Manifestations and treatment of ocular syphilis during an epidemic in France

OBJECTIVES: To review cases of ocular syphilis presenting to a tertiary uveitis clinic during a syphilis epidemic in France between January 2001 and January 2004. STUDY DESIGN: Retrospective chart and patient database review. RESULTS: Ten patients who presented with symptoms and signs of uveitis tested positive for active syphilis. Some of the patients also presented with a rash or headache. Human immunodeficiency virus (HIV) antibody testing was positive in eight of the 10 patients, with CD4 cell counts >200 cells/mm in seven of the patients. Ocular inflammation resolved and visual acuity improved in all patients after treatment. CONCLUSIONS: A diagnosis of ocular syphilis should be considered in any patient with visual loss associated with a rash or headache, irrespective of the patient's CD4 cell count. Ocular syphilis in HIV-positive patients should be treated as neurosyphilis, whereas ocular syphilis in non-HIV patients can be treated as secondary syphilis.