Prospective evaluation of ocular syphilis: a screening-based approach

Objective: This study aims to evaluate the prevalence and clinical characteristics of ocular syphilis (OS) through a screening-based approach in syphilis patients, including both symptomatic and asymptomatic cases.Methods: A total of 46 syphilis patients were included in this prospective study.Patients diagnosed with syphilis were referred for ophthalmologic evaluations regardless of symptoms.Clinical data, including syphilis stage, sexual orientation, and HIV co-infection, rapid plasma reagin (RPR) titer, and ocular findings were recorded. Results:The mean age was 43.0 11.6 years, and 42 patients (91.3%) were male.Among the patients, 8 (17.4%) had OS, affecting 14 eyes.The majority of OS patients were in the secondary stage of syphilis (87.5%).Six patients with OS exhibited ocular symptoms.The median RPR titer was significantly higher in the OS group (p< 0.001).Final diagnoses included interstitial keratitis, syphilitic optic neuropathy, granulomatous anterior uveitis, panuveitis, acute syphilitic posterior placoid chorioretinitis, and syphilis-related acute retinal necrosis.Baseline best-corrected visual acuity (BCVA) in OS patients was 0.81 0.83 logMAR, and the final BCVA improved to 0.14 0.13 logMAR (p= 0.001). Conclusion:This study demonstrates the significant prevalence of OS, particularly in secondary syphilis, and emphasizes the importance of comprehensive ocular screening, even in the absence of visual symptoms.Early detection and treatment can significantly improve visual outcomes.While syphilis stage, and elevated RPR titers were key factors, special attention should be given to HIV-negative patients, who may present with more subtle or asymptomatic manifestations, potentially leading to delayed diagnosis.