Ocular Syphilis Cases- Does Chicago Follow the Same Trends As the West Coast?

Background: Between December 1, 2014 and March 25, 2015, 12 cases of ocular syphilis were reported on the West Coast; nine of these were in HIV co-infected men who have sex with men (MSM). Following the clinical advisory, the Chicago Department of Public Health (CDPH) sought to describe cases of ocular syphilis reported in 2015.

Methods:Retrospective review of surveillance and interview data for neurosyphilis/ocular syphilis cases in Chicago was conducted. Only cases meeting the CDC ocular syphilis case definition (i. e., a person with symptoms or signs of ocular disease with syphilis of any stage) were included in analysis. 

Results:Between January 1 and December 31, 2015, five cases were reported to CDPH.  All cases were in males, and 60% were MSM. The median age was 46 years (IQR 32 -58), 40% were Non-Hispanic White, 40% were Hispanic, and 20% were African Americans. Four were infected with HIV (median CD4 count =221 cells/ml and median HIV-RNA = 56,037 copies/ml). None of the HIV-infected patients was on antiretroviral therapy. Two patients were diagnosed with secondary syphilis and three with late latent syphilis. All had visual symptoms and underwent ophthalmologic evaluations, resulting in diagnoses of either panuvetis or choroiretinits. Two of three patients who underwent cerebrospinal fluid  analysis had positive venereal disease research laboratory testing. All patients received treatment with aqueous crystalline penicillin G IV for 14 days.  In the three patients for whom there was follow-up, ocular symptoms improved following treatment. 

Conclusions:In Chicago, most ocular syphilis occurred in MSM and was associated with uncontrolled HIV infection, consistent with trends noted in the West Coast. Prognosis was good following adequate treatment. Continued surveillance for ocular syphilis remains a priority.