Ocular Syphilis and Human Immunodeficiency Virus Coinfection Among Syphilis Patients in North Carolina, 2014-2016

Overview

Journal Sex Transm Dis

Specialty Infectious Diseases

Date 2018 Sep 1

PMID 30169474

Citations 4

Authors

Anna B Cope

Victoria L Mobley

Sara E Oliver

Mara Larson

Nicole Dzialowy

Jason Maxwell

Jessica L Rinsky

Thomas A Peterman

Aaron Fleischauer

Erika Samoff

Affiliations

Soon will be listed here.

Abstract

Background: Ocular syphilis (OS) has been associated with human immunodeficiency virus (HIV) coinfection previously. We compared demographic and clinical characteristics of syphilis patients with and without HIV to identify risk factors for developing OS.

Methods: We reviewed all syphilis cases (early and late) reported to the North Carolina Division of Public Health during 2014 to 2016 and categorized HIV status (positive, negative, unknown) and OS status based on report of ocular symptoms with no other defined etiology. We estimated prevalence ratios (PR) and 95% confidence intervals (CI) for OS by HIV status. Among syphilis patients with HIV, we compared viral loads and CD4 cell counts by OS status. We compared symptom resolution by HIV status for a subset of OS patients.

Results: Among 7123 confirmed syphilis cases, 2846 (39.9%) were living with HIV, 109 (1.5%) had OS, and 59 (0.8%) had both. Ocular syphilis was more prevalent in syphilis patients with HIV compared to HIV-negative/unknown-status patients (PR, 1.8; 95% CI, 1.2-2.6). Compared with other patients with HIV, the prevalence of OS was higher in patients with viral loads greater than 200 copies/mL (1.7; 1.0-2.8) and in patients with a CD4 count of 200 cells/mL or less (PR, 2.3; 95% CI, 1.3-4.2). Among 11 patients with severe OS, 9 (81.8%) were HIV-positive. Among 39 interviewed OS patients, OS symptom resolution was similar for HIV-positive (70.0%) and HIV-negative/unknown-status (68.4%) patients.

Conclusions: Syphilis patients with HIV were nearly twice as likely to report OS symptoms as were patients without documented HIV. Human immunodeficiency virus-related immunodeficiency possibly increases the risk of OS development in co-infected patients.

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References

Sadiq S, McSorley J, Copas A, Bennett J, Edwards S, Kaye S . The effects of early syphilis on CD4 counts and HIV-1 RNA viral loads in blood and semen. Sex Transm Infect. 2005; 81(5):380-5. PMC: 1745048. DOI: 10.1136/sti.2004.012914. View

McLeish W, Pulido J, Holland S, Culbertson W, Winward K . The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host. Ophthalmology. 1990; 97(2):196-203. DOI: 10.1016/s0161-6420(90)32605-2. View

Zetola N, Klausner J . Syphilis and HIV infection: an update. Clin Infect Dis. 2007; 44(9):1222-8. DOI: 10.1086/513427. View

Bollemeijer J, Wieringa W, Missotten T, Meenken I, Ten Dam-van Loon N, Rothova A . Clinical Manifestations and Outcome of Syphilitic Uveitis. Invest Ophthalmol Vis Sci. 2016; 57(2):404-11. DOI: 10.1167/iovs.15-17906. View

Dyer J, Eron J, Hoffman I, Kazembe P, Vernazza P, Nkata E . Association of CD4 cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 (HIV-1) RNA concentrations with genital ulcer disease in HIV-1-infected men in Malawi. J Infect Dis. 1998; 177(1):224-7. DOI: 10.1086/517359. View

Kofoed K, Gerstoft J, Mathiesen L, Benfield T . Syphilis and human immunodeficiency virus (HIV)-1 coinfection: influence on CD4 T-cell count, HIV-1 viral load, and treatment response. Sex Transm Dis. 2006; 33(3):143-8. DOI: 10.1097/01.olq.0000187262.56820.c0. View

Browning D . Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. Ophthalmology. 2000; 107(11):2015-23. DOI: 10.1016/s0161-6420(00)00457-7. View

Woolston S, Cohen S, Fanfair R, Lewis S, Marra C, Golden M . A Cluster of Ocular Syphilis Cases - Seattle, Washington, and San Francisco, California, 2014-2015. MMWR Morb Mortal Wkly Rep. 2015; 64(40):1150-1. PMC: 4894317. DOI: 10.15585/mmwr.mm6440a6. View

Balba G, Kumar P, James A, Malani A, Palestine A, Welch J . Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy. Am J Med. 2006; 119(5):448.e21-5. DOI: 10.1016/j.amjmed.2005.11.016. View

10.

Biotti D, Bidot S, Mahy S, Buisson M, Duong M, Grappin M . Ocular syphilis and HIV infection. Sex Transm Dis. 2010; 37(1):41-3. DOI: 10.1097/OLQ.0b013e3181b3e4d8. View

11.

Mathew R, Goh B, Westcott M . British Ocular Syphilis Study (BOSS): 2-year national surveillance study of intraocular inflammation secondary to ocular syphilis. Invest Ophthalmol Vis Sci. 2014; 55(8):5394-400. DOI: 10.1167/iovs.14-14559. View

12.

Oliver S, Cope A, Rinsky J, Williams C, Liu G, Hawks S . Increases in Ocular Syphilis-North Carolina, 2014-2015. Clin Infect Dis. 2017; 65(10):1676-1682. PMC: 5740484. DOI: 10.1093/cid/cix604. View

13.

Parc C, Chahed S, Patel S, Salmon-Ceron D . Manifestations and treatment of ocular syphilis during an epidemic in France. Sex Transm Dis. 2007; 34(8):553-6. DOI: 10.1097/01.olq.0000253385.49373.1a. View

14.

Oliver S, Aubin M, Atwell L, Matthias J, Cope A, Mobley V . Ocular Syphilis - Eight Jurisdictions, United States, 2014-2015. MMWR Morb Mortal Wkly Rep. 2016; 65(43):1185-1188. DOI: 10.15585/mmwr.mm6543a2. View

15.

Shalaby I, Dunn J, Semba R, Jabs D . Syphilitic uveitis in human immunodeficiency virus-infected patients. Arch Ophthalmol. 1997; 115(4):469-73. DOI: 10.1001/archopht.1997.01100150471003. View

16.

Villanueva A, Sahouri M, Ormerod L, Puklin J, Reyes M . Posterior uveitis in patients with positive serology for syphilis. Clin Infect Dis. 2000; 30(3):479-85. DOI: 10.1086/313689. View

17.

Buchacz K, Patel P, Taylor M, Kerndt P, Byers R, Holmberg S . Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS. 2004; 18(15):2075-9. PMC: 6763620. DOI: 10.1097/00002030-200410210-00012. View

18.

Tucker J, Li J, Robbins G, Davis B, Lobo A, Kunkel J . Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect. 2010; 87(1):4-8. PMC: 3103105. DOI: 10.1136/sti.2010.043042. View

19.

Lee S, Cheng V, Rodger D, Rao N . Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection. J Ophthalmic Inflamm Infect. 2015; 5(1):56. PMC: 4546070. DOI: 10.1186/s12348-015-0056-x. View

20.

Kuo I, Kapusta M, RAO N . Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection. Am J Ophthalmol. 1998; 125(3):306-11. DOI: 10.1016/s0002-9394(99)80136-6. View