Syphilitic Uveitis in HIV-Positive and -Negative Patients: A Multicenter Cohort Study

Objectives: To evaluate the clinical manifestations and visual outcomes of patients with syphilitic uveitis, and to compare these features based on human immunodeficiency virus (HIV) infection status. Materials and Methods: The records of patients diagnosed with syphilitic uveitis between 2014 and 2024 were analyzed retrospectively. Demographics, history, ocular examination findings, syphilis and HIV serology, lumbar puncture test, treatment approaches, and best-corrected visual acuity (BCVA) results of all patients were documented. Results: A total of 51 eyes of 33 patients were included in the study. Twenty-seven patients (82%) were male, with a mean age of 44 years (range, 21-69). HIV co-infection was present in 39% of the patients (all male). Prior to presentation, 9 patients (27%) had received an incorrect diagnosis or inappropriate treatment. The most common form of syphilitic uveitis was panuveitis (63%), followed by posterior uveitis (31%). Anterior segment inflammation and optic nerve involvement were observed at higher rates in patients with HIV co-infection (p<0.05). All patients received systemic penicillin therapy, and 51% received systemic corticosteroids. Visual acuity improved significantly after treatment in all patients (p<0.01). HIV co-infection status was not associated with age, laterality, lumbar puncture findings, the development of ocular complications, or baseline and final BCVA outcomes (p>0.05). Conclusion: Syphilitic uveitis is an important clinical entity due to its broad spectrum of ocular manifestations. In this study, severe intraocular inflammatory findings, including panuveitis and optic nerve involvement, were more frequently observed in patients with HIV co-infection. However, HIV co-infection did not influence final visual acuity or the rate of ocular complication development.