Ocular manifestations of syphilis: recent cases over a 2.5-year period

  • Cindy Puech
  • Stéphane Gennai
  • Patricia Pavese
  • Isabelle Pelloux
  • Max Maurin
  • Jean-Paul Romanet
  • Christophe ChiquetEmail author
Inflammatory Disorders



The ocular manifestations of syphilis are protean and can affect every structure of the eye. There has been a recent increase of syphilis infection in Europe. We report recent cases of ocular syphilis infection in a tertiary center.


During a 2.5-year period (2005–2007) we collected the medical records of eight male patients with ocular syphilis. The diagnosis was based on serological tests on blood samples and cerebrospinal fluid. All patients underwent a check-up to rule out another etiological diagnosis and to detect the presence of any other sexually transmitted infections.


The ocular lesions included: chorioretinitis (one case), retinitis (two cases), panuveitis with macular edema (two cases), episcleritis (one case), anterior optic neuritis (one case), and retrobulbar optic neuropathy (one case). Infection of the cerebrospinal fluid was detected in three of the five patients tested. In six cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent at the 6-month follow-up visit. Co-infection with human immunodeficiency virus was reported in five patients, with a CD4 T lymphocyte count greater than 300/mm3. Most of the patients were treated with parenteral ceftriaxone (1 g daily) for 3 weeks with good tolerance. One patient was treated with intravenous penicillin G (18 MUI daily). Only one patient with anterior optic neuritis required systemic steroid therapy associated with antibiotics. Sequelae included sectorial atrophy of the optic nerve with visual field loss (n = 1) and abnormalities of the retinal pigment epithelium (n = 3).


All patients with ocular syphilis exhibited functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. As a great imitator, syphilis should be considered in all patients with uveitis, scleritis, episcleritis, or optic neuritis, especially in men with high-risk sexual behavior.


Ceftriaxone Human immunodeficiency virus Sexually transmitted infection Syphilis Uveitis 


  1. 1.
    Herida M, Michel A, Goulet V, Janier M, Sednaoui P, Dupin N, de Barbeyrac B, Semaille C (2005) Epidemiology of sexually transmitted infections in France. Méd Mal Infect 35:281–289CrossRefPubMedGoogle Scholar
  2. 2.
    Parc CE, Chahed S, Patel SV, Salmon-Ceron D (2007) Manifestations and treatment of ocular syphilis during an epidemic in France. Sex Transm Dis 34:553–556CrossRefPubMedGoogle Scholar
  3. 3.
    Doris JP, Saha K, Jones NP, Sukthankar A (2006) Ocular syphilis: the new epidemic. Eye 20:703–705CrossRefPubMedGoogle Scholar
  4. 4.
    Aldave AJ, King JA, Cunningham ET Jr (2001) Ocular syphilis. Curr Opin Ophthalmol 12:433–441CrossRefPubMedGoogle Scholar
  5. 5.
    Brown DL, Frank JE (2003) Diagnosis and management of syphilis. Am Fam Physician 68:283–290PubMedGoogle Scholar
  6. 6.
    Chao JR, Khurana RN, Fawzi AA, Reddy HS, Rao NA (2006) Syphilis: reemergence of an old adversary. Ophthalmology 113:2074–2079CrossRefPubMedGoogle Scholar
  7. 7.
    Hook EW 3rd, Peeling RW (2004) Syphilis control–a continuing challenge. N Engl J Med 351:122–124CrossRefPubMedGoogle Scholar
  8. 8.
    Gaudio PA (2006) Update on ocular syphilis. Curr Opin Ophthalmol 17:562–566CrossRefPubMedGoogle Scholar
  9. 9.
    Wilhelmus K, Lukehart S (1996) Syphilis. In: Pepose S, Holland G, Wilhelmus K (eds) Ocular infection and immunity. Mosby, pp 1437–1466Google Scholar
  10. 10.
    Young H, McMillan A (1979) Serological tests for syphilis and their clinical use. Br J Hosp Med 22:292PubMedGoogle Scholar
  11. 11.
    Weidmann M, Meyer-Konig U, Hufert FT (2003) Rapid detection of herpes simplex virus and Varicella-zoster virus infections by real-time PCR. J Clin Microbiol 41:1565–1568CrossRefPubMedGoogle Scholar
  12. 12.
    Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140:509–516CrossRefPubMedGoogle Scholar
  13. 13.
    Barile GR, Flynn TE (1997) Syphilis exposure in patients with uveitis. Ophthalmology 104:1605–1609PubMedGoogle Scholar
  14. 14.
    Tamesis RR, Foster CS (1990) Ocular syphilis. Ophthalmology 97:1281–1287PubMedGoogle Scholar
  15. 15.
    Drancourt M, Berger P, Terrada C, Bodaghi B, Conrath J, Raoult D, LeHoang P (2008) High prevalence of fastidious bacteria in 1520 cases of uveitis of unknown etiology. Medicine (Baltimore) 87:167–176CrossRefGoogle Scholar
  16. 16.
    Doherty L, Fenton KA, Jones J, Paine TC, Higgins SP, Williams D, Palfreeman A (2002) Syphilis: old problem, new strategy. BMJ 325:153–156CrossRefPubMedGoogle Scholar
  17. 17.
    Shalaby IA, Dunn JP, Semba RD, Jabs DA (1997) Syphilitic uveitis in human immunodeficiency virus-infected patients. Arch Ophthalmol 115:469–473PubMedGoogle Scholar
  18. 18.
    Bouyssou A, Gallay A, Janier M, Dupin N, Halioua B, Alcaraz I (2008) Surveillance de la syphilis en france, 2000-2006: recrudescence des diagnostics en 2006. Bull épidémiol Hebd 5–6:39–42Google Scholar
  19. 19.
    Tran TH, Cassoux N, Bodaghi B, Fardeau C, Caumes E, Lehoang P (2005) Syphilitic uveitis in patients infected with human immunodeficiency virus. Graefes Arch Clin Exp Ophthalmol 243:863–869CrossRefPubMedGoogle Scholar
  20. 20.
    Becerra LI, Ksiazek SM, Savino PJ, Marcus DK, Buckley RM, Sergott RC, Bosley TM (1989) Syphilitic uveitis in human immunodeficiency virus-infected and noninfected patients. Ophthalmology 96:1727–1730PubMedGoogle Scholar
  21. 21.
    Kiss S, Damico FM, Young LH (2005) Ocular manifestations and treatment of syphilis. Semin Ophthalmol 20:161–167CrossRefPubMedGoogle Scholar
  22. 22.
    Schwartz GS, Harrison AR, Holland EJ (1998) Etiology of immune stromal (interstitial) keratitis. Cornea 17:278–281CrossRefPubMedGoogle Scholar
  23. 23.
    Marks R, Thomas-Kaskel AK, Schmidt D, Donauer J (2006) Steroid refractory episcleritis as early manifestation of neurosyphilis. Eur J Med Res 11:309–312PubMedGoogle Scholar
  24. 24.
    Yoon KC, Im SK, Seo MS, Park YG (2005) Neurosyphilitic episcleritis. Acta Ophthalmol Scand 83:265–266CrossRefPubMedGoogle Scholar
  25. 25.
    Gass JD, Braunstein RA, Chenoweth RG (1990) Acute syphilitic posterior placoid chorioretinitis. Ophthalmology 97:1288–1297PubMedGoogle Scholar
  26. 26.
    Wickremasinghe S, Ling C, Stawell R, Yeoh J, Hall A, Zamir E (2009) Syphilitic punctate inner retinitis in immunocompetent gay men. Ophthalmology 116:1195–1200CrossRefPubMedGoogle Scholar
  27. 27.
    Mendelsohn AD, Jampol LM (1984) Syphilitic retinitis. A cause of necrotizing retinitis. Retina 4:221–224CrossRefPubMedGoogle Scholar
  28. 28.
    de Souza EC, Jalkh AE, Trempe CL, Cunha S, Schepens CL (1988) Unusual central chorioretinitis as the first manifestation of early secondary syphilis. Am J Ophthalmol 105:271–276PubMedGoogle Scholar
  29. 29.
    Jumper JM, Machemer R, Gallemore RP, Jaffe GJ (2000) Exudative retinal detachment and retinitis associated with acquired syphilitic uveitis. Retina 20:190–194CrossRefPubMedGoogle Scholar
  30. 30.
    Browning DJ (2000) Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. Ophthalmology 107:2015–2023CrossRefPubMedGoogle Scholar
  31. 31.
    Menon SR, Fleischhauer J, Jost K, Helbig H (2005) Clinical and electrophysiological course of acute syphilitic posterior placoid chorioretinitis. Klin Monatsbl Augenheilkd 222:261–263CrossRefPubMedGoogle Scholar
  32. 32.
    Ormerod LD, Puklin JE, Sobel JD (2001) Syphilitic posterior uveitis: correlative findings and significance. Clin Infect Dis 32:1661–1673CrossRefPubMedGoogle Scholar
  33. 33.
    Pao D, Goh BT, Bingham JS (2002) Management issues in syphilis. Drugs 62:1447–1461CrossRefPubMedGoogle Scholar
  34. 34.
    Levy JH, Liss RA, Maguire AM (1989) Neurosyphilis and ocular syphilis in patients with concurrent human immunodeficiency virus infection. Retina 9:175–180CrossRefPubMedGoogle Scholar
  35. 35.
    Amaratunge BC, Hall AJ (2008) Ocular syphilis in Victoria: four new cases and a brief discussion of the current Victorian experience. Clin Exp Ophthalmol 36:192–194CrossRefGoogle Scholar
  36. 36.
    Arruga J, Valentines J, Mauri F, Roca G, Salom R, Rufi G (1985) Neuroretinitis in acquired syphilis. Ophthalmology 92:262–270PubMedGoogle Scholar
  37. 37.
    Bourazza A, Kerouache A, Reda R, Mounach J, Mosseddaq R (2008) Meningovascular syphilis: study of five cases. Rev Neurol (Paris) 164:369–373Google Scholar
  38. 38.
    Peters M, Gottschalk D, Boit R, Pohle HD, Ruf B (1993) Meningovascular neurosyphilis in human immunodeficiency virus infection as a differential diagnosis of focal CNS lesions: a clinicopathological study. J Infect 27:57–62CrossRefPubMedGoogle Scholar
  39. 39.
    Centers for Disease Control and Prevention (CDC) (2002) Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–78Google Scholar
  40. 40.
    Stoner BP (2007) Current controversies in the management of adult syphilis. Clin Infect Dis 44(Suppl 3):S130–S146CrossRefPubMedGoogle Scholar
  41. 41.
    Jay CA (2006) Treatment of neurosyphilis. Curr Treat Options Neurol 8:185–192CrossRefPubMedGoogle Scholar
  42. 42.
    Dayan L, Ooi C (2005) Syphilis treatment: old and new. Expert Opin Pharmacother 6:2271–2280CrossRefPubMedGoogle Scholar
  43. 43.
    Shann S, Wilson J (2003) Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect 79:415–416CrossRefPubMedGoogle Scholar
  44. 44.
    Zhou P, Gu Z, Xu J, Wang X, Liao K (2005) A study evaluating ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy. Sex Transm Dis 32:495–498CrossRefPubMedGoogle Scholar
  45. 45.
    Steele RW (1984) Ceftriaxone therapy of meningitis and serious infections. Am J Med 77:50–53PubMedGoogle Scholar
  46. 46.
    Marra CM, Boutin P, McArthur JC, Hurwitz S, Simpson PA, Haslett JA, van der Horst C, Nevin T, Hook EW 3rd (2000) A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis 30:540–544CrossRefPubMedGoogle Scholar
  47. 47.
    Johnson RC, Bey RF, Wolgamot SJ (1982) Comparison of the activities of ceftriaxone and penicillin G against experimentally induced syphilis in rabbits. Antimicrob Agents Chemother 21:984–989PubMedGoogle Scholar
  48. 48.
    Korting HC, Walther D, Riethmuller U, Meurer M (1987) Ceftriaxone given repeatedly cures manifest syphilis in the rabbit. Chemotherapy 33:376–380CrossRefPubMedGoogle Scholar
  49. 49.
    Augenbraun M, Workowski K (1999) Ceftriaxone therapy for syphilis: report from the emerging infections network. Clin Infect Dis 29:1337–1338CrossRefPubMedGoogle Scholar
  50. 50.
    Danesh-Meyer H, Kubis KC, Sergott RC (1999) Not so slowly progressive visual loss. Surv Ophthalmol 44:247–252CrossRefPubMedGoogle Scholar
  51. 51.
    Strominger MB, Slamovits TL, Herskovitz S, Lipton RB (1994) Transient worsening of optic neuropathy as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease. J Neuroophthalmol 14:77–80PubMedGoogle Scholar
  52. 52.
    Margo CE, Hamed LM (1992) Ocular syphilis. Surv Ophthalmol 37:203–220CrossRefPubMedGoogle Scholar
  53. 53.
    Muthiah MN, Michaelides M, Child CS, Mitchell SM (2007) Acute retinal necrosis: a national population-based study to assess the incidence, methods of diagnosis, treatment strategies and outcomes in the UK. Br J Ophthalmol 91:1452–1455CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Cindy Puech
    • 1
  • Stéphane Gennai
    • 2
  • Patricia Pavese
    • 2
  • Isabelle Pelloux
    • 3
  • Max Maurin
    • 3
  • Jean-Paul Romanet
    • 1
  • Christophe Chiquet
    • 1
    • 4
    Email author
  1. 1.Department of OphthalmologyUniversity Hospital of Grenoble, Joseph Fourier UniversityGrenobleFrance
  2. 2.Department of Infectious DiseaseUniversity Hospital of Grenoble, Joseph Fourier UniversityGrenobleFrance
  3. 3.Department of MicrobiologyUniversity Hospital of Grenoble, Joseph Fourier UniversityGrenobleFrance
  4. 4.Clinique Universitaire d’Ophtalmologie, CHU de GrenobleGrenobleFrance

Personalised recommendations