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. 2017 Oct 30;65(10):1676-1682.
doi: 10.1093/cid/cix604.

Increases in Ocular Syphilis-North Carolina, 2014-2015

Sara E Oliver  1 , Anna Barry Cope  1   2 , Jessica L Rinsky  1   2 , Charnetta Williams  1 , Gui Liu  1 , Stephanie Hawks  2 , Thomas A Peterman  1 , Lauri Markowitz  1 , Aaron T Fleischauer  1   2 , Erika Samoff  2 ; Ocular Syphilis Disease Investigation Specialists Workgroup
Collaborators, Affiliations

Increases in Ocular Syphilis-North Carolina, 2014-2015

Sara E Oliver et al. Clin Infect Dis. .

Abstract

Background: Ocular syphilis is an inflammatory eye disease due to Treponema pallidum infection. In the United States, syphilis rates have increased since 2000; clusters of ocular syphilis were reported in 2015. We investigated ocular syphilis in North Carolina to describe the epidemiology and clinical course of disease.

Methods: We reviewed syphilis cases reported to North Carolina during 2014-2015 and abstracted information from health department interviews for cases with ocular symptoms and no other defined etiology. To assess duration and severity of ocular symptoms, we also reviewed medical records and conducted structured interviews. We compared the prevalence of ocular manifestations among reported syphilis cases by demographic and clinical characteristics.

Results: Among 4232 syphilis patients, 63 (1.5%) had ocular syphilis: 21 in 2014 and 42 in 2015, a 100% increase. Total syphilis cases increased 35% through 2015. No patient with ocular syphilis named another ocular syphilis patient as a sex partner. Patients presented in all syphilis stages; 24 (38%) were diagnosed in primary or secondary syphilis. Ocular manifestations were more prevalent among syphilis patients who were male, aged ≥40 years, white, and infected with human immunodeficiency virus. No risk behaviors were associated with ocular syphilis. Among 39 interviewed patients, 34 (87%) reported reduced vision during infection; 12 (31%) reported residual visual symptoms posttreatment.

Conclusions: In North Carolina, ocular syphilis increased from 2014 to 2015 and may be due to increased recognition of ocular manifestations, or a true increase in ocular syphilis. Many ocular syphilis patients experienced vision loss; however, most improved posttreatment.

Keywords: Treponema pallidum; epidemiology; surveillance; syphilis; vision loss.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1
Figure 1
Ocular syphilis case identification and follow-up interview participation—North Carolina, 2014–2015.
Figure 2
Figure 2
Mean visual function score by activity and time period—North Carolina, 2014–2015. “Before” was defined as prior to having eye or vision problems related to syphilis; “During” was defined as when syphilis-related eye or vision symptoms were at their worst; “Today” was defined as the time of the follow-up interview.
See this image and copyright information in PMC

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