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Maintain high level of suspicion for syphilis in young men presenting with uveitis
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KOLOA, Hawaii — Syphilis is a diagnosis that is easy to miss, but in a young man presenting with uveitis, it should be a consideration, a speaker here said.
“Syphilis can present in many, many ways. You need a high level of suspicion,” Sunil K. Srivastava, MD, said at Retina 2017, where he gave an update on infectious uveitis.
Sunil K. Srivastava
Syphilis can present as anterior uveitis, intermediate uveitis or posterior/panuveitis, as outer retinal whitening, as a punctate presentation or as a combination of findings, he said.
The demographics in the U.S. are such that 90% of cases are in men, he said.
“So, [for] young men with new-onset uveitis, you should be thinking syphilis,” Srivastava said.
The diagnosis can be missed in patients with inflammatory disease taking prednisone, which could mask some results.
However, the recommendations now of the Centers for Disease Control and Prevention is to obtain a treponemal test first (FTA-Abs, syphilis IgG), followed by non-treponemal tests (RPR, VDRL), then treatment for neurosyphilis, if positive, he said. – by Patricia Nale, ELS
Reference:
Srivastava SK. Update on infectious uveitis – 5 cool cases. Presented at: Retina 2017; Jan. 16-20, 2017; Koloa, Hawaii.
Disclosure: Srivastava reports he is a consultant or on the advisory board for Bausch + Lomb, Allergan, Clearside, Regeneron, Eleven, Santen, Sanofi, Zeiss and Optos; he has received research grant funding from Bausch + Lomb, Allergan, Novartis, Clearside, Zeiss and Sanofi; he receives licensing royalties from Bioptigen and Synergetics; and has loan agreements with Heidelberg.