Ocular Syphilis: a Clinical Review

  • Sophie L. WoolstonEmail author
  • Shireesha Dhanireddy
  • Jeanne Marrazzo
Central Nervous System Infections (K Bloch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Central Nervous System Infections


While ocular syphilis is not a new phenomenon, recent increased rates of new diagnoses, especially in human immunodeficiency virus (HIV)-infected persons and men who have sex with men, have sparked a new interest in an old disease. This article will review the clinical presentation, diagnosis, and treatment of ocular syphilis, and provide guidance on management.


Syphilis Human immunodeficiency virus (HIV)-related syphilis Ocular syphilis 



The authors wish to thank the University of Washington, King County and Seattle Department of Public Health, and Madison Clinic.

Compliance with Ethical Standards

Conflict of Interest

Drs Woolston, Dhanireddy, and Marrazzo do not find any conflicts of interest.

This work was supported by the Centers for Disease Control and Prevention Cooperative Agreement 1U62PS004854, University of Washington Clinical Prevention Training Center.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    (CDC) CfDCaP. Sexually transmitted disease surveillance, 2014. Atlanta: US Department of Health and Human Services; 2015.Google Scholar
  2. 2.
    Clinical Advisory: Ocular syphilis in the United States. 2015. Accessed February 26, 2016.
  3. 3.
    Woolston S, Cohen SE, Fanfair RN, Lewis SC, Marra CM, Golden MR. A Cluster of Ocular Syphilis Cases - Seattle, Washington, and San Francisco, California, 2014–2015. MMWR Morb Mortal Wkly Rep. 2015;64:1150–1. doi: 10.15585/mmwr.mm6440a6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Je M. Syphilitic iritis. Am J Opthalmol. 1931;14:110–26.CrossRefGoogle Scholar
  5. 5.•
    Marra CM, Maxwell CL, Smith SL, et al. Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004;189:369–76. Epub 2004 Jan 27. Cerebrospinal fluid of patients with syphilis is a highly nuance, complex subject. This paper provides a review and guide for providers Google Scholar
  6. 6.
    Balba GP, Kumar PN, James AN, et al. Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy. Am J Med. 2006;119:448.e21–5.CrossRefGoogle Scholar
  7. 7.
    Ormerod LD, Puklin JE, Sobel JD. Syphilitic posterior uveitis: correlative findings and significance. Clin Infect Dis. 2001;32(12):1661–73.Google Scholar
  8. 8.
    Margo CE, Hamed LM. Ocular syphilis. Surv Ophthalmol. 1992;37:203–20.CrossRefPubMedGoogle Scholar
  9. 9.
    Gass JD, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis. Ophthalmology. 1990;97:1288–97.CrossRefPubMedGoogle Scholar
  10. 10.
    Moradi A, Salek S, Daniel E, et al. Clinical features and incidence rates of ocular complications in patients with ocular syphilis. Am J Ophthalmol. 2015;159:334–43.e1. doi: 10.1016/j.ajo.2014.10.030. Epub Nov 5.CrossRefPubMedGoogle Scholar
  11. 11.•
    Amaratunge BC, Camuglia JE, Hall AJ. Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients. Clin Experiment Ophthalmol. 2010;38:68–74. doi: 10.1111/j.442-9071.2010.02203.x. This paper is a well written resource for providers treating ocular syphilis, particularly patients infected with Human Immunodeficiency Virus.CrossRefPubMedGoogle Scholar
  12. 12.
    Li JZ, Tucker JD, Lobo AM, et al. Ocular syphilis among HIV-infected individuals. Clin Infect Dis. 2010;51:468–71. doi: 10.1086/654797.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tucker JD, Li JZ, Robbins GK, et al. Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect. 2011;87:4–8. doi: 10.1136/sti.2010.043042. Epub 2010 Aug 26.CrossRefPubMedGoogle Scholar
  14. 14.
    Maves RC, Cachay ER, Young MA, Fierer J. Secondary syphilis with ocular manifestations in older adults. Clin Infect Dis. 2008;46:e142–5. doi: 10.1086/588483.CrossRefPubMedGoogle Scholar
  15. 15.
    Spoor TC, Ramocki JM, Nesi FA, Sorscher M. Ocular syphilis 1986. Prevalence of FTA-ABS reactivity and cerebrospinal fluid findings. J Clin Neuroophthalmol. 1987;7:191–5.PubMedGoogle Scholar
  16. 16.
    Ormerod LD, Puklin JE, Sobel JD. Syphilitic posterior uveitis: correlative findings and significance. Clin Infect Dis. 2001;32:1661–73. Epub 2001 May 21.CrossRefPubMedGoogle Scholar
  17. 17.
    Parc CE, Chahed S, Patel SV, Salmon-Ceron D. Manifestations and treatment of ocular syphilis during an epidemic in France. Sex Transm Dis. 2007;34:553–6.CrossRefPubMedGoogle Scholar
  18. 18.
    McLeish WM, Pulido JS, Holland S, Culbertson WW, Winward K. The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host. Ophthalmology. 1990;97:196–203.CrossRefPubMedGoogle Scholar
  19. 19.
    Tran TH, Cassoux N, Bodaghi B, Fardeau C, Caumes E, Lehoang P. Syphilitic uveitis in patients infected with human immunodeficiency virus. Graefes Arch Clin Exp Ophthalmol. 2005;243:863–9. Epub 2005 Mar 15.CrossRefPubMedGoogle Scholar
  20. 20.
    Marra C, Sahi S, Tantalo L, et al. Enhanced molecular typing of Treponema pallidum: geographical distribution of strain types and association with neurosyphilis. J Infect Dis. 2010;202:1380–8. doi: 10.086/656533.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Marty AS, Cornut PL, Janin-Manificat H, Perard L, Debats F, Burillon C. Clinical and paraclinical features of syphilitic uveitis. J Fr Ophtalmol. 2015;38:220–8. doi: 10.1016/j.jfo.2014.09.011. Epub 5 Jan 28.CrossRefPubMedGoogle Scholar
  22. 22.
    Fathilah J, Choo MM. The Jarisch-Herxheimer reaction in ocular syphilis. Med J Malaysia. 2003;58:437–9.PubMedGoogle Scholar
  23. 23.••
    Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR 2015;64. This is an essential text for any provider treating sexually transmitted diseases. It provides a guide for treatment of most syndromes, including very complex cases Google Scholar
  24. 24.
    Rescigno RJ, Glatman M, Patel SN. A complicated case of sarcoidosis. Neurosyphilis. JAMA Ophthalmol. 2014;132:649–50. doi: 10.1001/jamaophthalmol.2014.179.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sophie L. Woolston
    • 1
    Email author
  • Shireesha Dhanireddy
    • 1
  • Jeanne Marrazzo
    • 2
  1. 1.Division of Infectious DiseaseUniversity of WashingtonSeattleUSA
  2. 2.Division of Infectious Disease, School of MedicineUniversity of AlabamaBirminghamUSA

Personalised recommendations