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. 2011 Feb;87(1):4-8.
doi: 10.1136/sti.2010.043042. Epub 2010 Aug 26.

Ocular syphilis among HIV-infected patients: a systematic analysis of the literature

Joseph D Tucker  1 , Jonathan Z Li, Gregory K Robbins, Benjamin T Davis, Ann-Marie Lobo, Jan Kunkel, George N Papaliodis, Marlene L Durand, Donna Felsenstein
Affiliations

Ocular syphilis among HIV-infected patients: a systematic analysis of the literature

Joseph D Tucker et al. Sex Transm Infect. 2011 Feb.

Abstract

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/mm(3). Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm(3) (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.

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Figures

Figure 1
Figure 1
Search algorithm outlining strategy for identifying case series of HIV-infected individuals with ocular syphilis.
Figure 2
Figure 2
Range of RPR/VDRL titres comparing patients with CD4>200 cells/ml (white bars) with those with CD4<200 cells/ml (black bars). NR, non-reactive; RPR, rapid plasma reagin; VDRL, Venereal Disease Research Laboratory.
See this image and copyright information in PMC

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