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Rare Yet Alarming: US Study Maps Syphilitic Uveitis Trends
Between 2013 and 2024, syphilitic uveitis remained a rare but serious manifestation of syphilis in the United States, predominantly affecting men, older individuals, and patients with concurrent HIV, and frequently resulting in low vision and blindness.
METHODOLOGY:
Researchers analyzed data from a national clinical database to determine the incidence and prevalence of syphilitic uveitis in the United States, as well as the rates of sexually transmitted coinfections and associated ocular complications.
Participants with syphilitic uveitis were identified using diagnostic codes for uveitis and positive treponemal and nontreponemal test for syphilis obtained within 1 month of a diagnosis of uveitis.
Data collection included demographic information and rates of concurrent sexually transmitted infections, including HIV, gonorrhea, and chlamydia; these infections were recorded if diagnosed at the time of, or within 1 month after, a diagnosis of uveitis.
Ocular complications included macular edema and low vision or blindness, identified at the time of a diagnosis of uveitis or within 6 months thereafter.
TAKEAWAY:
The researchers identified 161,317 cases of syphilis and 237 cases of syphilitic uveitis; from 2013 to 2024, the cumulative incidence and prevalence rates of syphilitic uveitis were 0.36 and 0.27 per 100,000 individuals, respectively, with both incidence and prevalence increasing over this period.
Compared with the general population in the same database, patients with syphilitic uveitis were more likely to be men and older.
HIV was the most common concurrent sexually transmitted infection, occurring in 32.49% of cases; gonorrhea and chlamydia occurred less frequently, at 4.22%.
The most common complication was low vision or blindness, occurring predominantly in patients with panuveitis or posterior uveitis.
IN PRACTICE:
'Our findings reinforce the need for ordering syphilis testing at uveitis presentation and the prompt initiation of intravenous antibiotic therapy thereafter to prevent irreversible ocular damage,' the researchers wrote.
SOURCE:
The study was led by Lucy Ruoxi Zhou, of the Drexel University College of Medicine in Philadelphia. It was published online on June 4, 2025, in the American Journal of Ophthalmology .
LIMITATIONS:
The reliance on electronic health record databases may have introduced coding variability and inaccuracies. The requirement for syphilis testing to occur within 1 month after a diagnosis of uveitis potentially excluded patients tested before or on the same day as their diagnosis or those experiencing diagnostic delays longer than 1 month. This study could not assess prescribed treatments and changes in clinical endpoints, including improvement in vision or resolution of macular edema after treatment.
DISCLOSURES:
One author received support from the Hankins and Dracopoulos Uveitis Research Funds.
