Syphilis Should Prompt Clinician Consideration Of HIV Infection

The study showing association exists between ocular syphilis; and both early syphilis infection and HIV infection; which means that a diagnosis of ocular syphilis should prompt clinician consideration of HIV infection, and conversely; there should be a higher clinical suspicion for syphilis-related complications like ocular syphilis in those living with HIV.

As early syphilis, HIV infection associating with ocular syphilis; Additionally, many clinicians do not realize that severe complications of syphilis can occur quite early in infection; so these data really reinforce this; Over the last 20 years, syphilis case counts have increased globally. Last fall, Alaska reported its largest syphilis outbreak in at least 40 years, and this year Europe reported a 70% increase in the incidence of syphilis in 7 years.

Clinician consideration of HIV

In an effort to characterize ocular syphilis cases in British Columbia (BC) and determine risk factors for the condition, researchers compared ocular syphilis cases diagnosed in BC with case controls between January 2010 and December 2018. The rate of congenital syphilis has more than doubled since 2013 in the United States, according to the CDC.

Although researchers have shown that coinfection with HIV and syphilis can increase the risk for ocular syphilis, a study from 2018 revealed that every year, almost one-third of HIV-positive men who have sex with men (MSM) are not tested for syphilis. They identified 6,716 diagnosed syphilis cases, of which 0.98% were ocular syphilis. The median age of patients was 49.5 years and 87.8% were male, of whom 54.6% identified as MSM.

Sexually transmitted infection

As syphilis is a sexually transmitted infection that can cause serious health problems if it is not treated. Syphilis is divided into stages (primary, secondary, latent, and tertiary). There are different signs and symptoms associated with each stage. Conducting one of the largest (in terms of number of cases) studies published on ocular syphilis, and the first case-control study. In 2010 the incidence of ocular syphilis cases was 0.48%, increasing to 0.83% in 2018.

However, the study findings do add to the evidence base relating to a likely association between; HIV and increased risk for ocular syphilis. At 42.4%, panuveitis was the most common ophthalmologic diagnosis. Patients who were HIV positive at the time of their syphilis diagnosis comprising 48.5% of the reporting ocular syphilis cases comparing with 26.4% of controls;  according to the study.  Furthermore, the final multivariable model revealing that early syphilis stage which including primary and secondary infections; early latent stages and HIV serostatus were associating with ocular syphilis.