Don't Forget What You Can't See: A Case of Ocular Syphilis

Monica I. Lee, MD; Annie W.C. Lee, MD; Sean M. Sumsion, MD; Julie A. Gorchynski, MD


Western J Emerg Med. 2016;17(4):473-476. 

In This Article


Syphilis is known as the "great imitator" for its ability to infect any organ and cause diverse symptoms.[15] Currently there is a re-emergence of syphilis for which the case count and rate is the highest recorded since 1995 in the United States.[1,3,4,9] In 2000, the rates of syphilis were at an all-time low (2.2 cases per 100,000 persons) but by 2013 had more than doubled (5.5 cases per 100,000 persons).[1] Syphilis is a common worldwide sexually transmitted infection and is notorious for facilitating the transmission of the human immunodeficiency virus (HIV). The incidences of syphilis were highest among women in age groups 25 to 29 years and 20 to 24 years in men, especially in men who have sex with men (MSM).[1–9] Most of the case studies on ocular syphilis are isolated to the ophthalmology literature. As emergency physicians we should be aware and be able to recognize manifestations of ocular syphilis as a cause of painless vision loss and its high rate of coinfection with HIV. Painless bilateral loss of vision may be the only presenting symptom of syphilis, which can be observed in up to one-third of patients with neurosyphilis.[10,11] Centers for Disease Control and Prevention (CDC) guidelines now recommend that any ocular manifestation of syphilis such as iritis, uveitis, or chorioretinitis, be treated as neurosyphilis, with a 14-day course of intravenous (IV) penicillin G, regardless of the stage of clinical presentation of syphilis or lumbar puncture (LP) results.[1,3,4,5] Delay or lack of treatment may lead to long-term neurologic complications such as blindness, paralysis, dementia, psychosis and stroke.