Syphilitic Uveitis in HIV-Positive Patients. Current Perspective from a Clinical Case

Abstract

Syphilitic uveitis, caused by Treponema pallidum, has experienced a worrying coexistence with HIV infection in recent years. It has been observed that this coinfection has a significant prevalence in men, especially during the fifth decade of life. Identifying this association promptly is crucial due to similarities in transmission routes and epidemiological risks. We present the case of a 56-year-old male patient with HIV, referred for possible optic neuritis, who experienced progressive loss of vision in both eyes. The findings revealed intermediate uveitis in both eyes, vitreous and positive serological tests for syphilis and HIV. Intravenous administration of crystalline penicillin led to significant improvements in visual acuity. The resurgence of syphilis cases in recent decades underlines the importance of understanding its ocular manifestations. Syphilitic uveitis, especially the middle layer of the eye, can occur in various forms, with anterior uveitis being the most common. The diagnosis of ocular syphilis involves specific tests such as EIA, TPHA, FTA-ABS, VDRL and RPR. Intravenous crystalline penicillin is the standard treatment, although they are considered alternatives for patients allergic to penicillin. In addition, the use of systemic steroids is analyzed in selected cases. The rise of syphilis and its connection to HIV poses challenges in timely diagnosis and treatment. Education about these diseases becomes essential. Ocular syphilis requires a multidisciplinary approach to prevent irreversible damage to vision.