As syphilis cases increase across the globe, ocular syphilis is re-emerging as an important etiology of uveitis. Looking into this growing trend, a team of researchers from South Africa now suggest clinicians should also check the HIV status in patients with ocular syphilis since nearly one-fourth of individuals in their investigation tested positive for HIV.

The retrospective analysis included 215 eyes of 146 patients who were approximately 37 years old and diagnosed with ocular syphilis at the Tygerberg Hospital in South Africa over a five-year period.

The study found HIV co-infection was present in 52.1% of the patients, 23.7% of whom were newly diagnosed on presentation. The researchers found bilateral involvement occurred 47.3% of the time, with 68.1% of these patients also HIV-positive.

Looking at intraocular inflammation, the researchers reported the most common types were posterior uveitis (40.9%) and panuveitis (38.1%), and both were more predominant in HIV-positive eyes.

At presentation, 74% of all eyes had a visual acuity (VA) of 20/50 or less and 40% had VA of less than 20/200. A lumbar puncture was performed in 113 patients (77.4%). Additionally, 16 patients had confirmed neurosyphilis and 27 had probable neurosyphilis.

The study included the largest number of ocular syphilis cases and the greatest proportion of HIV infection to date, the researchers wrote in their paper.