Update on ocular syphilis

Purpose of review The present review updates the reader on publications from the past 5 years relevant to ocular syphilis. Recent findings Articles from this period are easily grouped into three categories: descriptions of syphilitic ocular manifestations, ocular syphilis in the setting of HIV infection, and treatment of syphilitic ocular disease. While all of the entities described were previously recognized, many are unusual and their description in connection with syphilis is a reminder to be vigilant for this uncommon but everpresent disease. Ocular syphilis can be more severe in patients with HIV infection who are not taking highly active antiretroviral therapy, while with this treatment syphilis is an increasingly likely cause of ocular inflammation. Ocular syphilis should be treated like neurosyphilis, with daily intravenous or intramuscular penicillin for 2 weeks. The prevalence of syphilis has increased markedly in the past 5 years, most notably among men who have sex with men. The fluorescent treponemal antibody assay and similar tests remain the appropriate diagnostic tests for syphilis in patients with ocular inflammation. Summary Syphilis lingers on the differential diagnosis of all forms of ocular inflammation and should be considered when evaluating such patients.