Clinical Manifestations and Treatment Prognosis of Patients with co-infection of Ocular Syphilis and HIV

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Methods A cohort of 31 patients (42 eyes) diagnosed with both ocular syphilis and HIV at Beijing You’an Hospital from January 2022 to March 2025 was analyzed. Diagnosis was confirmed through serological tests (TPPA, RPR) and ocular examinations. Patients received intravenous penicillin G followed by intramuscular benzathine penicillin. Best-corrected visual acuity (BCVA), ocular manifestations, and treatment responses were assessed. Results Posterior segment involvement was universal, with predominant subtypes being acute syphilitic posterior placoid chorioretinitis (13 eyes), confluent syphilitic retinochoroiditis (12 eyes), retinal vasculitis (4 eyes), and optic neuritis (13 eyes). BCVA improved significantly post-treatment. Optic neuritis showed better baseline and final BCVA, correlating with lower macular involvement. Conclusions Co-infection of ocular syphilis and HIV predominantly affects the posterior segment, with optic neuritis exhibiting a distinct clinical profile. A comprehensive ocular and serological evaluations in high-risk populations is recommended. Figures Figure 1 Introduction Syphilis is recognized as "a great imitator" owing to its diverse clinical manifestations and the capacity to impact multiple organs, including diseases of the nervous system, eyes, ear - nose - throat, and cardiovascular system. Since 2014, the incidence of syphilis has been on a gradual rise, the incidence of ocular syphilis has also increased concurrently [1, 2] . Due to the similarity of transmission routes, syphilis is frequently associated with human immunodeficiency virus (HIV) infection [3] . Approximately half of ocular syphilis cases are co - existent with HIV infection [4] . Ocular syphilis can be presented as various ocular manifestations including episcleritis, scleritis, chancre on the eyelid or conjunctiva, uveitis and optic retinitis are major clinical features of ocular syphilis [5-7] . Amid these clinical signs, uveitis and optic retinitis affect the posterior segment of the eye and may cause temporary or permanent vision loss. Also, the subtypes of syphilitic uveitis vary among different patients, making the diagnosis and prognosis of ocular syphilis difficult and uncertain. In the present study, we involved patients with co-infection of ocular syphilis and HIV and evaluated the subtype of their ocular manifestation and their visual prognosis. Material and methods This study included patients diagnosed with both ocular syphilis and HIV at the Department of Ophthalmology and the Center for HIV Infection of Beijing You'an Hospital between February 2022 and March 2025. In accordance with the Declaration of Helsinki (2013), ethical approval for this research was obtained from Beijing You'an Hospital before patient enrollment (Chinese Clinical Trial Registry. ChiCTR 2200056954. 24, February, 2022). HIV was diagnosed based on CD4 + T lymphocyte count and HIV antibody. HIV antibody was detected using the enzyme - linked immunosorbent assay (ELISA) and chemiluminescence assay, and the results were confirmed by the Western blot assay. Ocular syphilis was diagnosed based on the integration of ocular manifestations and laboratory tests for diagnosis. The Treponema pallidum particle agglutination (TPPA) using serum sample was firstly used to make a specific diagnosis. Furthermore, a test for anti - lipoidal antibodies, namely the RPR test, was utilized to evaluate disease activity. Other possible infectious factors, including tuberculosis, cryptococcus and toxoplasmosis and cytomegalovirus were excluded. The anti-HIV and anti-syphilitic treatments at the baseline and during the treatment process were recorded. After being diagnosed, all patients received an administration of intravenous infusion of aqueous crystalline penicillin G at a dosage of (3 million − 4 million) units every 4 hours for a treatment duration of 10–14 days, following by intramuscular injection of benzathine penicillin G at a dosage of 2.4 million units per week for three consecutive weeks [8, 9] . In cases of severe vitreous opacity, a local retrobulbar injection of 20 mg of methylprednisolone was employed. All eyes with ocular syphilis were divided into subgroups based on their predominant ocular manifestation using the terms proposed by Pichi F et al [10] . Fundus photography and fluorescein fundus angiography were performed to make detailed assessment. To further explore the reason for the vision loss, the existence of vitreous opacity and macular involvement were recorded. Other ocular examinations include best corrected visual acuity (BCVA), intraocular pressure (IOP), and ocular signs of the anterior and posterior segments. The BCVA was measured using a decimal chart and converted into logMAR. For VA of count fingers, hand movement, light perception and no light perception, value units of 2.0 logMAR, 2.3 logMAR, 2.7 logMAR and 3.0 logMAR were assigned respectively [11] . SPSS 26.0 statistical software (SPSS, Inc., Chicago, IL, USA) was used to analyze the data. The normalityof data was tested by the Kolmogorov–Smirnov test, which showed that the data of BCVA did not comply with the normal distribution. The paired t-test was used to analyze the BCVA at the baseline and the end of the treatment and the Kruskal–Wallis test was used to analyze the BCVA among different subgroups. Pearson’s chi-square test was used to compare the rate of vitreous opacity and macular involvement in different subgroups. Results Forty-two eyes of 31 patients were involved in this study. Among them, 11 patients were diagnosed with bilateral ocular syphilis, while 20 patients had unilateral disease. All 31 patients in this study were of Chinese ethnicity, with a male predominance (87.1%). The majority (n=23) were under 40 years of age. Nearly all patients (93.5%, n=29) were on highly active antiretroviral therapy (HAART), and 8 had undetectable HIV viral loads. The median baseline CD4+ T lymphocyte count was 132 cells/μl (IQR: 79–319). General characteristics of involved patients are listed in Table 1 . The mean LogMAR BCVA at baseline of all involved eyes was 1.08±0.66 (range:0-2.7). After receiving standard anti-syphilitic treatment, the mean LogMAR BCVA was 0.86±0.69 (range: 0.22-2.7), which was significantly improved (P=0.000). All eyes had posterior ocular segment involved. The co-existence of mild anterior uveitis was observed in 11 eyes. No episcleritis or scleritis was observed. The predominant ocular manifestations of involved eyes include acute syphilitic posterior placoid chorioretinitis, confluent syphilitic retinochoroiditis, retinal vasculitis and optic neuritis. Based on these fundus manifestations, all involved eyes were divided into 4 subgroups (Figure1) . Thirteen eyes presented as acute syphilitic posterior placoid chorioretinitis. Twelve eyes presented as confluent syphilitic retinochoroiditis. Four eyes presented as retinal vasculitis. Thirteen eyes presented as optic neuritis. The baseline and the final LogMAR BCVA in eyes with optic neuritis were the lowest among four groups (P＜0.05). The visual distribution of these four subgroups is listed in Table 2 . Vitreous opacity and macular involvement existed in 37 eyes (88.1%) and 29 eyes (69.0%) separately (Table 3) . The prevalence of vitreous opacity showed no significant difference across the four subgroups (P=0.277), while the prevalence of macular involvement was significantly lower in eyes with optic neuritis (P＜0.05). Discussion The correlation between syphilis and HIV was observed in approximately 15% of the patients in previous study [12] . Definite diagnosis could be difficult due to deteriorated general condition, complicated ocular manifestations and diverse sources of infection. Thus, it is important to make a cohort of these patients to evaluate the specific general and ocular manifestations. The count of CD4 + T lymphocytes reflects the immune status and plays a significant role in HIV co - infected with syphilitic optic retinitis. One study reported that ocular syphilis was more frequently diagnosed in patients with HIV with CD4 + T lymphocyte count less than 200 cells/µL [13] . In our study, the baseline mean CD4 + T lymphocyte count was 132 cells/µl, which is consistent with the aforementioned viewpoint. The viral load of HIV also exerts a certain influence on HIV - associated ocular syphilis. Previous studies showed that ocular syphilis is more prevalent among co - infected patients with unregulated HIV load. Inflammation related to uncontrolled HIV replication was supposed to fasten the development and deterioration of ocular syphilis [12,14] . In this research, HIV viral load was still tested positive in 23 (74.2%) patients, which further prove the aforementioned hypothesis. In our study, all eyes had posterior ocular segment involved, which was correlated with the previous argument that HIV positivity could be related to an increase risk of posterior segment involvement in ocular syphilis [15–17] . The minority involvement of anterior segment and the absence of episcleritis and scleritis in our cohort further proved the phenomenon observed by previous studies [17–18] . Optic neuritis was another predominant ocular manifestation in our cohort. In the previous studies, optic nerve involvement, including optic neuritis, atrophy, and disc swelling, occur more frequently in patients with co-infection of HIV and syphilis [19,20] . The involvement of optic nerve and retina may lead to a worse visual prognosis, which means that early diagnosis and early treatment are important in these patients. Due to the aforementioned challenges when facing patient with suspected co-infection of HIV and ocular syphilis, a comprehensive laboratory examination is necessary. Although standard syphilis screening typically begins with a non-treponemal test (e.g., RPR or VDRL) followed by confirmatory treponemal testing (e.g., TPPA or FTA-ABS) [20] , we reversed this sequence in our patient due to high clinical suspicion of ocular syphilis based on characteristic fundoscopic findings. Given the vision-threatening nature of ocular syphilis and the potential for false-negative RPR results—particularly in cases with localized infection, prior treatment, or the prozone effect [21] —we prioritized TPPA testing to rapidly establish a definitive diagnosis. This approach offers several advantages: (1) TPPA’s high specificity for Treponema pallidum antibodies provides immediate evidence of infection, supporting early empiric treatment while awaiting RPR results; (2) it mitigates the risk of delayed diagnosis from a non-reactive RPR; and (3) a positive TPPA, in conjunction with typical ocular manifestations, strongly supports the diagnosis even if RPR is negative or weakly positive. By expediting confirmation of syphilis, this strategy facilitates timely intervention to prevent permanent visual impairment. Apart from laboratory examinations, meticulous fundus examination also plays a pivotal role in diagnosis, differential diagnosis and prognosis of ocular syphilis. Although fundus manifestation of ocular syphilis could be eclectic, several pathogenic changes are predominant. In our study, we divided the involved eyes into four subgroups, which were ‘acute syphilitic posterior placoid chorioretinitis’, ‘confluent syphilitic retinochoroiditis’, ‘retinal vasculitis’ and ‘optic neuritis’ separately. Among these four groups, the baseline and final BCVA was better in ‘optic neuritis’ subgroup and were similar in other three subgroups. The possible reason was the significantly lower percentage of macular involvement in patients with optic neuritis. Although there was no difference in vitreous opacity among four subgroups, we also observed a milder level in ‘optic neuritis’ subgroup. This phenomenon showed that optic neuritis, rather than other ocular involvements, could presented as a unique symptom of ocular syphilis. Previous studies have already proposed that optic disc involvement could present as the only indication of treponemal infection [6] . Another interesting phenomenon we have observed was that ocular manifestation might be different from one eye to another in bilateral involvement of ocular syphilis. We observed one eye with ‘confluent syphilitic retinochoroiditis’ and another eye with mild ‘acute syphilitic posterior placoid chorioretinitis’ in one patient, which could be explained by the difference of immunological response to Treponema pallidum and the infection timing in two eyes. Conclusion This study highlights the complex interplay between ocular syphilis and HIV, revealing a high prevalence of posterior segment involvement and diverse clinical manifestations. The findings advocate for heightened clinical suspicion, multimodal diagnostic approaches (e.g., TPPA prioritization in high-risk cases), and tailored management in co-infected patients to mitigate vision-threatening complications. Future research should explore long-term outcomes and the impact of immune reconstitution on disease progression. Declarations Declarations Ethics approval and consent to participate In accordance with the Declaration of Helsinki (2013), ethical approval for this research was obtained from Ethics Committee of Beijing You'an Hospital affiliated to Capital Medical University which belonged to Beijing You'an Hospital affiliated to Capital Medical University before patient enrollment (Chinese Clinical Trial Registry. ChiCTR 2200056954. 24, February,2022). All patients have signed the informed consent. Consent for publication Not applicable. Competing interests The authors report no conflict of interest. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Author Contribution K.W.J wrote the main manuscript text. R.F.and X.L.Y. prepared figure. F.X. and G.Y.Q prepared table 1，2. Q.Z.Y and T.Y.prepared table 3. All authors reviewed the manuscript. Acknowledgements None Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References 1. Hughes EH, Guzowski M, Simunovic MP, Hunyor AP, McCluskey P. Syphilitic retinitis and uveitis in HIV-positive adults. Clin Exp Ophthalmol. 2010;38(9):851-6. 2. Oliver SE, Cope AB, Rinsky JL, Williams C, Liu G, Hawks S, et al. Increases in Ocular Syphilis-North Carolina, 2014–2015. Clin Infect Dis. 2017;65(10):1676-82. 3. Xu N, Yuan JG, Dai QJ, Yuan C, He Y, Jiang TS, et al. Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature. Int J Ophthalmol. 2023;16(8):1250-9. 4. Oliver SE, Aubin M, Atwell L, Matthias J, Cope A, Mobley V, et al. Ocular Syphilis - Eight Jurisdictions, United States, 2014–2015. MMWR Morb Mortal Wkly Rep. 2016;65(43):1185-8. 5. Shields MK, Furtado JM, Lake SR, Smith JR. Syphilitic scleritis and episcleritis: A review. Asia Pac J Ophthalmol (Phila). 2024;13(3):100073. 6. Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, et al. Ocular syphilis. Surv Ophthalmol. 2022;67(2):440 − 62. 7. Zhang T, Zhu Y, Xu G. Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis. J Ophthalmol. 2017;2017:6594849. 8. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. 9. WHO Guidelines Approved by the Guidelines Review Committee. WHO Guidelines for the Treatment of Treponema pallidum (Syphilis). Geneva: World Health Organization © World Health Organization 2016.; 2016. 10. Pichi F, Neri P. Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment. Int Ophthalmol. 2020;40(5):1319-29. 11. Grover S, Fishman GA, Anderson RJ, Tozatti MS, Heckenlively JR, Weleber RG, et al. Visual acuity impairment in patients with retinitis pigmentosa at age 45 years or older. Ophthalmology. 1999;106(9):1780-5. 12. Sudharshan S, Kaleemunnisha S, Banu AA, Shrikrishna S, George AE, Babu BR, et al. Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study. J Ophthalmic Inflamm Infect. 2013;3(1):2. 13. Cope AB, Mobley VL, Oliver SE, Larson M, Dzialowy N, Maxwell J, et al. Ocular Syphilis and Human Immunodeficiency Virus Coinfection Among Syphilis Patients in North Carolina, 2014–2016. Sex Transm Dis. 2019;46(2):80 − 5. 14. Biotti D, Bidot S, Mahy S, Buisson M, Duong M, Grappin M, et al. Ocular syphilis and HIV infection. Sex Transm Dis. 2010;37(1):41 − 3. 15. Tran TH, Cassoux N, Bodaghi B, Fardeau C, Caumes E, Lehoang P. Syphilitic uveitis in patients infected with human immunodeficiency virus. Graefes Arch Clin Exp Ophthalmol. 2005;243(9):863-9. 16. Amaratunge BC, Camuglia JE, Hall AJ. Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients. Clin Exp Ophthalmol. 2010;38(1):68–74. 17. Furtado JM, Arantes TE, Nascimento H, Vasconcelos-Santos DV, Nogueira N, de Pinho Queiroz R, et al. Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection. Sci Rep. 2018;8(1):12071. 18. Mathew RG, Goh BT, Westcott MC. 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. 19. Lee SY, 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. 20. Moradi A, Salek S, Daniel E, Gangaputra S, Ostheimer TA, Burkholder BM, et al. Clinical features and incidence rates of ocular complications in patients with ocular syphilis. Am J Ophthalmol. 2015;159(2):334 − 43.e1. 21. Berkowitz K, Baxi L, Fox HE. False-negative syphilis screening: the prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy. Am J Obstet Gynecol. 1990;163(3):975-7. Figure Tables Table 1. General characteristics of involved patients Patient No. Race, n (%) Chinese 31(100) Sex, n (%) Male Female 27(87.1) 4 (12.9) Age, n (%) <40 ≥40 23(74.2) 8(25.8) HAART, n (%) Yes No 29(93.5) 2(6.5) The HIV virus load, n (%) Negative positive 8(25.8) 23(74.2) Baseline CD4+ T lymphocyte count, median (Q3, Q1) (cell/μl) 132 (319,79) HARRT：Highly active antiretroviral therapy, HIV: Human immunodeficiency virus Table 2. Visual distribution in four subgroups Acute syphilitic posterior placoid chorioretinitis Confluent syphilitic retinochoroiditis Retinal vasculitis Optic neuritis Baseline LogMAR BCVA 1.08±0.58 1.52±0.78 1.21±0.54 0.62±0.30* Final LogMAR BCVA 0.78±0.68 1.20±0.77 1.41±0.87 0.46±0.24* BCVA：best corrected visual acuity, *: significant difference compared with subgroup of ‘Confluent syphilitic retinochoroiditis’ Table 3. Prevalance of vitreous opacity and macular involvement in four subgroups Acute syphilitic posterior placoid chorioretinitis Confluent syphilitic retinochoroiditis Retinal vasculitis Optic neuritis Vitreous opacity 11/13 12/12 4/4 10/13 Macular involvement 13/13 12/12 4/4 0/13* *: significant difference compared with other three subgroups Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Nov, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 29 Sep, 2025 Reviews received at journal 24 Sep, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 12 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers invited by journal 26 Aug, 2025 Editor assigned by journal 25 Aug, 2025 Submission checks completed at journal 24 Aug, 2025 First submitted to journal 24 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-7392729","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508086850,"identity":"38c0c9d1-4c5f-4c56-b89f-227063e47f79","order_by":0,"name":"Wenjun 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1","display":"","copyAsset":false,"role":"figure","size":59157,"visible":true,"origin":"","legend":"\u003cp\u003eFundus photography showed four predominant ocular manifestations of ocular syphilis.\u003c/p\u003e\n\u003cp\u003e1A: Acute syphilitic posterior placoid chorioretinitis presented as a large, placoid, circular and yellowish lesion at the level of pigment epithelium in the macular and juxtapupillary area.\u003c/p\u003e\n\u003cp\u003e1B: Confluent syphilitic retinochoroiditis presented as diffuse lesions with a ‘ground glass appearance’ associated with yellow, small, pre-retinal precipitates.\u003c/p\u003e\n\u003cp\u003e1C: Retinal vasculitis presented as diffuse white streaking of retinal vessels accompanied by peripapillary vascular hemorrhages.\u003c/p\u003e\n\u003cp\u003e1D: Optic neuritis present as papilledema, as well as tortuosity and dilation of the peripheral vessels.\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7392729/v1/00d9b445f3bf4fb84e681dc8.jpeg"},{"id":96650170,"identity":"ccfad4df-ebdd-49e1-99ab-ed01919bc180","added_by":"auto","created_at":"2025-11-24 16:09:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":501179,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7392729/v1/e2e030b0-c296-4960-896d-6d6617bf42b3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Manifestations and Treatment Prognosis of Patients with co-infection of Ocular Syphilis and HIV","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSyphilis is recognized as \"a great imitator\" owing to its diverse clinical manifestations and the capacity to impact multiple organs, including diseases of the nervous system, eyes, ear - nose - throat, and cardiovascular system. Since 2014, the incidence of syphilis has\u0026nbsp;been on a\u0026nbsp;gradual rise, the incidence of ocular syphilis has also increased concurrently\u003csup\u003e[1, 2]\u003c/sup\u003e. Due to the similarity of transmission routes, syphilis is frequently associated with human immunodeficiency virus (HIV) infection\u003csup\u003e[3]\u003c/sup\u003e. Approximately half of ocular syphilis cases are co - existent with HIV infection\u003csup\u003e[4]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOcular syphilis can be presented as various ocular manifestations including episcleritis, scleritis, chancre on the eyelid or conjunctiva, uveitis and optic retinitis are major clinical features of ocular syphilis\u003csup\u003e[5-7]\u003c/sup\u003e. Amid these clinical signs, uveitis and optic retinitis affect the posterior segment of the eye and may cause temporary or permanent vision loss. Also, the subtypes of syphilitic uveitis vary among different patients, making the diagnosis and prognosis of ocular syphilis difficult and uncertain. In the present study, we involved patients with co-infection of ocular syphilis and HIV and evaluated the subtype of their ocular manifestation and their visual prognosis.\u0026nbsp;\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis study included patients diagnosed with both ocular syphilis and HIV at the Department of Ophthalmology and the Center for HIV Infection of Beijing You'an Hospital between February 2022 and March 2025. In accordance with the Declaration of Helsinki (2013), ethical approval for this research was obtained from Beijing You'an Hospital before patient enrollment (Chinese Clinical Trial Registry. ChiCTR 2200056954. 24, February, 2022). HIV was diagnosed based on CD4\u003csup\u003e+\u003c/sup\u003e T lymphocyte count and HIV antibody. HIV antibody was detected using the enzyme - linked immunosorbent assay (ELISA) and chemiluminescence assay, and the results were confirmed by the Western blot assay. Ocular syphilis was diagnosed based on the integration of ocular manifestations and laboratory tests for diagnosis. The Treponema pallidum particle agglutination (TPPA) using serum sample was firstly used to make a specific diagnosis. Furthermore, a test for anti - lipoidal antibodies, namely the RPR test, was utilized to evaluate disease activity. Other possible infectious factors, including tuberculosis, cryptococcus and toxoplasmosis and cytomegalovirus were excluded. The anti-HIV and anti-syphilitic treatments at the baseline and during the treatment process were recorded.\u003c/p\u003e\u003cp\u003eAfter being diagnosed, all patients received an administration of intravenous infusion of aqueous crystalline penicillin G at a dosage of (3\u0026nbsp;million \u0026minus;\u0026thinsp;4\u0026nbsp;million) units every 4 hours for a treatment duration of 10\u0026ndash;14 days, following by intramuscular injection of benzathine penicillin G at a dosage of 2.4\u0026nbsp;million units per week for three consecutive weeks\u003csup\u003e[8, 9]\u003c/sup\u003e. In cases of severe vitreous opacity, a local retrobulbar injection of 20 mg of methylprednisolone was employed.\u003c/p\u003e\u003cp\u003eAll eyes with ocular syphilis were divided into subgroups based on their predominant ocular manifestation using the terms proposed by Pichi F et al\u003csup\u003e[10]\u003c/sup\u003e. Fundus photography and fluorescein fundus angiography were performed to make detailed assessment. To further explore the reason for the vision loss, the existence of vitreous opacity and macular involvement were recorded. Other ocular examinations include best corrected visual acuity (BCVA), intraocular pressure (IOP), and ocular signs of the anterior and posterior segments. The BCVA was measured using a decimal chart and converted into logMAR. For VA of count fingers, hand movement, light perception and no light perception, value units of 2.0 logMAR, 2.3 logMAR, 2.7 logMAR and 3.0 logMAR were assigned respectively\u003csup\u003e[11]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSPSS 26.0 statistical software (SPSS, Inc., Chicago, IL, USA) was used to analyze the data. The normalityof data was tested by the Kolmogorov\u0026ndash;Smirnov test, which showed that the data of BCVA did not comply with the normal distribution. The paired t-test was used to analyze the BCVA at the baseline and the end of the treatment and the Kruskal\u0026ndash;Wallis test was used to analyze the BCVA among different subgroups. Pearson\u0026rsquo;s chi-square test was used to compare the rate of vitreous opacity and macular involvement in different subgroups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eForty-two eyes of 31 patients were involved in this study. Among them, 11 patients were diagnosed with bilateral ocular syphilis, while 20 patients had unilateral disease.\u0026nbsp;All 31 patients in this study were of Chinese ethnicity, with a male predominance (87.1%). The majority (n=23) were under 40 years of age. Nearly all patients (93.5%, n=29) were on highly active antiretroviral therapy (HAART), and 8 had undetectable HIV viral loads. The median baseline CD4+ T lymphocyte count was 132 cells/\u0026mu;l (IQR: 79\u0026ndash;319). General characteristics of involved patients are listed in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean LogMAR BCVA at baseline of all involved eyes was 1.08\u0026plusmn;0.66 (range:0-2.7). After receiving standard anti-syphilitic treatment, the mean LogMAR BCVA was 0.86\u0026plusmn;0.69 (range: 0.22-2.7), which was significantly improved (P=0.000). All eyes had posterior ocular segment involved. The co-existence of mild anterior uveitis was observed in 11 eyes. No episcleritis or scleritis was observed.\u003c/p\u003e\n\u003cp\u003eThe predominant ocular manifestations of involved eyes include acute syphilitic posterior placoid chorioretinitis, confluent syphilitic retinochoroiditis, retinal vasculitis and optic neuritis. Based on these fundus manifestations, all involved eyes were divided into 4 subgroups \u003cstrong\u003e(Figure1)\u003c/strong\u003e. Thirteen eyes presented as acute syphilitic posterior placoid chorioretinitis. Twelve eyes presented as confluent syphilitic retinochoroiditis. Four eyes presented as retinal vasculitis. Thirteen eyes presented as optic neuritis. The baseline and the final LogMAR BCVA in eyes with optic neuritis were the lowest among four groups (P＜0.05). The visual distribution of these four subgroups is listed in\u003cstrong\u003e\u0026nbsp;Table 2\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVitreous opacity and macular involvement existed in 37 eyes (88.1%) and 29 eyes (69.0%) separately\u003cstrong\u003e\u0026nbsp;(Table 3)\u003c/strong\u003e. The prevalence of vitreous opacity showed no significant difference across the four subgroups (P=0.277), while the prevalence of macular involvement was significantly lower in eyes with optic neuritis (P＜0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe correlation between syphilis and HIV was observed in approximately 15% of the patients in previous study\u003csup\u003e[12]\u003c/sup\u003e. Definite diagnosis could be difficult due to deteriorated general condition, complicated ocular manifestations and diverse sources of infection. Thus, it is important to make a cohort of these patients to evaluate the specific general and ocular manifestations.\u003c/p\u003e\u003cp\u003eThe count of CD4\u003csup\u003e+\u003c/sup\u003e T lymphocytes reflects the immune status and plays a significant role in HIV co - infected with syphilitic optic retinitis. One study reported that ocular syphilis was more frequently diagnosed in patients with HIV with CD4\u003csup\u003e+\u003c/sup\u003e T lymphocyte count less than 200 cells/\u0026micro;L\u003csup\u003e[13]\u003c/sup\u003e. In our study, the baseline mean CD4\u003csup\u003e+\u003c/sup\u003e T lymphocyte count was 132 cells/\u0026micro;l, which is consistent with the aforementioned viewpoint. The viral load of HIV also exerts a certain influence on HIV - associated ocular syphilis. Previous studies showed that ocular syphilis is more prevalent among co - infected patients with unregulated HIV load. Inflammation related to uncontrolled HIV replication was supposed to fasten the development and deterioration of ocular syphilis\u003csup\u003e[12,14]\u003c/sup\u003e. In this research, HIV viral load was still tested positive in 23 (74.2%) patients, which further prove the aforementioned hypothesis.\u003c/p\u003e\u003cp\u003eIn our study, all eyes had posterior ocular segment involved, which was correlated with the previous argument that HIV positivity could be related to an increase risk of posterior segment involvement in ocular syphilis\u003csup\u003e[15\u0026ndash;17]\u003c/sup\u003e. The minority involvement of anterior segment and the absence of episcleritis and scleritis in our cohort further proved the phenomenon observed by previous studies\u003csup\u003e[17\u0026ndash;18]\u003c/sup\u003e. Optic neuritis was another predominant ocular manifestation in our cohort. In the previous studies, optic nerve involvement, including optic neuritis, atrophy, and disc swelling, occur more frequently in patients with co-infection of HIV and syphilis\u003csup\u003e[19,20]\u003c/sup\u003e. The involvement of optic nerve and retina may lead to a worse visual prognosis, which means that early diagnosis and early treatment are important in these patients.\u003c/p\u003e\u003cp\u003eDue to the aforementioned challenges when facing patient with suspected co-infection of HIV and ocular syphilis, a comprehensive laboratory examination is necessary. Although standard syphilis screening typically begins with a non-treponemal test (e.g., RPR or VDRL) followed by confirmatory treponemal testing (e.g., TPPA or FTA-ABS)\u003csup\u003e[20]\u003c/sup\u003e, we reversed this sequence in our patient due to high clinical suspicion of ocular syphilis based on characteristic fundoscopic findings. Given the vision-threatening nature of ocular syphilis and the potential for false-negative RPR results\u0026mdash;particularly in cases with localized infection, prior treatment, or the prozone effect\u003csup\u003e[21]\u003c/sup\u003e\u0026mdash;we prioritized TPPA testing to rapidly establish a definitive diagnosis. This approach offers several advantages: (1) TPPA\u0026rsquo;s high specificity for Treponema pallidum antibodies provides immediate evidence of infection, supporting early empiric treatment while awaiting RPR results; (2) it mitigates the risk of delayed diagnosis from a non-reactive RPR; and (3) a positive TPPA, in conjunction with typical ocular manifestations, strongly supports the diagnosis even if RPR is negative or weakly positive. By expediting confirmation of syphilis, this strategy facilitates timely intervention to prevent permanent visual impairment.\u003c/p\u003e\u003cp\u003eApart from laboratory examinations, meticulous fundus examination also plays a pivotal role in diagnosis, differential diagnosis and prognosis of ocular syphilis. Although fundus manifestation of ocular syphilis could be eclectic, several pathogenic changes are predominant. In our study, we divided the involved eyes into four subgroups, which were \u0026lsquo;acute syphilitic posterior placoid chorioretinitis\u0026rsquo;, \u0026lsquo;confluent syphilitic retinochoroiditis\u0026rsquo;, \u0026lsquo;retinal vasculitis\u0026rsquo; and \u0026lsquo;optic neuritis\u0026rsquo; separately. Among these four groups, the baseline and final BCVA was better in \u0026lsquo;optic neuritis\u0026rsquo; subgroup and were similar in other three subgroups. The possible reason was the significantly lower percentage of macular involvement in patients with optic neuritis. Although there was no difference in vitreous opacity among four subgroups, we also observed a milder level in \u0026lsquo;optic neuritis\u0026rsquo; subgroup. This phenomenon showed that optic neuritis, rather than other ocular involvements, could presented as a unique symptom of ocular syphilis. Previous studies have already proposed that optic disc involvement could present as the only indication of treponemal infection\u003csup\u003e[6]\u003c/sup\u003e. Another interesting phenomenon we have observed was that ocular manifestation might be different from one eye to another in bilateral involvement of ocular syphilis. We observed one eye with \u0026lsquo;confluent syphilitic retinochoroiditis\u0026rsquo; and another eye with mild \u0026lsquo;acute syphilitic posterior placoid chorioretinitis\u0026rsquo; in one patient, which could be explained by the difference of immunological response to Treponema pallidum and the infection timing in two eyes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the complex interplay between ocular syphilis and HIV, revealing a high prevalence of posterior segment involvement and diverse clinical manifestations. The findings advocate for heightened clinical suspicion, multimodal diagnostic approaches (e.g., TPPA prioritization in high-risk cases), and tailored management in co-infected patients to mitigate vision-threatening complications. Future research should explore long-term outcomes and the impact of immune reconstitution on disease progression.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDeclarations\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e In accordance with the Declaration of Helsinki (2013), ethical approval for this research was obtained from Ethics Committee of Beijing You'an Hospital affiliated to Capital Medical University which belonged to Beijing You'an Hospital affiliated to Capital Medical University before patient enrollment (Chinese Clinical Trial Registry. ChiCTR 2200056954. 24, February,2022). All patients have signed the informed consent.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors report no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eK.W.J wrote the main manuscript text. R.F.and X.L.Y. prepared figure. F.X. and G.Y.Q prepared table 1，2. Q.Z.Y and T.Y.prepared table 3. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e1. Hughes EH, Guzowski M, Simunovic MP, Hunyor AP, McCluskey P. Syphilitic retinitis and uveitis in HIV-positive adults. Clin Exp Ophthalmol. 2010;38(9):851-6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e2. Oliver SE, Cope AB, Rinsky JL, Williams C, Liu G, Hawks S, et al. Increases in Ocular Syphilis-North Carolina, 2014\u0026ndash;2015. Clin Infect Dis. 2017;65(10):1676-82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e3. Xu N, Yuan JG, Dai QJ, Yuan C, He Y, Jiang TS, et al. Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature. Int J Ophthalmol. 2023;16(8):1250-9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e4. Oliver SE, Aubin M, Atwell L, Matthias J, Cope A, Mobley V, et al. Ocular Syphilis - Eight Jurisdictions, United States, 2014\u0026ndash;2015. MMWR Morb Mortal Wkly Rep. 2016;65(43):1185-8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e5. Shields MK, Furtado JM, Lake SR, Smith JR. Syphilitic scleritis and episcleritis: A review. Asia Pac J Ophthalmol (Phila). 2024;13(3):100073.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e6. Furtado JM, Sim\u0026otilde;es M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, et al. Ocular syphilis. Surv Ophthalmol. 2022;67(2):440\u0026thinsp;\u0026minus;\u0026thinsp;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e7. Zhang T, Zhu Y, Xu G. Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis. J Ophthalmol. 2017;2017:6594849.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e8. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e9. WHO Guidelines Approved by the Guidelines Review Committee. WHO Guidelines for the Treatment of Treponema pallidum (Syphilis). Geneva: World Health Organization \u0026copy; World Health Organization 2016.; 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e10. Pichi F, Neri P. Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment. Int Ophthalmol. 2020;40(5):1319-29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e11. Grover S, Fishman GA, Anderson RJ, Tozatti MS, Heckenlively JR, Weleber RG, et al. Visual acuity impairment in patients with retinitis pigmentosa at age 45 years or older. Ophthalmology. 1999;106(9):1780-5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e12. Sudharshan S, Kaleemunnisha S, Banu AA, Shrikrishna S, George AE, Babu BR, et al. Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study. J Ophthalmic Inflamm Infect. 2013;3(1):2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e13. Cope AB, Mobley VL, Oliver SE, Larson M, Dzialowy N, Maxwell J, et al. Ocular Syphilis and Human Immunodeficiency Virus Coinfection Among Syphilis Patients in North Carolina, 2014\u0026ndash;2016. Sex Transm Dis. 2019;46(2):80\u0026thinsp;\u0026minus;\u0026thinsp;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e14. Biotti D, Bidot S, Mahy S, Buisson M, Duong M, Grappin M, et al. Ocular syphilis and HIV infection. Sex Transm Dis. 2010;37(1):41\u0026thinsp;\u0026minus;\u0026thinsp;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e15. Tran TH, Cassoux N, Bodaghi B, Fardeau C, Caumes E, Lehoang P. Syphilitic uveitis in patients infected with human immunodeficiency virus. Graefes Arch Clin Exp Ophthalmol. 2005;243(9):863-9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e16. Amaratunge BC, Camuglia JE, Hall AJ. Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients. Clin Exp Ophthalmol. 2010;38(1):68\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e17. Furtado JM, Arantes TE, Nascimento H, Vasconcelos-Santos DV, Nogueira N, de Pinho Queiroz R, et al. Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection. Sci Rep. 2018;8(1):12071.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e18. Mathew RG, Goh BT, Westcott MC. 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\u0026thinsp;\u0026minus;\u0026thinsp;400.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e19. Lee SY, 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.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e20. Moradi A, Salek S, Daniel E, Gangaputra S, Ostheimer TA, Burkholder BM, et al. Clinical features and incidence rates of ocular complications in patients with ocular syphilis. Am J Ophthalmol. 2015;159(2):334\u0026thinsp;\u0026minus;\u0026thinsp;43.e1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e21. Berkowitz K, Baxi L, Fox HE. False-negative syphilis screening: the prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy. Am J Obstet Gynecol. 1990;163(3):975-7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cdiv class=\"InlineMediaObject\"\u003e\u003c/div\u003eFigure\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. General characteristics of involved patients\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003eRace, n (%)\u003c/p\u003e\n \u003cp\u003eChinese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27(87.1)\u003c/p\u003e\n \u003cp\u003e4 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003eAge, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026lt;40\u003c/p\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23(74.2)\u003c/p\u003e\n \u003cp\u003e8(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003eHAART, n (%)\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29(93.5)\u003c/p\u003e\n \u003cp\u003e2(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003eThe HIV virus load, n (%)\u003c/p\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(25.8)\u003c/p\u003e\n \u003cp\u003e23(74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 319px;\"\u003e\n \u003cp\u003eBaseline CD4+ T lymphocyte count,\u003c/p\u003e\n \u003cp\u003emedian (Q3, Q1) (cell/\u0026mu;l)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e132 (319,79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 518px;\"\u003e\n \u003cp\u003eHARRT：Highly active antiretroviral therapy, HIV: Human immunodeficiency virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 2. Visual distribution in four subgroups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eAcute syphilitic posterior placoid chorioretinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eConfluent syphilitic retinochoroiditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eRetinal vasculitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eOptic neuritis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eBaseline LogMAR BCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.08\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.52\u0026plusmn;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.21\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.62\u0026plusmn;0.30*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eFinal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLogMAR BCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.78\u0026plusmn;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.20\u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.41\u0026plusmn;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.46\u0026plusmn;0.24*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003eBCVA：best corrected visual acuity, *: significant difference compared with subgroup of \u0026lsquo;Confluent syphilitic retinochoroiditis\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Prevalance of vitreous opacity and macular involvement in four subgroups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eAcute syphilitic posterior placoid chorioretinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eConfluent syphilitic retinochoroiditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eRetinal vasculitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eOptic neuritis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003eVitreous opacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e11/13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e12/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e4/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e10/13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003eMacular involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e13/13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e12/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e4/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e0/13*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 581px;\"\u003e\n \u003cp\u003e*: significant difference compared with other three subgroups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7392729/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7392729/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study aimed to evaluate the clinical manifestations and treatment prognosis of patients co-infected with ocular syphilis and HIV, focusing on ocular involvement subtypes and visual outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cohort of 31 patients (42 eyes) diagnosed with both ocular syphilis and HIV at Beijing You\u0026rsquo;an Hospital from January 2022 to March 2025 was analyzed. Diagnosis was confirmed through serological tests (TPPA, RPR) and ocular examinations. Patients received intravenous penicillin G followed by intramuscular benzathine penicillin. Best-corrected visual acuity (BCVA), ocular manifestations, and treatment responses were assessed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePosterior segment involvement was universal, with predominant subtypes being acute syphilitic posterior placoid chorioretinitis (13 eyes), confluent syphilitic retinochoroiditis (12 eyes), retinal vasculitis (4 eyes), and optic neuritis (13 eyes). BCVA improved significantly post-treatment. Optic neuritis showed better baseline and final BCVA, correlating with lower macular involvement.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCo-infection of ocular syphilis and HIV predominantly affects the posterior segment, with optic neuritis exhibiting a distinct clinical profile. A comprehensive ocular and serological evaluations in high-risk populations is recommended.\u003c/p\u003e","manuscriptTitle":"Clinical Manifestations and Treatment Prognosis of Patients with co-infection of Ocular Syphilis and HIV","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 23:53:05","doi":"10.21203/rs.3.rs-7392729/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T06:05:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T07:10:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T06:47:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296402070766504234180500308380719923462","date":"2025-09-12T06:01:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3652921009345752089606877551658810761","date":"2025-09-10T08:31:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302825427949833306959592618106077004656","date":"2025-09-09T02:46:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-26T14:37:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-25T11:20:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-25T03:11:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-08-25T03:09:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"769ea7af-fd8e-4ed2-ac67-650659ea9471","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:03:07+00:00","versionOfRecord":{"articleIdentity":"rs-7392729","link":"https://doi.org/10.1186/s12886-025-04475-0","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-11-19 15:57:25","publishedOnDateReadable":"November 19th, 2025"},"versionCreatedAt":"2025-09-03 23:53:05","video":"","vorDoi":"10.1186/s12886-025-04475-0","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04475-0","workflowStages":[]},"version":"v1","identity":"rs-7392729","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7392729","identity":"rs-7392729","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}