A 14-Year Retrospective Clinical Analysis of Ocular Manifestations of Syphilis in a Portuguese Tertiary Center

Ana Faria Pereira,1 Ana Gama e Castro,1 Rita Teixeira-Martins,1 Inês Coelho-Costa,1 Sónia Torres-Costa,1 Marta Silva,1 Ana Catarina Pedrosa,1 Joana Araújo,1 Luís Figueira,1– 3 Cláudia Oliveira-Ferreira1,4 1Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal; 2Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; 3MedInUP - Center for Drug Discovery and Innovative Medicines, Faculty of Medicine, University of Porto, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Ana Faria Pereira, Department of Ophthalmology, Unidade Local de Saúde de São João, Avenida Prof. Hernâni Monteiro, Porto, 4202 – 451, Portugal, Email acfariapereira@gmail.comPurpose: Syphilis is a re-emerging infectious disease with various systemic manifestations, including ocular involvement, which can lead to significant morbidity if untreated. This study aims to analyze the ocular manifestations of syphilis in patients treated at a Portuguese tertiary center over a 14-year period.Patients and Methods: A retrospective review of patients diagnosed with syphilis who presented with ocular symptoms from 2010 to 2023 was conducted. Data collected included demographic information, clinical presentation, ophthalmologic findings, serologic test results, treatment regimens and outcomes.Results: A total of 47 patients with ocular syphilis were identified. The mean age of the cohort was 45, with a male predominance of 78.7%. The most common ocular manifestations included uveitis (mostly posterior and panuveitis), optic neuritis, acute syphilitic posterior placoid chorioretinitis and vitritis. Best corrected visual acuity (BCVA) at presentation was highly variable, ranging from hand movements to no impairment of visual acuity. At the end of the follow-up period, the majority of the study eyes achieved a BCVA between 0 and 0.1 (p< 0,000). Acute syphilitic posterior placoid chorioretinitis was associated with poorer visual outcomes after treatment, indicating its presence is a poor prognosis factor. HIV status, the presence of vitritis, vasculitis and papillitis at presentation, a positive syphilis serology in cerebrospinal fluid and treatment regimen did not appear to have a significant impact on the final BCVA.Conclusion: Ocular syphilis, though rare, remains a significant cause of visual morbidity. Early recognition and prompt treatment are crucial for preventing permanent vision loss. Regular screening and increased awareness among clinicians are essential to manage this potentially sight-threatening condition effectively. Further research is needed to optimize treatment protocols and improve patient outcomes.Keywords: syphilis, uveitis, optic neuritis, retinal vasculitis, retrospective study, penicillin