The Centers for Disease Control and Prevention (CDC) has issued a clinical advisory on ocular syphilis due to recent confirmed and suspected cases in several states.

At least 15 cases of ocular syphilis in California and Washington have been reported to the CDC since December 2014 and at least five other states have suspected cases under investigation. The majority of cases have been among men who have sex with men (MSM) with HIV, but some cases have occurred among HIV-uninfected individuals including heterosexual men and women. Although ocular syphilis (a clinical manifestation of neurosyphilis that can occur during any stage of syphilis including primary and secondary syphilis) may involve almost any eye structure, posterior uveitis and panuveitis are most common.

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The CDC advises the following for clinicians:

  • Clinicians should be aware of ocular syphilis and screen for visual complaints in any patient at risk for syphilis. This includes MSM, HIV-infected persons, persons with risk factors, and persons with multiple or anonymous partners.
  • All patients with syphilis should receive an HIV test if status is unknown or previously HIV-negative.
  • Patients with positive syphilis serology and early syphilis without ocular symptoms should receive a careful neurologic exam, including all cranial nerves.
  • Patients with syphilis and ocular complaints should receive immediate ophthalmologic evaluation.
  • A lumbar puncture with cerebrospinal fluid (CSF) examination should be performed in patients with syphilis and ocular complaints.
  • Ocular syphilis should be managed according to treatment recommendations for neurosyphilis. Aqueous crystalline penicillin G IV or Procaine penicillin IM with probenecid for 10–14 days (see the 2010 STD Treatment Guidelines for more information). 
  • Cases of ocular syphilis should be reported to your state or local health department within 24 hours of diagnosis. Ocular syphilis cases diagnosed since December 1, 2014, should be reported through your local or state health department to CDC by email. The case definition for an ocular syphilis case is as follows: a person with clinical symptoms or signs consistent with ocular disease (ie, uveitis, panuveitis, diminished visual acuity, blindness, optic neuropathy, interstitial keratitis, anterior uveitis, and retinal vasculitis) with syphilis of any stage.
  • If possible, pre-antibiotic clinical samples (whole blood, primary lesions and moist secondary lesions, CSF or ocular fluid) should be saved and stored at -80°C for molecular typing.

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