Reported Ocular Syphilis Cases in Maryland, 2012-2015

Background:  In April 2015, CDC released a clinical advisory on ocular syphilis based on case reports from California and Washington State.  High syphilis rates prompted us to investigate the frequency of ocular involvement among reported cases in Maryland. 

Methods:  We queried the surveillance system to identify cases investigated between 2012 and 2015 which contained one of the following key words in the notes section: vision, blurry, ocular or optic. We reviewed identified cases individually to determine if they met the ocular syphilis CDC case definition. 

Results:  The key word query identified 105 cases investigated during 2012-2015. Upon review, 61 cases were excluded based on other non-syphilitic health issues. Manual case review identified 44 probable ocular syphilis cases during this time period: 5 in 2012, 12 in 2013, 10 in 2014 and 17 in 2015. Thirty-five (80%) cases were male and 17 cases were among men who have sex with men. Twenty-four (55%) cases were black and 18 (41%) white. Twenty-five (61%) cases were co-infected with HIV. Median age of the patients was 41 years (range = 20–67 years). Thirteen (30%) cases were staged as secondary syphilis presenting with a rash, 9 (20%) as early latent, 16 (36%) as late latent, 4 (9%) as unknown latent and 2 as unknown stage. Diagnoses included uveitis, iritis and retinitis. Thirty-eight (86%) had a positive serum RPR (titer range = 1:8-1:8192).

Conclusions:  Reports of ocular involvement in syphilis cases in Maryland are increasing. The majority of the reported ocular cases occurred in secondary or late latent syphilis cases. The cause of this upward trend is not clear at this time.  Maryland will continue to monitor ocular syphilis reports to identify significant increases overall or among certain vulnerable populations.