Ocular syphilis: clinical and demographic spectrum - A case series from Colombia

Ocular syphilis: clinical and demographic spectrum - A case series from Colombia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ocular syphilis: clinical and demographic spectrum - A case series from Colombia Sara Margarita Pérez-Pérez, Luciana García Dussan, Juan Camilo Sánchez, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9559477/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Purpose To describe the clinical and demographic characteristics of ocular syphilis based on a case series of patients evaluated at a tertiary ophthalmology unit in Bogotá, Colombia. Methods A descriptive observational study was conducted through a retrospective review of medical records from 23 patients diagnosed with syphilis and ocular involvement between January 2023 and July 2024 at San Ignacio University Hospital, Bogotá. Collected data included demographic characteristics, medical history (including HIV coinfection), ophthalmologic findings at presentation and follow-up, diagnostic tests, and treatment. Data were analyzed using frequency tables and descriptive statistics. Results The study included 23 patients, 18 men and 5 women, with a total of 33 affected eyes. Bilateral involvement was observed in 10 patients, while unilateral right and left involvement occurred in 8 and 5 eyes, respectively. The mean age was 35 years (range: 13 days – 73 years), and the mean symptom duration before presentation was 19 days. Non-treponemal serologic testing was reactive in 22 patients. HIV coinfection was identified in 6 patients, including previously known, recently diagnosed, and de novo cases. Neuroretinitis was the most common ocular manifestation, followed by chorioretinitis. Baseline visual acuity ranged from light perception to 20/20. After penicillin treatment, visual acuity improved in 27 eyes, remained stable in 2, and worsened in 4. Mean follow-up time was 12 days. Overall, patients with active ocular inflammation showed favorable responses to treatment when diagnosed and managed promptly. Conclusions Ocular syphilis represents a significant diagnostic challenge due to its heterogeneous clinical presentation. Early recognition, appropriate serologic testing, and timely treatment are critical to reduce inflammation and optimize visual outcomes. Syphilis Ocular Uveitis Neuroretinitis Chorioretinitis Treponema pallidum HIV Coinfection Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Syphilis is a sexually transmitted bacterial infection caused by the Treponema Pallidum bacterium, which unfolds through distinct stages - early (primary, secondary, and early latent) and late (or tertiary) stages ( 1 ). This multistage disease involves systemic dissemination of the bacteria, inducing persistent chronic inflammation in various tissues, initiated by contact of the bacteria with the skin or mucous membranes, then the bacteria multiply locally and spread through blood and lymphatic vessels for several days. The subsequent appearance of a painless ulcer (or "chancre") typically occurs 2–4 weeks later, marking the onset of secondary syphilis with pronounced systemic features manifesting within 4–10 weeks of infection. Despite adaptive immune responses and opsonic antibodies, the host may take weeks or months to control the pathogen, resulting in asymptomatic latent syphilis. Early latency (first 4 years post-infection) may involve spirochetemia recurrences and clinical relapses, reflecting the host's struggle to fully eradicate the bacteria. Progressing to late latency, 15–40% of individuals develop recrudescent tertiary syphilis years later ( 2 ). Ocular syphilis, although rare, occurs predominantly in secondary and tertiary syphilis, as well as in its latent phases ( 3 ). However, documented cases reveal that ocular involvement can occur in any of the three phases, even in the presence or absence of coinfections such as HIV. Unfortunately, ocular involvement may be asymptomatic or manifest as the sole symptom, presenting a wide range of clinical presentations and mimicking various eye diseases ( 4 ), thereby posing challenges to prompt diagnosis and treatment, potentially leading to irreversible visual consequences. The most common complaint in patients with ocular involvement is blurred or decreased vision. Following a decline due to antibiotic use, syphilis has experienced a global resurgence since the year 2000, predominantly in developing countries ( 5 ). This resurgence coincides with the HIV crisis and shifts in sexual behaviors, especially among men who have sex with men ( 6 ). In this study, we present a series of 23 cases of ocular syphilis diagnosed at our ophthalmology unit, mainly describing the demographic, clinical, and laboratory characteristics, with the aim of improving the understanding of the natural evolution and prognosis of the disease. METHODS Subjects The medical records of 23 patients diagnosed with syphilis with ocular manifestations were retrospectively collected between January 2023 and July 2024, in the ophthalmology unit of San Ignacio University Hospital in Bogotá, Colombia. The diagnosis of ocular syphilis was based on positive serum test results of Treponema pallidum particle agglutination (TPPA), rapid plasma reagin (RPR), as well as ophthalmic examinations. Detailed medical records were collected and analyzed, including systemic and ophthalmic history, complete ophthalmic examination, spectral domain optical coherence tomography (SD-OCT), laboratory tests of serum and cerebrospinal fluid (CSF) samples, as well as visual field testing and orbital or cranial MRI in cases with suspected optic neuritis or optic atrophy. Ophthalmic Examination A complete ophthalmologic examination was performed in the 23 patients including slit-lamp examination and ophthalmoscopy, some of them required SD-OCT. Visual acuity was tested using the snellen table, SD-OCT was performed using radial linear scan (10 mm in length) centered at fovea for outer retina analysis by RTVue XR (Optovue Inc, USA). Orbital or Cranial MRI Examination Patients with suspected optic neuritis, optic atrophy, or cranial nerve III, VI paralysis underwent orbital or cranial MRI examination using T1, T2-weighted imaging sequence with fat suppression and T1-weighted imaging sequence with gadolinium-enhancement. Serum and CSF Test All patients underwent serum tests including TPPA and RPR (or TRUST). 14 cases also underwent serum tests for IgM or IgG antibodies of other pathogens including herpes viruses, CMV, toxoplasma gondii, and HIV. 12 patients underwent lumbar puncture for CSF tests including RPR, white cell counting, and protein quantity. Antibiotic Therapy All patients underwent standard neurosyphilis treatment regimen, i.e., intravenous injection of penicillin G benzathine 4 ~ 6 million units per 6 hours for 2 weeks. 2 cases were treated with intravenous injection of ceftriaxone 2.0 per 12 hours for 2 weeks, due to in-hospital shortage of medication, Among which, none showed positive skin test results for penicillin. Topical steroids with or without cycloplegic eye drops were routinely used in patients with active uveitis. Grouping and Statistics Analysis Table 1 Patient Characteristics N = 33 eyes (23 patients) n % Male 18 78 Age (years) 0–10 1 4 11–20 1 4 21–30 8 35 31–40 5 22 41–50 2 9 71–80 1 4 Female 5 22 Age (years) 41–50 3 13 51 – 60 2 9 VIH test Reactive 6 26 Non reactive 15 65 No test 2 9 Non treponemal test Reactive 22 96 Non reactive 1 4 Toxoplasma test IGM negative IGG negative 9 39 IGM negative IGG positive 3 13 Not applied 11 48 Eye involved Right eye 8 35 Left eye 5 22 Both eye 10 43 DISCUSSION Syphilis is a sexually transmitted infection caused by Treponema Pallidum, a Gram-negative motile spirochete, associated with high morbidity and mortality if untreated ( 7 ). It is transmitted through sexual contact with infectious lesions via oral, vaginal or anal, transplacental routes and spreads hematogenously. Although the eye is considered a relatively uncommon site of syphilitic infection, it occurs approximately with a frequency described in the literature of 0.6–2.7% ( 8 ). However, the increase in the incidence of syphilis globally over the last two decades underscores its importance as a public health problem, with estimates that approximately 8 million adults between 15 and 49 years of age will acquire the disease in 2022 according to data from the WHO ( 9 ). This increase is especially notable in high-risk groups such as gay men and men who have sex with men (MSM), with a global syphilis prevalence of 7.5% compared to 0.5% in the general population between 2000 and 2020. Coexistence with HIV can aggravate the severity of syphilis and increase the likelihood of central nervous system involvement. Therefore, it is essential to consider syphilis as part of the differential diagnosis in patients with visual disorders, given its increasing incidence and implications for global public health ( 10 ). In the current study, characteristics of ocular syphilis are reported in an ophthalmological care reference center in Bogotá, Colombia. The clinical manifestations of ocular syphilis can mimic any other ocular disease. Timely treatment of these patients can minimize visual damage, but their diagnosis is often a challenge for the ophthalmologist ( 11 ). More than half of the patients in our study were men (78%) as was found in other studies ( 12 – 13 – 14 ) ( 15 – 16 ). (Table 1 ) Six of them (26%) had HIV coinfection, a prevalence similar to that reported in the literature ( 16 – 17 ). While the literature describes a mean age of presentation close to 40.2 years, in our series we observed a mean of 35 years, with a predominance of cases in the 21 to 30 year range (Fig. 1 ). Regarding ocular involvement, it was predominantly unilateral (57%) although significant bilateral involvement was also observed (43%), an aspect frequently documented in other studies ( 18 ). The ocular manifestations in syphilis can be varied since they can compromise any anatomical structure of the eye. The forms of presentation are multiple, including ocular pain, conjunctival erythema, photophobia and decreased visual acuity. In some studies, disorders in the posterior pole are mentioned as the most frequent finding ( 19 ), which is consistent with the findings in our study, in which eight patients presented neuroretinitis (35%) and three chorioretinitis (13%) (Figs. 2 and 3). Other literature mentions uveitis as the most common finding ( 13 – 14 – 15 – 16 – 17 ). In our study, 22% of patients presented with panuveitis, we had 3 patients with non-granulomatous anterior uveitis (13%) and 1 case of intermediate and posterior uveitis (4%). Other ocular manifestations described are optic neuritis, vitritis, vasculitis, retinal detachment and retinal necrosis, in most cases non-specific, however, two specific findings such as acute syphilitic posterior placoid chorioretinitis and superficial retinal precipitates have been reported, proposed as highly specific to guide the diagnosis. Regarding HIV coinfection, we did not find significant differences in clinical presentation; this is consistent with previous reports that did not report differences in clinical presentation or outcome between HIV-infected and non-HIV-infected individuals ( 17 – 18 – 19 ). In our cohort, the majority of cases with posterior segment involvement were considered strongly suggestive of ocular syphilis (56.5%), underscoring the importance of maintaining a high index of suspicion for this infection. However, a substantial proportion of patients presented with overlapping features that required differentiation from other infectious etiologies: 34.8% of cases were clinically indistinguishable from ocular toxoplasmosis, while 8.7% showed similarities with herpetic retinitis. These findings highlight the overlapping manifestations of ocular syphilis and the diagnostic challenge it poses, often mimicking other infectious uveitides. (Fig. 4 ). From the total of 33 eyes that showed manifestations due to syphilis infection, twenty-seven eyes (82%) showed improvement in visual acuity, four eyes (12%) showed a worsening of visual acuity, and two eyes (6%) maintained the same visual acuity. Regarding laboratory tests, twenty-two (96%) of the patients had a positive non-treponemal RPR test, with an average dilution for men of 329 and women of 299. The treatment was crystalline Penicillin G 4,000,000 IU every 4 hours for 14 days for all patients, of whom cyclopentolate was added to three (13%) and ganciclovir to two (9%). The follow-up lasted an average of 12 days. At discharge, more than half of the patients (70%) showed a reduction in intraocular inflammation. The current study has limitations due to its retrospective design, limited number of cases, incomplete examination data, insufficient follow-up time, and assessments made at different time intervals by different evaluators that must be considered in its interpretation. To support these findings, larger prospective studies are needed. CONCLUSION Ocular syphilis represents a significant diagnostic challenge in ophthalmology practice due to the diversity of presentations that can be nonspecific, as well as their similarity to other ocular diseases. Therefore, it is vital to have an in-depth understanding of the most frequent manifestations and to maintain a high level of rigor in the ophthalmologic evaluation, which could facilitate the timely performance of the corresponding diagnostic tests, bearing in mind that early initiation of treatment is associated with decreased inflammation and better visual prognosis. Declarations Funding The authors received no financial support for the research, authorship, and/or publication of this article. Conflicts of interest The authors declare that they have no competing interests. Ethics approval This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Ethics Committee of Hospital Universitario San Ignacio, Bogotá, Colombia. Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee. No identifiable personal information is included in this manuscript. Consent to participate Not applicable due to the retrospective design of the study and the use of anonymized clinical data. Written consent for publication Not applicable. This study is based on retrospective analysis of anonymized clinical data. Availability of data and material The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy considerations but are available from the corresponding author on reasonable request. Code availability Not applicable. Authors’ contributions S.M.P.P. contributed to the conception and design of the study, data collection, and manuscript drafting. L.G.D. contributed to data analysis, interpretation of results, and critical revision of the manuscript. J.C.S. contributed to literature review, data analysis and manuscript drafting. C.E.M. contributed to study supervision and critical revision of the manuscript. All authors read and approved the final manuscript. References Chen Z-Q, Zhang G-C, Gong X-D, Lin C, Gao X, Liang G-J, et al. Syphilis in China: results of a national surveillance programme. Lancet. 2007;369:132–38. Rangel CM, Ortiz AI, Varón CL, Acuña MF, Moreno NJ, Prada AM, Sánchez-Avila RM. Sífilis ocular en una población Colombiana: manifestaciones clínicas y resultados del tratamiento. Revista Sociedad Colombiana de Oftalmología. 2019;52(2):87–94. Sun C, Bin, Liu GH, Wu R, Liu Z. Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China. Front Immunol. 2022;13:1–9. Aguilar-González M, Fernández-Santodomingo AS, Marín-Payá E, Rahhal-Ortuño M, Udaondo P. Bilateral exudative retinal detachment in undiagnosed ocular syphilis after treatment with corticosteroids. Eur J Ophthalmol. 2019;31(2):86–90. Pratas AC, Goldschmidt P, Lebeaux D, Aguilar C, Ermak N, Benesty J, Charlier C, Benveniste E, Merabet L, Sedira N, Hope-Rapp E, Chaumeil C, Bodaghi B, Héron E, Sahel JA, Lortholary O, Errera MH. Increase in Ocular Syphilis Cases at Ophthalmologic Reference Center, France, 2012–2015. Emerg Infect Dis. 2018;24(2):193–200. Gu X, Gao Y, Yan Y, Marks M, Zhu L, Lu H, Guan Z, Shi M, Ni L, Peng R, Zhao W, Wu J, Qi T, Lu S, Qian Y, Gong W, Zhou P. The importance of proper and prompt treatment of ocular syphilis: a lesson from permanent vision loss in 52 eyes. J Eur Acad Dermatol Venereol. 2020;34(7):1569–78. Shen J, Feng L, Li Y. Ocular syphilis: an alarming infectious eye disease. Int J Clin Exp Med. 2015;8(5):7770–7. World Health Organization. Data on syphilis, Appears in: Sexually Transmitted Infections [document on the internet] Available from: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/data-on-syphilis World Health Organization. Syphilis [document on the internet]. 2025 May. Available from: https://www.who.int/news-room/fact-sheets/detail/syphilis Tsuboi M, Evans J, Davies EP, Rowley J, Korenromp EL, Clayton T, Taylor MM, Mabey D, Chico RM. Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000-20. Lancet Glob Health. 2021;9(8):1110–e1118. Artiles K, Ambou I, Pérez A, Lascaiba N. Ocular syphilis, the great pretender. Revista Cubana de Oftalmología. 2023;36(1). Borges CR, De Almeida SM, Sue K, Koslyk JLA, Sato MT, Shiokawa N, et al. Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: A case series. Arquivos de Neuro-Psiquiatría. 2018;76(6):373–80. Camporro JP, Del Castillo M, Mora CA. Ocular syphilis: alert for clinicians and ophthalmologists. Medicina (B. Aires) 2023 Dic;83(6): 972–975. Majunder PD, Chen EJ, Shah J, Ho DC, Biswas J, Yin LS, et al. Ocular syphilis: an update. Ocul Immunol Inflamm. 2017;11:1–9. Rodrigues R, Salomao G, Nascimento H, Muccioli C. Yellowish dots in the retina: a new finding of ocular syphilis? Investig Ophthalmol Vis Sci. 2023 June;54(15). Jahnke S, Sunderkötter C, Lange D, Wienrich R, Kreft B. Ocular syphilis - a case series of four patients. J Dtsch Dermatol Ges. 2021;19(7):987–91. Harvey J, Lee IJ, Lee CS, Hinkle D. Ocular syphilis on the rise: a 10-year analysis from 2010 to 2020. Int Ophthalmol. 2023;43(12):4419–26. Furtado J, Simões M, Vasconcelos D, Oliver G, Tyagi M, Nascimento H, Gordon D, Smith J. Ocular syphilis. Surv Ophthalmol. 2022(2): 440–62. Tsan GL, Claiborne RT. Ocular syphilis. Clin experimental optometry. 2021;104(7):756–9. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9559477","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639237288,"identity":"54455ff8-c2fe-4c4b-a8ec-352316a9e831","order_by":0,"name":"Sara Margarita 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bacterial infection caused by the Treponema Pallidum bacterium, which unfolds through distinct stages - early (primary, secondary, and early latent) and late (or tertiary) stages (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This multistage disease involves systemic dissemination of the bacteria, inducing persistent chronic inflammation in various tissues, initiated by contact of the bacteria with the skin or mucous membranes, then the bacteria multiply locally and spread through blood and lymphatic vessels for several days. The subsequent appearance of a painless ulcer (or \"chancre\") typically occurs 2\u0026ndash;4 weeks later, marking the onset of secondary syphilis with pronounced systemic features manifesting within 4\u0026ndash;10 weeks of infection. Despite adaptive immune responses and opsonic antibodies, the host may take weeks or months to control the pathogen, resulting in asymptomatic latent syphilis. Early latency (first 4 years post-infection) may involve spirochetemia recurrences and clinical relapses, reflecting the host's struggle to fully eradicate the bacteria. Progressing to late latency, 15\u0026ndash;40% of individuals develop recrudescent tertiary syphilis years later (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOcular syphilis, although rare, occurs predominantly in secondary and tertiary syphilis, as well as in its latent phases (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, documented cases reveal that ocular involvement can occur in any of the three phases, even in the presence or absence of coinfections such as HIV. Unfortunately, ocular involvement may be asymptomatic or manifest as the sole symptom, presenting a wide range of clinical presentations and mimicking various eye diseases (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), thereby posing challenges to prompt diagnosis and treatment, potentially leading to irreversible visual consequences. The most common complaint in patients with ocular involvement is blurred or decreased vision. Following a decline due to antibiotic use, syphilis has experienced a global resurgence since the year 2000, predominantly in developing countries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This resurgence coincides with the HIV crisis and shifts in sexual behaviors, especially among men who have sex with men (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, we present a series of 23 cases of ocular syphilis diagnosed at our ophthalmology unit, mainly describing the demographic, clinical, and laboratory characteristics, with the aim of improving the understanding of the natural evolution and prognosis of the disease.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThe medical records of 23 patients diagnosed with syphilis with ocular manifestations were retrospectively collected between January 2023 and July 2024, in the ophthalmology unit of San Ignacio University Hospital in Bogot\u0026aacute;, Colombia. The diagnosis of ocular syphilis was based on positive serum test results of Treponema pallidum particle agglutination (TPPA), rapid plasma reagin (RPR), as well as ophthalmic examinations. Detailed medical records were collected and analyzed, including systemic and ophthalmic history, complete ophthalmic examination, spectral domain optical coherence tomography (SD-OCT), laboratory tests of serum and cerebrospinal fluid (CSF) samples, as well as visual field testing and orbital or cranial MRI in cases with suspected optic neuritis or optic atrophy.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOphthalmic Examination\u003c/h3\u003e\n\u003cp\u003eA complete ophthalmologic examination was performed in the 23 patients including slit-lamp examination and ophthalmoscopy, some of them required SD-OCT. Visual acuity was tested using the snellen table, SD-OCT was performed using radial linear scan (10 mm in length) centered at fovea for outer retina analysis by RTVue XR (Optovue Inc, USA).\u003c/p\u003e\n\u003ch3\u003eOrbital or Cranial MRI Examination\u003c/h3\u003e\n\u003cp\u003ePatients with suspected optic neuritis, optic atrophy, or cranial nerve III, VI paralysis underwent orbital or cranial MRI examination using T1, T2-weighted imaging sequence with fat suppression and T1-weighted imaging sequence with gadolinium-enhancement.\u003c/p\u003e\n\u003ch3\u003eSerum and CSF Test\u003c/h3\u003e\n\u003cp\u003eAll patients underwent serum tests including TPPA and RPR (or TRUST). 14 cases also underwent serum tests for IgM or IgG antibodies of other pathogens including herpes viruses, CMV, toxoplasma gondii, and HIV. 12 patients underwent lumbar puncture for CSF tests including RPR, white cell counting, and protein quantity.\u003c/p\u003e\n\u003ch3\u003eAntibiotic Therapy\u003c/h3\u003e\n\u003cp\u003eAll patients underwent standard neurosyphilis treatment regimen, i.e., intravenous injection of penicillin G \u003cem\u003ebenzathine\u003c/em\u003e 4\u0026thinsp;~\u0026thinsp;6\u0026nbsp;million units per 6 hours for 2 weeks. 2 cases were treated with intravenous injection of ceftriaxone 2.0 per 12 hours for 2 weeks, due to in-hospital shortage of medication, Among which, none showed positive skin test results for penicillin. Topical steroids with or without cycloplegic eye drops were routinely used in patients with active uveitis.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eGrouping and Statistics Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;33 eyes (23 patients)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e71\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51 \u0026ndash; 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVIH test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon reactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon treponemal test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon reactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eToxoplasma test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIGM negative IGG negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIGM negative IGG positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot applied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEye involved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSyphilis is a sexually transmitted infection caused by Treponema Pallidum, a Gram-negative motile spirochete, associated with high morbidity and mortality if untreated (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It is transmitted through sexual contact with infectious lesions via oral, vaginal or anal, transplacental routes and spreads hematogenously. Although the eye is considered a relatively uncommon site of syphilitic infection, it occurs approximately with a frequency described in the literature of 0.6\u0026ndash;2.7% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, the increase in the incidence of syphilis globally over the last two decades underscores its importance as a public health problem, with estimates that approximately 8\u0026nbsp;million adults between 15 and 49 years of age will acquire the disease in 2022 according to data from the WHO (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This increase is especially notable in high-risk groups such as gay men and men who have sex with men (MSM), with a global syphilis prevalence of 7.5% compared to 0.5% in the general population between 2000 and 2020. Coexistence with HIV can aggravate the severity of syphilis and increase the likelihood of central nervous system involvement. Therefore, it is essential to consider syphilis as part of the differential diagnosis in patients with visual disorders, given its increasing incidence and implications for global public health (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the current study, characteristics of ocular syphilis are reported in an ophthalmological care reference center in Bogot\u0026aacute;, Colombia. The clinical manifestations of ocular syphilis can mimic any other ocular disease. Timely treatment of these patients can minimize visual damage, but their diagnosis is often a challenge for the ophthalmologist (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMore than half of the patients in our study were men (78%) as was found in other studies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Six of them (26%) had HIV coinfection, a prevalence similar to that reported in the literature (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). While the literature describes a mean age of presentation close to 40.2 years, in our series we observed a mean of 35 years, with a predominance of cases in the 21 to 30 year range (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Regarding ocular involvement, it was predominantly unilateral (57%) although significant bilateral involvement was also observed (43%), an aspect frequently documented in other studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The ocular manifestations in syphilis can be varied since they can compromise any anatomical structure of the eye. The forms of presentation are multiple, including ocular pain, conjunctival erythema, photophobia and decreased visual acuity. In some studies, disorders in the posterior pole are mentioned as the most frequent finding (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), which is consistent with the findings in our study, in which eight patients presented neuroretinitis (35%) and three chorioretinitis (13%) (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and 3). Other literature mentions uveitis as the most common finding (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In our study, 22% of patients presented with panuveitis, we had 3 patients with non-granulomatous anterior uveitis (13%) and 1 case of intermediate and posterior uveitis (4%). Other ocular manifestations described are optic neuritis, vitritis, vasculitis, retinal detachment and retinal necrosis, in most cases non-specific, however, two specific findings such as acute syphilitic posterior placoid chorioretinitis and superficial retinal precipitates have been reported, proposed as highly specific to guide the diagnosis. Regarding HIV coinfection, we did not find significant differences in clinical presentation; this is consistent with previous reports that did not report differences in clinical presentation or outcome between HIV-infected and non-HIV-infected individuals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn our cohort, the majority of cases with posterior segment involvement were considered strongly suggestive of ocular syphilis (56.5%), underscoring the importance of maintaining a high index of suspicion for this infection. However, a substantial proportion of patients presented with overlapping features that required differentiation from other infectious etiologies: 34.8% of cases were clinically indistinguishable from ocular toxoplasmosis, while 8.7% showed similarities with herpetic retinitis. These findings highlight the overlapping manifestations of ocular syphilis and the diagnostic challenge it poses, often mimicking other infectious uveitides. (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrom the total of 33 eyes that showed manifestations due to syphilis infection, twenty-seven eyes (82%) showed improvement in visual acuity, four eyes (12%) showed a worsening of visual acuity, and two eyes (6%) maintained the same visual acuity. Regarding laboratory tests, twenty-two (96%) of the patients had a positive non-treponemal RPR test, with an average dilution for men of 329 and women of 299. The treatment was crystalline Penicillin G 4,000,000 IU every 4 hours for 14 days for all patients, of whom cyclopentolate was added to three (13%) and ganciclovir to two (9%). The follow-up lasted an average of 12 days. At discharge, more than half of the patients (70%) showed a reduction in intraocular inflammation.\u003c/p\u003e \u003cp\u003eThe current study has limitations due to its retrospective design, limited number of cases, incomplete examination data, insufficient follow-up time, and assessments made at different time intervals by different evaluators that must be considered in its interpretation. To support these findings, larger prospective studies are needed.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOcular syphilis represents a significant diagnostic challenge in ophthalmology practice due to the diversity of presentations that can be nonspecific, as well as their similarity to other ocular diseases. Therefore, it is vital to have an in-depth understanding of the most frequent manifestations and to maintain a high level of rigor in the ophthalmologic evaluation, which could facilitate the timely performance of the corresponding diagnostic tests, bearing in mind that early initiation of treatment is associated with decreased inflammation and better visual prognosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Ethics Committee of Hospital Universitario San Ignacio, Bogotá, Colombia. Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee. No identifiable personal information is included in this manuscript.\u003c/p\u003e\n\u003col start=\"4\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eNot applicable due to the retrospective design of the study and the use of anonymized clinical data.\u003c/p\u003e\n\u003col start=\"5\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eWritten consent for publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eNot applicable. This study is based on retrospective analysis of anonymized clinical data.\u003c/p\u003e\n\u003col start=\"6\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient privacy considerations but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003col start=\"7\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003col start=\"8\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eS.M.P.P. contributed to the conception and design of the study, data collection, and manuscript drafting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eL.G.D. contributed to data analysis, interpretation of results, and critical revision of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJ.C.S. contributed to literature review, data analysis and manuscript drafting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eC.E.M. contributed to study supervision and critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen Z-Q, Zhang G-C, Gong X-D, Lin C, Gao X, Liang G-J, et al. Syphilis in China: results of a national surveillance programme. Lancet. 2007;369:132\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRangel CM, Ortiz AI, Var\u0026oacute;n CL, Acu\u0026ntilde;a MF, Moreno NJ, Prada AM, S\u0026aacute;nchez-Avila RM. S\u0026iacute;filis ocular en una poblaci\u0026oacute;n Colombiana: manifestaciones cl\u0026iacute;nicas y resultados del tratamiento. Revista Sociedad Colombiana de Oftalmolog\u0026iacute;a. 2019;52(2):87\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun C, Bin, Liu GH, Wu R, Liu Z. Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China. Front Immunol. 2022;13:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAguilar-Gonz\u0026aacute;lez M, Fern\u0026aacute;ndez-Santodomingo AS, Mar\u0026iacute;n-Pay\u0026aacute; E, Rahhal-Ortu\u0026ntilde;o M, Udaondo P. Bilateral exudative retinal detachment in undiagnosed ocular syphilis after treatment with corticosteroids. Eur J Ophthalmol. 2019;31(2):86\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePratas AC, Goldschmidt P, Lebeaux D, Aguilar C, Ermak N, Benesty J, Charlier C, Benveniste E, Merabet L, Sedira N, Hope-Rapp E, Chaumeil C, Bodaghi B, H\u0026eacute;ron E, Sahel JA, Lortholary O, Errera MH. Increase in Ocular Syphilis Cases at Ophthalmologic Reference Center, France, 2012\u0026ndash;2015. Emerg Infect Dis. 2018;24(2):193\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu X, Gao Y, Yan Y, Marks M, Zhu L, Lu H, Guan Z, Shi M, Ni L, Peng R, Zhao W, Wu J, Qi T, Lu S, Qian Y, Gong W, Zhou P. The importance of proper and prompt treatment of ocular syphilis: a lesson from permanent vision loss in 52 eyes. J Eur Acad Dermatol Venereol. 2020;34(7):1569\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen J, Feng L, Li Y. Ocular syphilis: an alarming infectious eye disease. Int J Clin Exp Med. 2015;8(5):7770\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Data on syphilis, Appears in: Sexually Transmitted Infections [document on the internet] Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/data/gho/data/themes/topics/topic-details/GHO/data-on-syphilis\u003c/span\u003e\u003cspan address=\"https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/data-on-syphilis\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Syphilis [document on the internet]. 2025 May. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/syphilis\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/syphilis\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsuboi M, Evans J, Davies EP, Rowley J, Korenromp EL, Clayton T, Taylor MM, Mabey D, Chico RM. Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000-20. Lancet Glob Health. 2021;9(8):1110\u0026ndash;e1118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArtiles K, Ambou I, P\u0026eacute;rez A, Lascaiba N. Ocular syphilis, the great pretender. Revista Cubana de Oftalmolog\u0026iacute;a. 2023;36(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorges CR, De Almeida SM, Sue K, Koslyk JLA, Sato MT, Shiokawa N, et al. Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: A case series. Arquivos de Neuro-Psiquiatr\u0026iacute;a. 2018;76(6):373\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCamporro JP, Del Castillo M, Mora CA. Ocular syphilis: alert for clinicians and ophthalmologists. Medicina (B. Aires) 2023 Dic;83(6): 972\u0026ndash;975.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajunder PD, Chen EJ, Shah J, Ho DC, Biswas J, Yin LS, et al. Ocular syphilis: an update. Ocul Immunol Inflamm. 2017;11:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodrigues R, Salomao G, Nascimento H, Muccioli C. Yellowish dots in the retina: a new finding of ocular syphilis? Investig Ophthalmol Vis Sci. 2023 June;54(15).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJahnke S, Sunderk\u0026ouml;tter C, Lange D, Wienrich R, Kreft B. Ocular syphilis - a case series of four patients. J Dtsch Dermatol Ges. 2021;19(7):987\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarvey J, Lee IJ, Lee CS, Hinkle D. Ocular syphilis on the rise: a 10-year analysis from 2010 to 2020. Int Ophthalmol. 2023;43(12):4419\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFurtado J, Sim\u0026otilde;es M, Vasconcelos D, Oliver G, Tyagi M, Nascimento H, Gordon D, Smith J. Ocular syphilis. Surv Ophthalmol. 2022(2): 440\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsan GL, Claiborne RT. Ocular syphilis. Clin experimental optometry. 2021;104(7):756\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Syphilis, Ocular, Uveitis, Neuroretinitis, Chorioretinitis, Treponema pallidum, HIV Coinfection","lastPublishedDoi":"10.21203/rs.3.rs-9559477/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9559477/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo describe the clinical and demographic characteristics of ocular syphilis based on a case series of patients evaluated at a tertiary ophthalmology unit in Bogot\u0026aacute;, Colombia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A descriptive observational study was conducted through a retrospective review of medical records from 23 patients diagnosed with syphilis and ocular involvement between January 2023 and July 2024 at San Ignacio University Hospital, Bogot\u0026aacute;. Collected data included demographic characteristics, medical history (including HIV coinfection), ophthalmologic findings at presentation and follow-up, diagnostic tests, and treatment. Data were analyzed using frequency tables and descriptive statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 23 patients, 18 men and 5 women, with a total of 33 affected eyes. Bilateral involvement was observed in 10 patients, while unilateral right and left involvement occurred in 8 and 5 eyes, respectively. The mean age was 35 years (range: 13 days \u0026ndash; 73 years), and the mean symptom duration before presentation was 19 days. Non-treponemal serologic testing was reactive in 22 patients. HIV coinfection was identified in 6 patients, including previously known, recently diagnosed, and de novo cases. Neuroretinitis was the most common ocular manifestation, followed by chorioretinitis. Baseline visual acuity ranged from light perception to 20/20. After penicillin treatment, visual acuity improved in 27 eyes, remained stable in 2, and worsened in 4. Mean follow-up time was 12 days. Overall, patients with active ocular inflammation showed favorable responses to treatment when diagnosed and managed promptly.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOcular syphilis represents a significant diagnostic challenge due to its heterogeneous clinical presentation. Early recognition, appropriate serologic testing, and timely treatment are critical to reduce inflammation and optimize visual outcomes.\u003c/p\u003e","manuscriptTitle":"Ocular syphilis: clinical and demographic spectrum - A case series from Colombia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 02:36:09","doi":"10.21203/rs.3.rs-9559477/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T20:10:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167381993365591530156409808561615042691","date":"2026-05-12T18:43:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226417196255680038278248439591427729495","date":"2026-05-11T08:53:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220279971637925216229837895804710497134","date":"2026-05-11T06:22:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56646056514110840675285259036516065174","date":"2026-05-09T15:54:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-06T05:58:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-05T07:58:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-05T07:43:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2026-04-29T02:29:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a31a3a2c-89fe-452d-b67e-074a80684bce","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T20:10:41+00:00","index":46,"fulltext":""},{"type":"reviewerAgreed","content":"167381993365591530156409808561615042691","date":"2026-05-12T18:43:15+00:00","index":44,"fulltext":""},{"type":"reviewerAgreed","content":"226417196255680038278248439591427729495","date":"2026-05-11T08:53:20+00:00","index":42,"fulltext":""},{"type":"reviewerAgreed","content":"220279971637925216229837895804710497134","date":"2026-05-11T06:22:56+00:00","index":41,"fulltext":""},{"type":"reviewerAgreed","content":"56646056514110840675285259036516065174","date":"2026-05-09T15:54:33+00:00","index":39,"fulltext":""},{"type":"reviewersInvited","content":"24","date":"2026-05-06T05:58:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-05T07:58:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-05T07:43:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T02:36:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 02:36:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9559477","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9559477","identity":"rs-9559477","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}