pathology; Optic nerve diseases; Penicillin; Posterior uveitis; Retina; Retinitis; Retrospective Studies; Syphilis; Uveitis; Uveitis, Posterior - complications; Uveitis, Posterior - pathology; Human; Choroiditis; Nervous system diseases; Clinical form; Exploration; Uvea disease; Neurosyphilis; Treponematosis; Fundus of the eye; Infection; Symptomatology; Eye disease; Chronic; Sexually transmitted disease; Association; Syphilis; Central nervous system disease; Bacteriosis; Posterior chamber; Spirachaetosis
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/320766

Twenty-one patients with syphilitic posterior uveitis were investigated retrospectively to study the disease spectrum, associations with neurosyphilis, and therapeutic implications. Ophthalmologic manifestations of syphilitic posterior uveitis are differentiated into acute and chronic uveitides. The several distinct acute uveitic syndromes are usually florid and are associated with early syphilis, with VDRL-positive syphilitic meningitis, and frequently with human immunodeficiency virus coinfection. The chronic posterior uveitides are often insidious, a manifestation of late syphilis, and associated commonly with subclinical neurosyphilis. All patients with acute cases and 54% of patients with chronic cases in our study received penicillin therapy appropriate for neurosyphilis. The frequent association of syphilitic posterior uveitis with neurosyphilis and the analogous spirochetal sequestration beyond the blood-brain and the blood-ocular barriers suggest that all patients with syphilitic posterior uveitis, irrespective of ocular disease intensity, should undergo evaluation of cerebrospinal fluid and be treated with penicillin regimens appropriate for neurosyphilis.