Clinical Features of Syphilis Patients with Ocular Symptoms as the Initial Manifestation

PURPOSE: This study aimed to investigate the clinical features of patients with syphilis having ocular symptoms as the initial manifestation. PATIENTS AND METHODS: Eleven patients diagnosed with ocular syphilis at Dokkyo Medical University Hospital and Jichi Medical University Hospital between November 2018 and April 2022 were studied retrospectively. RESULTS: Six patients were diagnosed with secondary, three were latent, and one was tertiary stage syphilis. Ten out of 11 patients underwent cerebrospinal fluid analysis, and 1 refused. Nine out of 10 patients tested positive, of which 4 presented with neurological symptoms and the others were asymptomatic. Nine out of 11 patients tested negative for human immunodeficiency virus. Antiluetic therapy was administered to 10 out of 11 patients, which improved or maintained visual acuity at −0.1 logMAR in 9 patients. One patient achieved the best-corrected visual acuity −0.1 logMAR in one eye, whereas the other showed no improvement due to severe chorioretinal degeneration. CONCLUSION: Ocular syphilis presents with various clinical findings and has no significant ocular manifestations without acute syphilitic posterior placoid chorioretinitis. Patients diagnosed with syphilis based on ocular symptoms should undergo cerebrospinal fluid analysis.