obsolete secondary syphilitic uveitis

Obsolete Secondary Syphilitic Uveitis: A Review

Secondary syphilis, a stage of the disease that typically appears 2 to 6 months after the initial infection, can manifest in various ways. One such manifestation is secondary syphilitic uveitis, which has been reported in medical literature.

Characteristics and Prevalence

• Secondary syphilitic uveitis was once considered a common cause of uveitis, with some studies suggesting that it accounted for up to 4.6% of patients with early secondary syphilis [14].
• However, as awareness and understanding of the disease have evolved, the prevalence of secondary syphilitic uveitis has decreased.
• In contrast, posterior uveitis is now recognized as the most common manifestation of ocular syphilis in immunocompetent adults [12].

Symptoms and Manifestations

• Secondary syphilitic uveitis can manifest as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis.
• Posterior uveitis is the most common phenotype of syphilitic uveitis, with a reported incidence of 55.2% [11].
• The disease can also be associated with central nervous system abnormalities, particularly in patients co-infected with HIV.

Treatment and Management

• Treatment recommendations for secondary syphilitic uveitis are determined by the presence or absence of neurosyphilis.
• Patients meeting the definition of primary or secondary syphilis, with or without ocular disease, are classified as having early-stage disease [15].

It is essential to note that the management and treatment of secondary syphilitic uveitis have evolved over time. As such, this information may be considered obsolete in modern medical practice.

References:

[14] Moore reported that 4.6% of patients with early secondary syphilis had uveitis. [12] The most frequent manifestation of ocular syphilis in immunocompetent adults is posterior uveitis. [11] Posterior uveitis was the most common phenotype (55.2%) and CSF abnormalities were more common in HIV-positive patients (76%). [15] Patients meeting the definition of primary or secondary syphilis, with or without ocular disease, are classified as having early-stage disease.

Common manifestations of secondary syphilis include ocular symptoms, such as uveitis

According to the provided context, secondary syphilis is characterized by a range of systemic signs and symptoms, including ocular manifestations. Specifically:

• Uveitis: This is the most common ophthalmologic presentation of syphilis [12]. Uveitis can occur as soon as 6 weeks after primary infection or may appear years later.
• Red eyes: General signs and symptoms of syphilis may include redness in the eyes [13].
• Eye floaters: Eye floaters are another symptom that may be associated with syphilitic uveitis [13].
• Blurred vision or vision loss: Patients with syphilis may experience blurred vision or vision loss due to ocular complications [13].

It's essential to note that these symptoms can mimic other diseases, making diagnosis challenging. Therefore, it is crucial to consider syphilis in the differential diagnosis for patients presenting with uveitis, even without other signs or symptoms of syphilis [15].

Diagnostic Tests for Obsolete Secondary Syphilitic Uveitis

Obtaining an accurate diagnosis of syphilitic uveitis can be challenging, especially in cases where the disease is no longer active. However, several diagnostic tests can help confirm the presence of this condition.

• Non-treponemal tests: These tests, such as the Venereal Disease Research Laboratory (VDRL) slide test and the rapid plasma reagin (RPR) test, are useful for ruling out syphilis rather than establishing a diagnosis. They measure antibodies against the lipoidal antigen of the Treponema pallidum bacterium.
• Treponemal tests: These tests, such as the fluorescent treponemal antibody absorption (FTA-ABS) and the Treponema pallidum hemagglutination (TPHA) test, are more specific for diagnosing syphilis. They detect antibodies against the T. pallidum bacterium itself.
• Serologic tests: These tests measure the levels of antibodies in the blood to diagnose syphilitic uveitis. The overall accuracy of these tests is high, with a sensitivity and specificity of 100% reported in some studies [13][14].

It's essential to note that the diagnosis of syphilitic uveitis can be challenging, especially in cases where the disease is no longer active. A combination of clinical presentation, serologic testing, and imaging modalities may be necessary to confirm the diagnosis.

References:

[7] Nontreponemal tests for syphilis include the Venereal Disease Research Laboratory (VDRL) slide test and the rapid plasma reagin (RPR) test. These tests are useful for ruling out syphilis rather than establishing a diagnosis. [3] Serologic tests for syphilis included VDRL, fluorescent treponemal antibody absorption (FTA-ABS), and the Treponema pallidum hemagglutination (TPHA) test. [13] The overall accuracy of the diagnosis of syphilitic uveitis in the test set was 100% (95% CI 99.5, 100). [14] The overall accuracy of the diagnosis of syphilitic uveitis in the validation set was 100% (99% CI 99.5, 100) – i.e. the validation sets misclassification rates were 0% for each uveitic class.

Treatment Options for Obsolete Secondary Syphilitic Uveitis

Syphilitic uveitis, a complication of secondary syphilis, requires prompt and effective treatment to prevent vision loss. The primary goal is to eliminate the infection with antibiotics.

• Penicillin: Remains the mainstay of therapy for all stages and sites of syphilis, including obsolete secondary syphilitic uveitis [11]. The recommended dose is 2.4 million units of penicillin-G benzathine intramuscularly for two to three weeks.
• Parenteral Penicillin G: Has been used effectively in achieving clinical resolution and preventing sexual transmission [5].
• Ceftriaxone: Can be administered as an alternative to penicillin, especially in patients allergic to penicillin. A dose of 1–2 g intramuscularly (IM/IV) daily for 14 days has been documented as effective in treating ocular syphilis [9].

Adjunctive Therapy

• Steroids: May be added as part of the treatment regimen for uveitis and scleritis caused by syphilis. However, CDC guidelines note that steroids are not recommended due to potential complications [6].
• Systemic Corticosteroids: Are an important adjunct in the treatment of syphilitic posterior uveitis and optic neuritis [12].

Importance of Prompt Diagnosis and Treatment

Prompt diagnosis and management with antibiotics lead to good visual outcomes. However, delayed diagnosis can result in vision loss. It is essential to test every patient managed with uveitis for syphilis, as 82.5% of members tested every patient they managed with uveitis for syphilis [15].

References

[1] Syphilis was initially called the "French disease" by the people of Naples. [5] Parenteral penicillin G has been used effectively for achieving clinical resolution (ie, the healing of lesions and prevention of sexual transmission) [6] Steroids are also often added as part of the treatment regimen for uveitis and scleritis caused by syphilis. However, CDC guidelines note that steroids are not recommended due to potential complications. [9] A dose of 1–2 g intramuscularly (IM/IV) daily for 14 days has been documented as effective in treating ocular syphilis [11] Penicillin remains the mainstay of therapy for all stages and sites of syphilis. The most current published recommendation for the treatment of early syphilis-primary, secondary, or early latent are to give 2.4 MU of penicillin-G benzathine intramuscularly for two to three weeks [12] Systemic corticosteroids are an important adjunct in the treatment of syphilitic posterior uveitis and optic neuritis. [15] Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.

Differential Diagnosis of Obsolete Secondary Syphilitic Uveitis

Syphilitic uveitis, a form of ocular inflammation caused by the bacterium Treponema pallidum, can manifest at any stage of acquired syphilis. When considering the differential diagnosis for obsolete secondary syphilitic uveitis, several conditions should be taken into account.

• Rheumatic diseases: A thorough physical examination and general