How is ophthalmic syphilis in HIV infection treated?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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All HIV-positive patients with syphilitic eye findings are considered to have tertiary syphilis and are treated accordingly. Treatment of syphilis is with intravenous penicillin G (24 million U/day for 7-10 days). Relapse may occur in spite of adequate treatment. For penicillin-allergic patients, alternatives include tetracycline 500 mg 4 times per day or doxycycline 200 mg twice a day by mouth for 30 days or a third-generation cephalosporin (eg, ceftriaxone).

Cycloplegia with either cyclopentolate 2% or homatropine 5% 3 times daily and prednisolone acetate 1% 4 times daily is recommended if anterior segment inflammation is present.

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